Angioplasty (Treatment for Coronary Heart Disease)

– The information has been reviewed by Dr. Lo Ka Yip, David

Coronary heart disease (CHD), also known as coronary artery disease, is one of the most common types of heart disease. In 2019 alone, 3,740 people died of the disease in Hong Kong. CHD may be categorized as either chronic or acute, and acute CHD has a mortality rate of up to 30%. CHD patients who fail to receive vascular treatment (such as thrombolytic therapy, angioplasty, or coronary artery bypass graft (CABG)) within the first four hours of symptom onset are at greater risk of developing complications.

What is Angioplasty?

CHD occurs when plaques build up in the arteries (major vessels that supply blood to the heart), which leads to a narrowing or blockage of the arteries and insufficient blood supply to the heart. When this happens, patients may experience angina pectoris (chest pain), myocardial infarction (heart attack), and in severe cases, myocardial necrosis (cell death of cardiomyocytes) or even death.

Patients with an artery that is 70% narrowed or blocked, or those admitted to the hospital for acute CHD may require angioplasty. Today, angioplasty is performed through a minimally invasive approach, which offers advantages such as less surgical trauma and a high success rate. Both angioplasty and coronary artery bypass graft are effective in restoring blood flow to the heart.

Angioplasty vs. Coronary Artery Bypass Graft (CABG)

	Angioplasty	Coronary Artery Bypass Graft (CABG)
Procedure	A thin tube is inserted into a blood vessel in the patient’s wrist or groin to reach the narrowed artery. A balloon at the tip of the tube is inflated to widen the artery, and a stent is implanted to keep the artery open and prevent it from narrowing again.	A healthy blood vessel is taken from the patient’s chest or limb and connected to the narrowed artery in a way that bypasses the blockage and restores blood circulation.
When is it performed?	As the less invasive treatment option, angioplasty is the first choice of treatment for CHD and is suitable for 90% of CHD patients.	CABG may be considered for patients with the following conditions: Severely blocked blood vessels that are too narrow for the angioplasty tube to pass through Blockages in multiple coronary arteries Severe vascular calcification
Anesthesia	Patients may choose to undergo general or local anesthesia	Patients must undergo general anesthesia
Recovery time	Patients may be discharged one or two days after surgery	Several weeks to several months

Angioplasty, Cardiac Catheterization, and Coronary Angiogram

Before an angioplasty, the doctor performs cardiac catheterization and a coronary angiogram to accurately evaluate the condition of the patient’s arteries. This is considered the gold standard for diagnosing heart disease. Under the guidance of X-rays, the doctor inserts a special catheter through the patient’s blood vessel to reach the heart. Blood is drawn and contrast material is injected through the catheter to facilitate performance of the coronary angiogram.

Angioplasty with Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT)

Our Cardiac Catheterization & Interventional Operating Room is equipped to perform intravascular ultrasound (IVUS) and optical coherence tomography (OCT), both of which may be used before or after an angioplasty to provide a real-time view of the condition of the coronary artery. Doctors are able to determine whether there are atheromatous plaques, blood clots, and whether the stent is positioned near the artery wall, reducing the patient’s risk of recurrent heart attacks.

What is IVUS and OCT?

IVUS is a long-established diagnostic procedure that does not involve the use of radiation. It allows doctors to view the inside of a coronary artery and the extent of narrowing of the artery.
OCT uses near-infrared light to capture two- and three-dimensional images during heart surgery. These images are very high-resolution and enhance the degree of precision of the surgery. The technology may also be used to check the condition of stents several years after implantation to assess the risk of recurrence.

Angioplasty and Stent Placement

After angioplasty, a small wire mesh tube called a stent is placed in the blocked artery to prop it open and prevent it from narrowing again. The stent is coated with medication, which is gradually released to slow down the buildup of tissue within the artery.

After Angioplasty

Although angioplasty helps restore blood flow through a previously narrowed artery, fatty plaques may still remain in the blood vessels, so patients need to continue taking medications to lower the risk of plaque buildup within the artery and around the stent. Patients should also adopt a healthy lifestyle, such as by quitting smoking, exercising regularly, and maintaining a healthy diet, so as to combat the “three highs” (high blood pressure, high cholesterol, and high blood sugar) and better manage their heart disease.

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