Coronary Artery Disease

Other Treatment

Several nonsurgical procedures are used to treat coronary artery disease (CAD). They are called nonsurgical procedures because the repair is done through a catheter inserted into an artery, and neither a large incision nor general anesthesia is needed. Such procedures include:

• Angioplasty and stenting (percutaneous coronary intervention), which is done to open a partially blocked blood vessel so that blood can flow through it more easily.
• Atherectomy, a procedure that removes fat and calcium buildup to open partially blocked coronary arteries and improve blood flow.
• Enhanced external counterpulsation (EECP), a relatively new treatment method for people with chronic angina who do not qualify for other treatment methods, such as angioplasty or surgery.

Angioplasty (often combined with stenting) and atherectomy are used to reopen blocked or narrowed coronary arteries.

Angioplasty is also known as percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA). Angioplasty has become a common procedure in large medical centers in the United States. The goal of this revascularization procedure is to increase blood flow to the heart muscle tissue.

Angioplasty is less invasive and has a shorter recovery time than bypass surgery, which requires open-heart surgery. Most of the time stents are placed during this procedure. Studies show that angioplasty with stent placement, compared to angioplasty alone, reduces the chance that the artery will renarrow (restenosis) and possibly the risk of death.²⁴ See a picture of angioplasty with stenting.

Drug-eluting stents can almost completely prevent restenosis.²⁵ These stents are coated with medicines that prevent the growth of cells around the stent, thereby keeping the artery open. But they are more expensive than conventional stents. And experts do not know yet how safe the drug-eluting stents are over the long term or how well they work over the long term.

Whether you have angioplasty (with or without stenting) or bypass surgery depends on a number of factors, including the number of blocked arteries and how badly they are blocked, as well as other heart problems you have and your personal preferences. Understanding the advantages and disadvantages of each treatment is important in making the right decision. For more information, see:

Should I have angioplasty for stable angina?

Atherectomy is done only in certain cases and only at large medical centers. During atherectomy, plaque is shaved away from the inside of the coronary arteries. Atherectomy may be needed because of the location, size, or type of plaque or during angioplasty and stenting. See a picture of different ways atherectomy can be done.

What to Think About

You may be advised to participate in a cardiac rehabilitation (rehab) program to help you recover from complications of or treatment for coronary artery disease. After a heart attack, or after you have had surgery or angioplasty, a rehab program often helps improve your heart function and overall health. For more information, see the topic Cardiac Rehabilitation.

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Author:	Robin Parks, MS	Last Updated: January 8, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition
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