Treatments for Advanced Atherosclerosis
Stents vs. Surgery for Atherosclerosis Treatment
Which is the better treatment for the late stages of atherosclerosis -- stents or bypass surgery? Each procedure has advantages and disadvantages. Certain situations may make one procedure the clear choice, but often it's a judgment call.
Living longer when you have multiple blockages. CABG is the best treatment for extending life in people with multiple severe blockages. CABG has been shown to extend life for patients with several patterns of severe blockages, and is clearly superior to stenting in these cases. Stenting has not been demonstrated to help people live longer.
Pain relief. Sometimes treatment with drugs can't control chronic chest pain. Both CABG and stenting provide near-complete relief from angina more than 90% of the time. Angina often returns over time, though, which may lead to future procedures.
Emergency treatment. During a heart attack, stents are usually better than CABG. Stents can be placed in minutes, without the risks and recovery time of major surgery.
Atherectomy for Arteries Blocked by Atherosclerosis
In rare circumstances, other tools and procedures may be used to help open arteries blocked by atherosclerosis plaques.
Rotational atherectomy: A diamond burr rapidly spins and pulverizes plaque into tiny particles. The particles dissipate without causing major damage.
Directional atherectomy: A rotating blade cuts slices of plaque, which are captured by the catheter and removed from the body.
These procedures have good commonsense appeal, but they don't work as well as stenting or bypass surgery. They are rarely used, and only in special cases. Usually, atherectomy is used to improve the success of placing a stent.
After Atherosclerosis Treatment
Stenting and coronary bypass surgery open blocked arteries, but they do nothing to prevent other atherosclerotic plaques from causing problems. After a procedure to open a blockage, it's more important than ever to reduce risk factors for atherosclerosis.
After stenting or coronary bypass surgery, most people should take a daily regimen of anti-atherosclerosis medication that includes:
- A statin, to lower cholesterol levels
- An aspirin, to prevent blood clots
- Plavix (clopidogrel), Effient (prasugrel), or Brilinta (ticagrelor) also work to prevent clots, especially if a stent was placed. They are normally taken for one month up to a year depending on the type of stent.
Blood pressure drugs, especially beta-blockers and angiotensin-converting enzyme (ACE) inhibitors
Also important are three lifestyle habits proven to reduce heart disease: