You may have experienced the discomfort and chest pain that comes with not getting enough blood to your heart. You may have even feared a heart attack. The main cause of this is blockage of the coronary arteries that supply blood to the heart. Fortunately, today there are advanced treatments that can reopen these blocked blood vessels and allow blood to flow properly to the heart. Today, we are talking about these treatments that can revive the heart.
What is 'Coronary Revascularization'?
Simply put, this is a set of treatments used to restore blood flow to your heart muscle when it is not getting the blood it needs. This condition is medically called ``Ischemia''. These treatments can help prevent a heart attack after it has occurred, as well as in people who are at high risk of having one.
We are mainly talking about two treatment methods below:
- Percutaneous Coronary Intervention (PCI): This is not surgery. It is a procedure in which a thin tube is inserted into a blood vessel and used to widen the blocked area from the inside, restoring blood flow. Many people know this as 'stenting'.
- Coronary Artery Bypass Grafting (CABG): This is a surgery that creates a new 'bypass', or side route, for blood to flow around a blocked artery in the heart.
Why are these treatments used?
Just as our kitchen sink drains get clogged with oil and dirt over time, a waxy substance like fat begins to build up in the blood vessels of our heart. We call this plaque . This is the condition in which plaque builds up inside the blood vessels and narrows them, which is called ``Atherosclerosis.`` This is a major symptom of coronary artery disease.
Over time, these deposits can become very narrow in the blood vessels. Sometimes, if one of these deposits ruptures, a blood clot can form and completely block the vessel. This causes a part of the heart to lose blood supply and the cells in that part begin to die. This is called a heart attack .
The important thing is that if heart muscle cells die, the damage is permanent. However, if blood flow is restored as quickly as possible, this damage can be limited or even prevented altogether.
These treatments are required for any heart condition that falls under the category of ``Acute Coronary Syndrome''. For example:
- Heart attack
- Stable angina - chest pain that is relieved by rest and worsens with exercise
- Unstable angina - Unexpected chest pain that occurs even at rest
What happens before treatment?
Before undergoing this type of treatment, doctors will perform several tests to accurately assess your condition and choose the treatment that is most suitable for you. Some of them include:
- ECG (Electrocardiogram): Testing the electrical activity of the heart.
- Echocardiogram: A scan of the heart.
- Cardiac Catheterization (Angiogram): A procedure in which a dye is injected into the blood vessels of the heart and an X-ray is used to check for blockages.
- X-ray Angiography or CT Angiography: Examination of blood vessels using a computerized tomography scan.
- Blood tests: Complete Blood Count, Cardiac Enzymes, etc.
If the procedure is not an emergency, your doctor will advise you to fast for a few hours before the procedure. Also, before the procedure begins, an IV line will be placed in your arm to allow you to easily administer the necessary medications and fluids. During PCI, you will be given medication to put you into a light sleep, while during CABG surgery, you will be given a general anesthetic.
What happens during treatment?
Although the purpose of both PCI and CABG procedures is the same, the way they are performed is completely different. Let's take a look at how.
| Treatment method | What happens is simple. |
|---|---|
| PCI (stent placement) | The doctor inserts a very thin tube (catheter) through your wrist or groin into a major blood vessel. Then, using an X-ray screen, the tube is guided to the blocked blood vessel in your heart. Next, a small balloon at the end of the tube is inflated (Balloon Angioplasty) to widen the blocked area. Often, a mesh-like device (stent) is permanently placed inside the widened area to prevent it from narrowing again. |
| CABG (Bypass Surgery) | This is a surgical procedure. In this procedure, the surgeon first takes a piece of healthy blood vessel from another part of your body (often from your leg, arm, or chest). Then, either through open surgery or through small incisions (minimally-invasive surgery), the surgeon uses the piece of blood vessel to create a new path (bypass) for blood to flow around the blocked artery in your heart. It's like taking a side road to avoid traffic. |
What happens after treatment?
You will need some time to recover after the procedure. This time depends on the type of procedure you had, your overall health, and whether it was an emergency. Usually, it only takes a few days to recover from PCI. However, it can take weeks or months to fully recover from CABG surgery.
Your doctor may suggest that you participate in a cardiac rehabilitation program . In these programs, doctors, nurses, exercise instructors, and nutritionists work together to teach you how to exercise appropriately, control your diet, and take your medications correctly.
Also, it is essential to visit the doctor again at the scheduled time (follow-up visits) and undergo tests. Following the doctor's instructions exactly will help speed up your recovery.
What are the benefits of these treatments?
- Preventing heart attacks: If coronary artery disease is diagnosed before a heart attack occurs, this treatment can prevent it.
- Lifesaving: A heart attack is a life-threatening emergency. In such cases, these treatments can save lives.
- Preserving heart function: Early treatment can prevent the death of heart cells due to ischemia. This can minimize permanent damage to the heart.
Are there any risks to these treatments?
As with any medical treatment, there are risks involved, depending on your health condition and the treatment being performed.
- For PCI: There may be a small risk of blood vessel damage, irregular heartbeats (arrhythmias), blood clots, stroke, or bleeding.
- For CABG: Surgery carries a risk of pain, bleeding, and infection.
Discuss any questions or concerns you have about this with your doctor . He or she will clearly explain the risks that may arise depending on your situation.
When should you see a doctor again?
After treatment, if the following symptoms recur , see your doctor immediately or go to the Emergency Department (ETU) .
- Chest pain or tightness (Angina)
- Difficulty breathing (Dyspnea)
- Feeling dizzy or faint
- Fainting
It's normal to feel scared and anxious when you learn about heart disease. But by understanding advanced treatments like these, you can overcome that fear, get the necessary treatment, and live a healthy life again.
Take-Home Message
- Coronary revascularization refers to treatments that open blocked blood vessels in the heart and restore blood flow.
- Stent placement (PCI) and bypass surgery (CABG) are the two main treatment methods.
- These treatments can prevent heart attacks and save lives in the event of a heart attack.
- The most appropriate treatment for you will be determined by your doctor after examining your condition.
- To get the best results after treatment, be sure to follow your doctor's instructions (medication, diet, exercise).
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