Are your heart arteries blocked? Let's talk about Coronary Revascularization!

Do you sometimes feel a little tightness or pain in your chest? Or do you find it difficult to breathe when you are a little tired? These things can be signs of the blood vessels in our heart (coronary arteries) gradually becoming blocked. It is like dirt accumulating inside a water pipe in our house and gradually becoming blocked. If this is not treated, it can even lead to a heart attack. But don't worry, modern medicine has very effective treatments for this. Today we are going to talk about a treatment method that can revive such a heart.

What is this Coronary Revascularization?

This may sound like a long, strange word, but its meaning is very simple. "Coronary" refers to the blood vessels that connect to the heart. "Revascularization" means "to re-establish blood flow." So, in simple terms, Coronary Revascularization is a treatment that restores the blood flow to the heart when the heart muscle is not getting the blood it needs (a condition we call ischemia in medicine) . Either by reopening the blocked blood vessel or by creating a new route around the blockage.

These treatments can minimize the damage to your heart after a heart attack, and can also prevent it if you are at high risk of having a heart attack.

We are mainly talking about two treatment methods under this:

1. Percutaneous Coronary Intervention (PCI): This is what many people call "stent placement." This involves going inside the blood vessel, removing the blockage, and creating a path for blood to flow, without surgery.

2. Coronary Artery Bypass Grafting (CABG): This is also known as "Bypass Surgery." This involves creating a new path (bypass) around the blocked blood vessel using a piece of blood vessel taken from another part of the body.

Who needs this treatment?

Anyone with reduced blood flow to the heart can benefit from these treatments. The main cause of this is coronary artery disease . The risk of this condition increases with age. Therefore, people over the age of 65 are usually the ones who need these treatments the most.

Imagine, a thick substance made of oil and cholesterol (we call it plaque) gradually builds up inside our blood vessels. This process is called atherosclerosis . It's like oil getting stuck in the kitchen sink pipe and getting clogged. Over time, this deposit narrows the blood vessel. If one day this deposit bursts, a blood clot can form at that location and completely block the blood vessel. That's when a part of the heart stops getting blood, causing a heart attack.

So, for people with this type of blockage, this treatment is used to quickly restore blood flow before the heart cells die.

What conditions are treated with these treatments?

These treatments are mainly used for conditions that fall under the category of acute coronary syndrome. That is:

• Heart attack: Damage to the heart muscle due to the sudden blockage of a blood vessel.
• Stable Angina: A condition in which chest pain occurs during exertion, such as when climbing stairs, and subsides when you rest.
• Unstable Angina: A dangerous condition characterized by chest pain that worsens even at rest.

What happens before treatment?

Once you have decided to undergo one of these treatments, doctors will perform several tests to accurately assess your condition and plan the best course of treatment.

Unless it is an emergency, you will need to fast for about 8 hours before the procedure. Before the procedure begins, an IV line (a tube that gives you saline) will be placed in a vein in your arm. This is where the necessary medications and fluids will be given to your body. For a PCI, you will be given sedation. For a CABG bypass surgery, you will be put under general anesthesia.

What happens during treatment?

Although the goal of both PCI and CABG procedures is the same, the way they are performed is very different.

PCI (stent placement) procedure

Here, the doctor inserts a very thin, flexible tube (catheter) into a major blood vessel, either through your wrist or groin. The tube is then guided to the blocked blood vessel in your heart under X-ray guidance.

Next, a small balloon at the end of the tube is inflated at the site of the blockage. This causes the narrowed blood vessel to expand from the inside. This is called balloon angioplasty .

Then, to keep the widened blood vessel from narrowing again, a small metal frame made like a mesh is placed in place. This is what we call a stent . Some stents have a drug in them that prevents the blood vessel from narrowing again. These are called drug-eluting stents . After the work is done, the tube is taken out, a small stitch is placed where it was inserted, and the treatment is completed.

CABG (Bypass Surgery) Method

This is a surgical procedure. The surgeon first takes a piece of healthy blood vessel from somewhere else in your body (usually from your leg, arm, or inside your chest).

After that, the heart is reached in two ways:

• Open surgery: An incision is made several inches down the center of the chest, opening the breastbone (sternum) to access the heart.
• Minimally-invasive surgery: This involves making one or more small incisions in the chest and using a camera and special instruments to reach the heart through the ribs. Sometimes this is done using robotic surgery.

During surgery, the heart may be temporarily stopped and connected to a heart -lung bypass machine to do the job. However, some surgeries are performed while the heart is still beating (off-pump bypass).

The surgeon then uses the previously removed blood vessel to create a new path by connecting the blocked blood vessel above and below it. It is like creating a new bypass to bypass a busy road. This bypasses the blockage and allows the blood to flow to the heart muscle along the new path. Once the bypass is complete, the chest is closed, stitches are applied, and the surgery is completed.

What happens after treatment?

You will need some time to recover after the procedure. This time depends on the type of procedure you had (PCI or CABG) and your overall health. Usually, you will be back to normal within a few days after a PCI. However, it may take several weeks or even months after a CABG surgery.

During your recovery, your doctor may refer you to a cardiac rehabilitation program . In these programs, doctors, nurses, exercise instructors, and nutritionists work together to help you.

• What exercise suits you?
• What foods should you eat?
• How to take medicine correctly?
• How to live a healthy life again?

I will inform you about everything that is said.

Also, it is essential to attend the follow-up appointments provided by the doctor. Taking your medication on time, controlling your diet, and following your doctor's instructions are very important to speed up your recovery and prevent a recurrence of this condition.

What are the benefits and risks of these treatments?

As with any medical treatment, these methods have both benefits and risks.

What are the advantages?

• Life-saving potential: These treatments are life-saving in cases like a heart attack.
• Heart attack prevention: If you detect a blocked blood vessel early, you can prevent a heart attack by treating it before it occurs.
• Protecting heart function: If treated quickly, damage to the heart muscle can be completely prevented or minimized.

What are the risks and complications?

The risk depends on the treatment, your age, and other medical conditions you have (such as diabetes and high blood pressure).

How long will it take to recover? When will I need to see a doctor again?

While you can return to normal life within a few days after PCI, it can take several months to fully recover from CABG surgery. Your doctor will tell you exactly how long you need to rest, what you can and can't do.

After treatment, if the following symptoms occur, you should see a doctor immediately .

• Chest pain (Angina)
• Difficulty breathing (Dyspnea)
• Dizziness or feeling light-headed
• Loss of consciousness

It is normal to feel scared and anxious when you hear about a heart problem. However, this treatment called Coronary Revascularization can greatly improve heart problems and prevent them from getting worse. The most important thing is to understand this treatment properly, get the necessary medical help without fear, and try to live a healthy, happy life again.

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