Like other tissues in the body, the heart needs oxygen-rich blood to function. Also, oxygen-depleted blood must be carried away. The coronary arteries serve both functions as they run along the outside of the heart and branch into the heart bringing blood in and taking blood out.
Since the coronary arteries deliver blood to the heart, any coronary artery disorder or disease can have a serious impact, possibly creating a blockage, which may reduce the flow of oxygen and nutrients to the heart. The result may lead to a heart attack and possibly death. Atherosclerosis (a buildup of plaque in the inner lining of an artery causing it to narrow or become blocked) is the most common cause of heart disease.
The Summa Health Heart and Vascular Institute uses advanced imaging equipment to look for possible blockages in coronary arteries (the arteries that supply blood to the heart) through the use of cardiac catheterization. These procedures require small, thin, flexible plastic tubes (catheters) to be inserted into the blood vessels, which are carefully threaded through arteries to determine if there are any blockages. By assessing coronary (heart) or peripheral arteries (in the neck, arms or legs), doctors can develop a treatment plan for the blocked blood vessels.
Treatments for coronary artery disease include:
- Coronary Bypass
- Angioplasty
- Cardiac Catheterization
- Coronary Artery Stenting
- Transcarotid Artery Revascularization (TCAR)
Summa also uses a variety of noninvasive tests to record images of the heart and see how the heart is functioning during both contraction and relaxation. All without catheters, tubes or needles inserted into the body.
Coronary Bypass
Coronary bypass surgery is typically performed to treat coronary artery disease, a blockage or narrowing of one or more of the coronary arteries, in order to restore the blood supply to the heart. Coronary artery bypass grafts (CABG) deliver a new source of blood to regions of the heart served by blocked arteries. Surgeons use segments of your own veins or arteries to go around (or bypass) these blockages.The traditional “on-pump” procedure requires the surgeon to stop the heart and place the patient on bypass. However, Summa Health cardiothoracic surgeons use a new less invasive technique known as the “off-pump” method. Rather, the surgeon operates directly on the beating heart, reducing the risks often associated with the on-pump procedure. Selection of an on- versus off-pump procedure is dependent on the patient’s current health and medical history.
Bypass surgery requires a consultation with a Summa Health cardiologist.
Angioplasty
An angioplasty is a procedure used to open narrowed coronary arteries and improve blood flow to the heart. It can either be performed during a diagnostic catheterization after a blockage has been found – or it may be scheduled after a catheterization has confirmed the diagnosis of significant coronary artery disease.During an angioplasty, a small balloon-tipped catheter is inserted inside the blocked area of the coronary artery. The balloon is inflated and deflated several times, which presses the fatty plaque deposit against the artery walls and dilates the vessel, allowing the blood to flow more easily through the heart. Almost all angioplasty procedures are followed by the implantation of a small, metal mesh tube called a stent, which aids in keeping the artery open. Once the procedure is completed, the catheter and balloon are removed.
The catheter site will be checked for any bleeding or swelling, and your heart rate and blood pressure will be monitored. Medication will be administered to relax you to protect the arteries against any spasms. About half of the patients will go home the same day, the other half remain in the hospital overnight to be monitored. If there are no complications, you’ll be able to go home the next day.
Three quarters of the catheterizations and angioplasties are performed through the wrist. The other quarter are performed through the leg. After an angioplasty procedure, if the procedure is performed through the wrist, patients are typically able to walk within one hour. If the procedure is performed through the leg, then it’s typically two to six hours. You are asked to avoid any physical activity for several days, as well as to avoid any lifting or other strenuous physical activity until your cardiologist indicates you can return to your normal activities.
Cardiac Catheterization
A cardiac catheterization is a procedure to examine how well your heart is working. It’s commonly used to diagnose and treat a variety of cardiovascular conditions, including:
- Atherosclerosis: A gradual clogging of the arteries by fatty materials and other substances.
- Cardiomyopathy: An enlargement of the heart due to thickening or weakening of the heart.
