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Updated: July 2, 2011 16:56 IST

No need for a bypass

DR. SANJIV AGRAWAL
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Heart
Heart

Angioplasty has become as safe and long lasting as a bypass for patients with multiple blocks in the heart.

Sagar (43) was a social drinker, non-smoker, maintained ideal weight and followed a vegetarian diet. Three years ago he was suddenly struck down by a heart attack; an eerily familiar tale in India.

Heart disease is one of India's biggest public-health threats. The steep increase in heart attacks among Indians below 45 years is of grave concern. In particular, the occurrence of lesions or blockage in the heart vessels due to deposits of fat, cholesterol, platelets, and calcium has become a common cardiac ailment. It impedes blood flow and if left untreated could result in myocardial infarction (heart attack). This condition, also known as Coronary Artery Disease (CAD), is the leading cause of death in the world. Symptoms could range from chest pain, palpitation or dizziness to none at all. Several causes could lead to these heart blocks including being overweight, smoking, hypertension, diabetes, physical exertion and stress.

Treatment options

Oral medication, by-pass surgery or angioplasty is recommended for patients. However, treatment varies with every individual case. For some patients prescription of oral pills and lifestyle modification would suffice, while cardiologists might advise bypass surgery or angioplasty for more complex cases. By-pass is a major surgery suggested to patients with a clogged main artery or multiple blocks especially with a weak heart.

Angioplasty is recommended when patients are in the pre-heart attack stage or continue to experience discomfort such as chest pain despite medication. Patients with one or multiple blocks in important blood vessels with symptoms are also advised to undergo angioplasty. If the lesions are suitable, angioplasty serves as a safe and effective alternative to bypass. It is especially effective for complex cases such as multiple lesions and Chronic Total Occlusion (CTO), a condition where there is complete blockage for over 30 days.

Percutaneous Coronary Intervention (PCI), commonly referred to as Angioplasty, is a minimally invasive procedure performed in order to improve blood flow in the body's arteries. Guided by imaging techniques, the interventional cardiologist negotiates a small balloon-tipped catheter into a narrowed blood vessel. The balloon helps to widen the blood vessel and improve blood flow. In some cases to ensure the artery remains open, a small mesh tube called a stent may be permanently placed in the vessel during the procedure. Angioplasty and stenting are usually done through a small puncture, in your skin, called the access site.

Types of stents

The two types of stents used are bare metal stents (non-medicated stents) and medicated stents (DES). The increased use of medicated stents has resulted in an improved success rate with the need for a repeat procedure declining. This has made angioplasty as safe and long-lasting as bypass surgery for patients with multiple blocks.

The proven efficacy of PCI through numerous clinical studies has reduced the need for bypass surgery in patients with multiple blocks. In addition, it has the advantage of being a non-surgical procedure that doesn't entail blood transfusion. Since the pain involved is minimal, patients don't require anaesthesia and can even view the procedure live on a TV screen. Being minimally invasive, time for recuperation is limited to a couple of days following which the patient can resume work.

Patients suffering from heart blocks can now take comfort in the advancement of reliable procedures like angioplasty that have high success rates. Nevertheless, the most crucial thing is to improve lifestyle and get tested at regular intervals. It is also crucial to be informed of heart attack symptoms and first aid involved, since the first hour after a heart attack is crucial to the patient's survival. Awareness can save lives.

The writer is a Chennai-based Senior Consultant Interventional Cardiologist.

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