Interventional Cardiology

Coronary artery disease

Sometimes, a build up of fatty deposits, called atheroma, can cause the coronary arteries to become narrowed or blocked. This build up can restrict the amount of blood flowing to the heart muscle and can lead to coronary artery disease, with angina or a heart attack. If your coronary arteries are narrowed, or blocked, revascularisation treatment, such as a coronary angioplasty or coronary bypass surgery, may be recommended.

Coronary Revascularisation

Either angioplasty and stenting or bypass surgery can be used to restore the blood supply in coronary artery disease. Coronary angioplasty is a surgical procedure that is used to treat coronary artery disease by opening up blocked, or narrowed, coronary arteries. It is a fairly straightforward procedure with about 45,000 angioplasties being carried out in the UK every year. A coronary artery bypass involves replacing the blocked arteries with grafts (blood vessels taken from elsewhere in the body).

The medical name for coronary angioplasty is percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). The procedure involves using a catheter (a flexible tube) to pass a balloon to the narrowed artery to dilate the vessel. Then a stent (a piece of metal mesh tubing) is implanted using a balloon catheter to keep the coronary artery open and improve blood flow to the heart muscle.

Coronary angioplasty is carried out as a planned procedure, or as a form of emergency treatment.

Planned coronary angioplasty

Coronary angioplasty is not suitable for everyone with angina. Initially, your GP will refer you to a heart specialist, called a cardiologist, for some tests. The tests that you will usually have include:

§ blood tests,

§ an electrocardiogram (ECG) - an electrical recording of your heart to measure how well it is working, and

§ a coronary angiogram.A coronary angiogram is used to show the blockages in your coronary arteries.

A catheter (thin, flexible tube) is gently inserted into your coronary artery and a special dye is injected which shows up on X-ray pictures to highlight any blockages. The heart specialist will use the test results to determine the most suitable form of treatment for you. About three in every 10 people who have a coronary angiogram go on to have a coronary angioplasty.

If there are too many narrow sections in your arteries, or if there are lots of branches coming off the arteries, that are also blocked, a coronary angioplasty may not be possible. In such cases, alternative operations, such as a coronary artery bypass, may be considered.

Emergency coronary angioplasty

Coronary angioplasty may sometimes be used to treat people who have acute coronary syndrome, such as a heart attack, or unstable angina. If you have unstable angina, you will experience chest pain even while you are resting. Emergency coronary angioplasty and planned coronary angioplasty use the same procedure, although if you have acute coronary syndrome, you may require additional medication when the procedure is performed.

PCI Strategy and Opinions

It is important that your clinical history and angiogram are assessed by a cardiologist who is an expert in PCI to determine the best strategy to treat the vessels. This is particularly important in patients who have had previous bypass surgery, previous angioplasty and stent procedures and those with heart failure.

If you would like to discuss the management of your coronary artery disease please contact Dr Qasim’s PA to make an appointment.