Heart Associates     Commonly Asked Questions

"How can we remove or correct those blockages in the coronary arteries?"

CAD is a permanent and progressive disease. Once you have it, you just had it. Total removal of the atherosclerotic plaques by medications or devices will be the challenge of the present millennium. In rare instances, we are able to remove the critical portion of an atherosclerotic blockage by a device called directional atherectomy. In most such instances, the atheroma will grow back.

For thick and calcified blockages another device called Rotablator have been used to drill through the blockages using high speed, diamond-head, pear-shaped drilling balls with some success. None of these devices are capable of removing the atherosclerotic blockages completely or permanently. Angio-Jet is a relatively new device used to remove fresh blood clots from newly infarcted coronary arteries by using a flushing-suction technique. This is used as an adjunct for angioplasty.

Apart from risk factor modification, coronary revascularization techniques are the mainstay in the management of coronary artery disease.

Currently available revascularization techniques are listed below:

    Percutaneous transluminal coronary angioplasty (PTCA).
    Coronary stenting.
    Coronary rotablation (Rotational atherectomy).
    Directional atherectomy.
    Intracoronary radiation therapy (Brachytherapy).
    Transmyocardial laser recanalization (TMR).
    Angiogenesis.
    Eximer Laser coronary revascularization.
    Above all, coronary artery bypass graft surgery.
Here, I would like to reemphasize that the fight against atherosclerosis is not just with angioplasty or the newer techniques; arresting the progression of atherosclerosis and even some regression has been demonstrated by coronary angiograms with meticulous lifestyle modification. Controlling cardiac risk factors particularly by cholesterol lowering medications, a very low fat diet, cessation of smoking, regular exercise, maintaining an ideal body weight, and stress management training are all found to be useful. Such aggressive lifestyle modifications are strongly recommended for patients with known CAD and those who are at high risk.

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