The mortality rate of Coronary Artery Disease (CAD) is about 20-50% higher in Asian Indians compared to other population, as per studies. When coronary arteries (arteries supplying oxygen-rich blood to the heart) get narrowed or blocked due to plaque (fatty substance) accumulation over time, they cause CAD. These arteries play a vital role in the healthy functioning of the heart, and hence, they must be healthy.

There is a pressing need to address this life-threatening condition through its awareness and timely management and control, including medications, alternate treatment modalities, and positive lifestyle changes. Treatment for CAD includes surgical intervention using conventional Coronary Artery Bypass Grafting (CABG) or a minimally invasive procedure called Angioplasty.

Angioplasty has been gaining extensive acceptance as a standard of care for CAD patients unfit for CABG and those with less complex arterial blockages. To understand Balloon Angioplasty and the reasons for its wide acceptance in treating CAD, continue reading the blog.

What causes CAD?

Atherosclerosis (the condition of plaque buildup in the inner walls of coronary arteries), narrowing the arteries supplying blood to the heart, is the prime cause of CAD. The narrowed arteries cause interrupted blood supply to the heart, often leading to heart attacks and other heart-related problems, like heart failure, cardiac arrest, and arrhythmia (abnormal heart rhythm). Numerous factors contribute to CAD, namely age, obesity, sedentary lifestyle, unhealthy diet and other habits, family history, heredity, and regular stress. High blood pressure, diabetes, high cholesterol, and sleep disorders also raise the risk of CAD.

Treatment For CAD

Management and control of CAD starts with lifestyle changes, a healthy diet low in fat, sugar, cholesterol, sodium, plant-based food, and healthy fats. Increasing physical activity, limiting alcohol, abstinence from smoking, and stress management through meditation and mindfulness practices are equally vital. Risk management of certain contributing factors of CAD, through doctor-recommended medications is crucial to preventing CAD. Preventive measures are always a preferred choice for CAD.

When all possible alternatives for treating coronary artery disease are explored with no desired results, CABG and Angioplasty are the two effective treatment options to treat this condition.

Choice of Appropriate Treatment Option

The choice between CABG, an open surgery for CAD, or Angioplasty, a minimally invasive procedure, depends on various factors to be considered by the cardiologist in consultation with his professional team and after considering the patient’s preferred choice. The decision depends on the percentage and severity of the blockages, the patient’s anatomy and medical history, age, overall health, suitability, and the associated risks of the treatment option.

• CABG- A surgical treatment option
  As a surgical treatment for CAD, CABG has been a standard of care for decades. It is called bypass surgery, where a new pathway for the blood flow is created by bypassing the diseased artery. The new artery is taken from the healthy blood vessels from other body parts and detoured to restore uninterrupted blood flow to the heart. CABG is recommended for patients with severe blockages that include blockage of the left main artery, or three or more arteries blocked or young patients with no comorbidity who are suitable for open surgery.
  CABG, an invasive treatment with a larger incision, causes more tissue scarring, pain, and discomfort, requiring more healing and recovery. 

• Angioplasty- Non-Surgical less invasive treatment option
  Angioplasty, also known as Balloon Angioplasty or Percutaneous Coronary Artery Intervention (PCI), is a minimally invasive procedure to treat CAD. It restores the blood supply to the heart by treating and relieving the symptoms of the blocked coronary artery.
  PCI has been treating patients with CAD for decades and has undergone advancement from being a plain balloon procedure to present-day PCI, using dissolving stents. Each
  advancement in PCI has been marked with improved stent material, composition, and biocompatibility features.

Advancement in Angioplasty

Balloon angioplasty was introduced nearly four decades ago and revolutionized the field of interventional cardiology. Subsequently, stents became part of this treatment option that supported the treated artery to remain open for extended time for smooth blood flow. Bare metal stents (BMS), drug-eluting stents (DES), and recent bioresorbable scaffolds (dissolving stents) have changed the scope of CAD treatment.

