The Future of Your Heart Attack
BUT SUPPOSE CLEANER LIVING DOESN'T DO IT AND THE MRI'S KEEP SHOWING A PROBLEM. IS THERE ANYTHING MORE WE CAN DO ABOUT IT, SHORT OF OPEN-HEART SURGERY?
Yes. Let's say your latest scan shows a couple of arteries blocked by 70 percent and you've been suffering intermittent angina--a level of atherosclerosis that tends to call for serious intervention. In the old days, you'd be on the block and opened up, no question about it. But these days, you may have the option of one or more considerably less invasive and traumatic angioplasties--the minor surgery in which a balloon catheter is threaded up through an artery in your groin and then into one or more of your coronary arteries and expanded to compact the plaque and open the vessel.
True, the procedure has a checkered reputation. First heralded as a civilized alternative to open-heart bypass when it showed up on the scene in the late seventies, it quickly proved disappointing, since the rehabilitated vessels of almost half of all patients reclogged within six months to a year, necessitating another angioplasty and, in some cases, the dreaded open-heart surgery. But the widespread use of stents--tiny wire-mesh tubes that are inserted into the freshly expanded blood vessel to fortify it against renarrowing--over the past decade or so has not only restored angioplasty's reputation but also taken it to the top of many cardiologists' lists of potential treatments for all but the most advanced blockages.
According to the American Heart Association, heart patients who receive angioplasty plus stents these days have a 40 percent lower chance of needing an additional angioplasty or open-heart surgery than their fellow patients who underwent angioplasty with no stents back in the eighties. And according to the Cleveland Clinic Heart Center--named the best heart hospital in the nation by US News & World Report eight times in the past decade--angioplasties have become so reliable that the number of open-heart surgeries performed is expected to drop 5 to 10 percent per year over the next decade. Moreover, increased trust in angioplasty is encouraging its use preventively, which is to say, on those many patients who have serious coronary-artery disease but are not yet at Imminent risk of a heart attack. The idea of prophylactic surgery--actually getting your body rearranged in some fairly major way merely in anticipation of a life-threatening problem--may strike you as a little creepy. But one reason that heart disease remains our number-one killer is that its treatment has always been reactive. New and better imaging devices, coupled with a simple day surgery like angioplasty, allow cardiologists to treat the disease proactively, preventing both heart attacks and the gruesome open-heart surgery that they call for.