In , the American Medical Association issued a report that said stents were one of the most highly overused medical interventions. To continue reading this article, you must log in. Already a member? Login ». As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
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Recent Blog Articles. Cutlip says. And this question has an answer—bypass surgery—as long as the individual's surgery risk isn't too high. The heart's three coronary arteries are not all equal. The most important artery is called the left anterior descending artery LAD. It feeds blood to the whole front wall of the heart, which represents much more muscle than the area fed by either of the other two coronary arteries. A narrowing or blockage in the LAD is more serious than narrowing or blockage in the other arteries.
Bypass surgery usually is the best choice for a blocked LAD. If the LAD is not blocked, and there are no other complicating factors, stents are more likely to be used, even if both of the other arteries are blocked. One major factor is that LAD bypass uses another artery—the mammary artery, located in the chest near the heart—for the graft.
Complications are rare, and CABG using the mammary artery lasts for decades. Moreover, for reasons still unknown, the mammary artery is nearly immune to blockage. Medical therapy here means medication and follow-up visits with your cardiologist, but no invasive interventions such as bypass or angioplasty. These procedures typically use veins rather than arteries, and in half of people, these repurposed veins start to fail after eight to 10 years.
For people with diabetes, there are fewer questions regarding the choice between bypass surgery and stents. Bypass surgery is generally superior to angioplasty. When more than one heart artery is blocked, CABG may also offer better survival rates for people with heart failure. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Managing Your Cholesterol offers up-to-date information to help you or a loved one keep cholesterol in check. The report spells out what are healthy and unhealthy cholesterol levels, and offers specific ways to keep cholesterol in line.
It covers cholesterol tests and the genetics of cholesterol. The report also focuses on treatments based on the latest scientific evidence, including the pros and cons of statins and other medications, and provides the lowdown on other substances advertised to lower cholesterol. Angioplasty uses a tiny balloon catheter that is inserted in a blocked blood vessel to help widen it and improve blood flow to the heart. Angioplasty is often combined with the placement of a small wire mesh tube called a stent.
The stent helps prop the artery open, decreasing its chance of narrowing again. Most stents are coated with medication to help keep the artery open drug-eluting stents. Rarely, bare-metal stents are used. Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty is also often used during a heart attack to quickly open a blocked artery and reduce the amount of damage to the heart.
If you have too many cholesterol particles in your blood, cholesterol may accumulate on your artery walls. Eventually, deposits called plaques may form. The deposits may narrow — or block — your arteries. These plaques can also burst, causing a blood clot to form. Angioplasty is used to treat the buildup of fatty plaques in the heart's blood vessels. This buildup is a type of heart disease known as atherosclerosis.
Angioplasty isn't for everyone. Depending on the extent of your heart disease and your overall health, your doctor may determine that coronary artery bypass surgery is a better option than angioplasty for you.
In coronary artery bypass surgery, the blocked part of your artery is bypassed using a healthy blood vessel from another part of your body. Although angioplasty is a less invasive way to open clogged arteries than bypass surgery is, the procedure still carries some risks.
Blood clots. Blood clots can form within stents even after the procedure. These clots can close the artery, causing a heart attack. It's important to take aspirin in combination with clopidogrel Plavix , prasugrel Effient or another medication that helps reduce the risk of blood clots exactly as prescribed to decrease the chance of clots forming in your stent. Talk to your doctor about how long you'll need to take these medications. Never stop taking these medications without discussing it with your doctor.
Before a scheduled angioplasty, your doctor will review your medical history and do a physical exam. You may need to have some tests, including a chest X-ray, electrocardiogram and blood tests, before your procedure.
Your doctor will also perform an imaging test called a coronary angiogram to see if the arteries to your heart are blocked and if they can be treated with angioplasty. If your doctor finds a blockage during your coronary angiogram, he or she may decide to perform angioplasty and stenting immediately after the angiogram while your heart is still catheterized.
Angioplasty is performed by a heart specialist cardiologist and a team of specialized cardiovascular nurses and technicians in a special operating room called a cardiac catheterization laboratory. Angioplasty is performed through an artery in your groin, arm or wrist area. General anesthesia isn't needed. You'll receive a sedative to help you relax, but you may be awake during the procedure depending on how deeply you are sedated.
Angioplasty can take up to several hours, depending on the difficulty and number of blockages and whether any complications arise. You might feel pressure in the area where the catheter is inserted. You may also feel some mild discomfort when the balloon is inflated and your artery is stretched, but typically you shouldn't feel any sharp pain during the procedure.
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