Surgery

Surgery

Percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery are the standard operations for opening narrowed or blocked arteries. They are known as revascularization procedures.

• Emergency angioplasty is the standard procedure for heart attacks and is more effective than the use of thrombolytic drugs for most patients. Unfortunately, not all communities have the facilities for emergency angioplasty. (A 2002 study suggested that in spite of the delay, transporting patients to facilities where angioplasties are available may still be more beneficial than thrombolytics for many individuals.)
• Coronary bypass surgery is typically used as elective surgery for patients with blocked arteries. It may be used after a heart attack if angioplasty or thrombolytics fail or are not appropriate. It is usually not performed for a few days to allow recovery of the heart muscles.

Such procedures are proving to be very important for many patients.

Click the icon to see an illustrated series detailing a heart bypass surgery.

Angioplasty (PCI) and Coronary Stents

Percutaneous coronary intervention (PCI), also called percutaneous transluminal coronary angioplasty (PTCA) or angioplasty for short, involves opening the blocked artery. A typical angioplasty procedure has the following steps:

Click the icon to see an image of an angioplasty.

• The surgeon threads a narrow catheter (a tube) containing a fiber optic camera directly to the blocked vessel.
• The surgeon opens the blocked vessel using balloon angioplasty, in which a tiny deflated balloon is passed through the catheter to the vessel.
• The balloon is inflated to compress the plaque against the walls of the artery, flattening it out so that blood can once again flow through the blood vessel freely.
• To keep the artery open afterwards, surgeons use a device called a coronary stent, an expandable metal mesh tube that is implanted during angioplasty at the site of the blockage.
• Once in place, the stent pushes against the wall of the artery to keep it open. Stenting is improving results in patients with heart attack who have emergency angioplasty. It also significantly prevents reclosure and reduces heart attack rates in patients with ACS.