What is Coronary Artery Disease?
 
Coronary arteries supply your heart muscle with oxygen and other nutrients necessary for the normal function of the heart. Coronary Artery Disease (CAD) is a condition in which plaque, a composite of fat deposits, cholesterol and other substances, builds up inside the coronary arteries. When your coronary arteries are narrowed or blocked, not adequate oxygen and nutrients can reach your heart muscle. This can cause stable or unstable angina, myocardial infarction or sudden death.
 
What are the symptoms of Coronary Artery Disease (CAD)?
 
  • Angina: Transient chest pain for a few minutes. It can feel like pressure or a squeezing pain in the chest, behind breastbone sometimes in between the shoulders, arms, neck, jaw, or back.
  • Can be associated with cold sweats and shortness of breath.
  • Typically, angina is brought on by strenuous physical activity, emotional stress, eating, or cold temperatures.
 
Treatment options for Coronary Artery Disease (CAD)
 
There are several treatment options for CAD. Current treatments range from drug therapy to surgical interventions to help restore the flow of oxygen to the heart. The aim of these therapies is to dilate the blockages in the coronary vessels and increase blood supply to the heart. Current procedures used to treat CAD include balloon angioplasty, stenting and bypass surgery.
  • Drug therapy: A variety of drug therapy is available for enabling oxygen-rich blood to reach the heart or to reduce the demand for oxygen. Eg. Nitrates, Beta blocking agent, Calcium ion blocking agent, angiotensin converting enzyme inhibitors.
  • Interventional procedures such as balloon angioplasty and coronary artery stenting or bypass surgery.
 
What is Percutaneous Transluminal Coronary Angioplasty (PTCA) and Coronary Artery Stenting?
 
PTCA, sometimes referred to as balloon angioplasty, is a non-surgical procedure used to treat CAD.
During PTCA, a catheter containing a small balloon is advanced into the coronary arteries. The balloon is placed across the blockages and is inflated, opening up the blocked segment of artery and hence increasing the blood flow. Coronary Stent is a small, expandable, tubular metal mesh scaffolds which is implanted in the artery to help prevent the narrowing of the arteries that can occur following PTCA. In stenting, after widening the artery by balloon angioplasty, a stent mounted over a balloon is positioned inside the dilated segment of artery. The balloon is then inflated, causing the stent to expand. When the balloon is deflated and withdrawn, the stent remains in place, serving as a permanent scaffolding for the artery.
 
PCI Procedures:
 
PCI procedure is done via percutaneous femoral, radial, or brachial artery puncture. A guiding catheter is inserted into a large peripheral artery and advanced to the appropriate coronary ostium under direct fluoroscopy. A guidewire is advanced to the diseased artery and maneuvered across the lesion and its tip is placed distally.
A balloon catheter is then advanced over the guidewire, across the stenosis, then it is inflated for 15-60 seconds to it optimal size to disrupt the atherosclerotic plaque and dilate the artery. The balloon is deflated, a coronary angiogram is repeated to ensure the diameter of the stenosis has been improved sufficiently. Doctor often places a bare metal stent or drug-eluting stent after balloon dilatation. Patients can resume normal daily activity within 1 day after the stent implantation. To prevent stent thrombosis, patients need to take dual anti-platelet therapy (Aspirin + Clopidogrel) for 6-12 months. Patients are often discharged from hospital 1-2 days after the PCI procedure. Many patients can get back to work within 1 week.
 
What is Drug-Eluting Stent (DES)?
 
To minimize cell proliferation after the stent is placed in the coronary artery. The polymer containing a drug is coated on the bare metal stent. After the stent is positioned and implanted at narrowed artery, the drug in the polymer will slowly released over a month to inhibit the cell proliferation and reduce chance of restenosis / re-blocking of the artery in 1 year. The polymer usually remains permanently unchanged in the body.
 
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