- Congenital heart disease: Defects in one or more heart structures that occur during fetal development, such as a ventricular septal defect (hole in the wall between the two lower chambers of the heart)
- Congestive heart failure: The heart has become too weak to properly pump blood, causing fluid buildup (congestion) in the blood vessels and lungs, and edema (swelling) in the feet, ankles, and other parts of the body
- Valvular heart disease: Malfunction of one or more of the heart valves that can affect blood flow within the heart
A cardiac catheterization may also be performed if you have recently experienced chest pain or angina, shortness of breath, dizziness or fatigue.
The cardiac catheterization procedure is performed in the hospital with the goal of getting pictures of your heart muscle and arteries. After you are given a sedative medication to help you relax, a catheter is inserted into a blood vessel in your groin or arm. The catheter is carefully guided through the vessel until it reaches your coronary arteries. Using a special X-ray machine to guide the movements of the catheter, your doctor advances the catheter into the arteries of the heart. X-ray dye is passed through the catheter into your arteries so your cardiologist can see how blood is flowing through your heart. Images of the dye flowing through the heart’s chambers, valves and vessels are displayed on a screen during the short procedure.
Different camera angles are used to get a complete picture of your coronary arteries. This diagnostic procedure normally lasts about 30 minutes. When the procedure is completed, the catheter is removed.
Coronary Artery Stenting
A coronary artery stent is a small metal mesh tube that expands inside a coronary artery. A stent is often placed during or immediately after angioplasty. It helps prevent the artery from closing up again. Coronary artery stenting is performed to relieve the recurrence of chest pain, and reduce other complications from coronary artery disease.The stent is mounted on a balloon-tipped catheter in a collapsed state and is then inserted and carefully guided to the blocked artery. When the balloon is inflated, the stent expands to fit the size of the blocked artery and pushes against the inner wall of the artery to provide a pathway for increased blood flow. When the balloon is deflated, the catheter and balloon are removed, leaving the stent in place. After several weeks, the artery heals around the stent. The stent keeps the artery open and prevents it from narrowing again. Your cardiologist also may use a stent coated with medication to prevent the artery from re-narrowing.
The procedure can take 30 to 60 minutes dependent upon the number of stents that have to be implanted. While you remain awake, a mild sedative is provided to make you more comfortable. Once your cardiologist is satisfied with the results, the tubes in the arm or leg will be removed. You will be allowed to walk with assistance after about one to six hours. Patients with stents inserted from the arm frequently will be discharged the same day. Otherwise, patients are discharged the following morning if there are no complications.
Transcarotid Artery Revascularization (TCAR)
TCAR is a minimally invasive procedure that clears blockages and opens a narrowed carotid artery. The surgeon makes an incision over the common carotid artery to perform the repair. During the TCAR procedure, the surgical team reverses blood flow in the area of the blockage.
Compared to carotid endarterectomy (CEA), a surgical carotid treatment, features of TCA include:
- Less Time in Operating Room
- Less Myocardial Infarction
- Less Cranial Nerve Injury
- Less Time in the Hospital > 1 Day
- Less Clamp Time
Who Is Eligible
TCAR is well-suited for patients who are at high risk of surgical complications due to age, medical co-morbidities or anatomical issues. This includes:
- Symptomatic patients with > 50% stenosis
- Asymptomatic patients with > 80% stenosis
Safe and Simple Procedure
The transcarotid artery revascularization (TCAR) procedure takes place at the Summa Health System – Akron Campus. It begins with a small incision just above the collarbone. A temporary sheath (short hollow tube) is placed directly into the carotid artery in an area away from the diseased area (plaque). The sheath connects to a filter outside of the body. The filter connects to another small sheath and, through a needle puncture in the groin, is placed directly into the vein, similar to an IV.
The difference in pressure causes the blood to flow in reverse from the artery (high flow), through the filter, and into the vein (low flow), away from the brain. This establishes a circuit outside of the body. A stent (an expandable mesh tube) is then inserted through the arterial sheath to open the blocked artery. Because of the blood flow reversal, any debris that might break loose during stent placement won’t travel up to the brain. Rather, it travels downward and gets trapped in the filter, and the filtered blood returns into the vein.
Post-Procedure
Most patients are able to go home the day after the procedure. They should follow their TCAR physician’s instructions for taking care of the incision. While they may experience some pain, it should be minimal.