• Balloon Angioplasty is a basic and minimally invasive procedure to open the blocked arteries using a catheter with a balloon attached to its tip. The catheter is guided to the diseased artery through a small incision either on the wrist or the groin. The balloon on the tip of the catheter is inflated once it reaches the exact location of the diseased artery. This inflated balloon helps push the plaque to the sides of the artery, opening/widening the narrowed/ blocked artery for the smooth flow of blood. The balloon is deflated, the catheter is removed, and the incision is closed.

• Angioplasty with stenting Atherosclerosis cannot be cured and can be treated through removing the plaque and the subsequent control and management of the condition. There are chances of the previously treated arteries getting narrowed in the future due to
  atherosclerosis in many cases. This poses the need for reintervention and may lead to other heart health-related issues. A stent (a small mesh) was invented to address this issue. In Angioplasty with stent, a stent is mounted on the balloon that is attached to the tip of the catheter. Once the plaque is removed using the inflated balloon and the artery widened, the stent is implanted in the artery to keep it open for extended periods.
  Stents minimize the future chances of the treated vessels narrowing through plaque buildup. They help in keeping the artery open. BMS successfully met the need to support the treated coronary artery by keeping it open for an extended time. The subsequent DES is an improvement over BMS. The stent comes with a metallic body, polymer coating, and anti-proliferative drug within the coated polymer that is released over time to prevent blood clots and help heal the lesion. BMS and DES both have proved useful in avoiding restenosis. With each improvisation, DES provides better deliverability, efficacy, and safety than their previous version.
  A fiction come true is the case with Bioresorbable stents, which, as the name suggests, are drug-coated stents that get absorbed in the body after the artery is healed, leaving no-residue. They mimic the DES in many aspects. These dissolving stents are a boon to patients resulting in no permanence of a foreign body in blood vessels. They provide temporary scaffolding to the artery and leave the body once their work is done.

Angioplasty- Transforming Lives for the Better

The role of Angioplasty in treating CAD could be examined, given its contribution to enhancing patient outcomes and care.

• As a minimally invasive alternative for CAD treatment, it is ideal for patients with less complex or single vessel blockage.

•  It is ideal in emergency cases of heart attacks as it reduces heart damage and also chances of another heart attack.

• It relieves the symptoms of CAD i.e., pain, discomfort, chest tightness, breathlessness.

• It restores the blood flow to the heart by opening the blocked artery through minimal invasiveness. Hence, it results in less tissue scarring and lesions.

• The procedure entails faster healing and recovery due to smaller incisions and less tissue scarring.

• The treated patient can have shorter hospital stays and earlier return to normalcy.

The role of Angioplasty with new generation dissolving stents in treating CAD.

The next-generation bioresorbable stents have marked the dawn of new-age technology in treating CAD, offering the following advantages that aim to address the challenges faced by the previous-generation stents.

• BRS rules out the permanence of foreign bodies, thus avoiding permanent metallic cage.

• These dissolving stents leave behind the options for future re-intervention of the arteries whenever the need arises.

• These latest stents remove the potential reasons for inflammation that often contribute to late stent thrombosis and restenosis.

• Once dissolved, they help the artery restore its natural stateand functionality.
  

Conclusion

The treatment for CAD through PCI has been evolving and, with new advancements, has always aimed to answer the challenges faced by the current line of treatment options. PCI has made treating the disease less painful with smaller incisions and less tissue damage, faster healing and recovery, shorter hospital stays, and hence less anxiety and stress for the patients and care providers. It has become a common and widely acceptable standard of care for CAD patients in cases where CABG is not suitable or where CABG can be avoided in cases of less complex arterial blockages.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994761/

https://www.beaumont.org/services/heart-vascular/coronary-arteries

https://www.nhsinform.scot/tests-and-treatments/surgical-procedures/coronary-angioplasty-and-stenting

https://www.merillife.com/medical-devices/vascular-intervention/coronary/scaffold/bioresorbable-scaffold/meres100