Dr. Ripple Doshi
Updated: March 21, 2013 6:14AM
Heart disease affects a staggering number of people — about 13 million in the United States, according to the American Heart Association, making it the No. 1 killer.
As we age, a waxy substance called plaque can build up inside the arteries. This condition is called atherosclerosis, and it can affect any artery in the body.
When atherosclerosis affects the coronary arteries, the condition is called coronary artery disease. Over time, plaque can harden or rupture. Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina.
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery leading to a heart attack. And when it comes to treating heart attack, time is of the essence.
If you have symptoms of heart disease, you may undergo an imaging procedure called cardiac catheterization. It involves threading a long, thin tube (called a catheter) through an artery or vein into the heart. A larger plastic thin tube called a sheath is placed into a vein or artery in your leg or arm. Then longer plastic tubes called catheters are carefully moved up into the heart using live X-rays as a guide.
The doctor can then collect blood samples from the heart, measure pressure and blood flow in the heart’s chambers, measure the oxygen in different parts of your heart and examine the arteries of the heart.
During a cardiac catheterization, a cardiologist typically gains access to the heart’s arteries by placing the catheter in the femoral artery near the groin and threading it up into the heart.
But the femoral artery is not the only route available. Doctors also can use the radial artery, located in the wrist. Bleeding is one of the major risks of a cardiac catheterization. Because the radial artery is smaller than the femoral artery, it is much easier to apply direct pressure to the puncture site afterwards to stop the bleeding. The decreased bleeding risk has actually led to a decrease in mortality when a cardiac catheterization is performed from the radial artery for certain types of heart attack.
For most patients, radial access does not cause as much discomfort as femoral access. Even better, radial artery access allows most patients to get out of bed and walk around shortly after the procedure versus having to stay in bed for four to six hours with a femoral-access procedure.
In about 5 percent of people, certain anatomical reasons make a cardiac catheterization through the radial artery impossible. People who are of an advanced age or those with problems with their renal function may not be good candidates for the radial approach either.
In the late 1970s, doctors began using a technique called balloon angioplasty to treat narrowed coronary arteries. During this procedure, a very thin, long, balloon-tipped catheter is inserted into an artery in the leg or arm and is moved to the site of the blockage with help from an X-ray.
The balloon at the tip of the catheter is inflated to compress the blockage and restore blood flow. The balloon is then deflated to allow the catheter to be removed.
Because no additional support is left at the site of the blockage during balloon angioplasty, in a small percentage of cases, the artery may resume its previous shape or even collapse after the balloon is deflated.
To help solve these problems, doctors developed small stents, which can be mounted on the balloon section of the catheter and inserted into a blood vessel.
During a stenting procedure, the stent (usually made of metal mesh) expands when the balloon is inflated, locks into place, and forms a permanent scaffold to hold the coronary artery open after the balloon is removed.
Drug-eluting stents are metal stents that have been coated with special pharmacologic agents that can suppress restenosis — the re-blocking or closing up of an artery after angioplasty due to excess tissue growth inside or at the edge of the stent.
Unlike coronary artery bypass surgery, balloon angioplasty and stenting are considered minimally invasive because they involve no major incisions. Performed with local anesthesia and mild sedation, the procedures usually take about an hour, longer if multiple stents are required. Patients who undergo stenting experience significantly less discomfort and can usually be discharged home the following day as opposed to the longer recovery time for those who undergo coronary artery bypass surgery.
Rotational atherectomy is a type of interventional coronary procedure to help reopen coronary arteries blocked with more calcified material and restore blood flow to the heart. Sometimes the presence of calcium may prohibit a balloon from being inflated or a stent from being placed. Rotation atherectomy utilizes a high-speed rotational “burr” that is coated with microscopic diamond particles.
It rotates at high speed (approximately 160,000 rotations per minute), breaking up blockages into tiny fragments smaller than red blood cells, which can pass, harmlessly, into the circulation.
Ingalls Memorial Hospital offers a full range of minimally invasive coronary interventional procedures to treat heart disease. It also is equipped with an all-digital cardiac catheterization lab and some of the most advanced cardiac equipment available anywhere.
For a referral to a heart specialist, call Ingalls Care Connection at (708) 915-2273.
Dr. Doshi is a board-certified interventional cardiologist on staff at Ingalls Memorial Hospital.