Coronary artery disease (CAD), also called ischemic heart disease, means blocked coronary arteries. It is one of the most common heart ailments in the United States. We offer comprehensive treatment options may include medications, minimally invasive interventional procedure or surgery. Our care team includes interventional cardiologists, cardiothoracic surgeons, anesthesiologists and heart-imaging specialists.
CAD is due to buildup of calcium blockage in arteries that supply oxygen and nutrients to the heart muscle. While typically marked by chest pain, CAD symptoms can also include fatigue and shortness of breath. CAD is typically treated with medication. Advanced care requires intervention that increases blood flow to the heart either through percutaneous coronary intervention or surgery.
For patients with complex coronary artery disease, the Heart and Vascular Center provides the Complex and High-Risk Interventional Procedures (CHIP) and Chronic Total Occlusion (CTO) Program.
This program offers non-surgical treatment for patients whose coronary artery disease symptoms are not improving with medication, who are not eligible for cardiac surgery, or cannot be treated with standard interventional techniques. The program also treats CTO, a complete blockage within one or more of the heart’s arteries that requires specialized care. Most program patients have had cardiac bypass surgery, have complex anatomy requiring specialized equipment or other illnesses such as diabetes, lung, kidney or vascular disease.
Arterial bypass grafting involves using grafts of artery from the arm or both sides of the chest, based on patient anatomy and patient preference.
Yale New Haven Hospital offers brachytherapy to treat coronary artery restenosis, which is excessive scar tissue that has developed inside stents previously implanted to treat coronary artery disease. The incidence of scar tissue developing inside a stent is about 10 percent.
If patients with a coronary stent experience chest pain or angina resulting from their CAD, restenosis may be present. An angiogram (cardiac catheterization) is performed to check for scar tissue. Depending on amount of scar tissue, brachytherapy, a type of radiation therapy, may be offered as a treatment to prevent scar tissue from forming again. Both an interventional cardiologist and therapeutic radiologist perform brachytherapy.
Before brachytherapy, scar tissue is broken up and cleared from the treated area. A specialized brachytherapy catheter is placed within the site of the former coronary blockage. The catheter delivers radioactive sources to the treatment site to reduce the types of cells that may grow and could trigger restenosis. From 16 to 24 radiation sources, each about the size of a grain of rice, are used for the procedure. Once the dosage is given, typically within about five minutes, the radiation sources are removed from the catheter and catheter is then removed from the patient. Patients go home the same or next day after treatment.
Coronary artery bypass grafting (CABG) is the most common operation to treat blocked coronary arteries (coronary artery disease), particularly when it affects multiple coronary arteries and in patients with diabetes. Based on the size, number and locations of artery blockages, your doctor may decide that bypass surgery, often referred to as open-heart surgery, is the best treatment. The operation may be done with or without the heart-lung machine, depending on patient anatomy and surgeon preference. Off-pump coronary artery bypass surgery (when the heart-lung machine is not used) offers benefits for some patients, including a reduced need for blood transfusions; less risk of bleeding, stroke, and kidney failure.
For many patients, catheter-based and minimally invasive interventional procedures are alternatives to open-heart surgery. Benefits include improved outcomes, quicker recovery, and fewer complications. Procedures are performed with advanced imaging using intravascular ultrasound or optical coherence tomography.
Among our comprehensive treatment options for complex coronary artery disease:
Medications to treat coronary artery disease include anti-platelet (blood thinner) such as aspirin, clopidogrel, or ticagrelor; cholesterol-lowering such as statins; and those that reduce the workload of the heart including beta blockers. In addition, your healthcare provider may recommend medications that aid blood flow through the arteries, such as nitroglycerin.
Minimally invasive direct coronary artery bypass (MIDCAB) is offered for patients with isolated blockage of the left anterior descending artery or as part of a surgical procedure that combines coronary artery stenting and surgical bypass, also called hybrid procedure. Hospital stays are shorter, and patients can make a quicker return to day-to-day activities.
Complex and high-risk cases are discussed at Heart Care Team meetings where cardiac surgeons and cardiologists jointly review each patient′s case and provide a recommended treatment plan toward best outcomes.
Coronary artery disease (CAD) is the most common type of heart disease, according to the Centers for Disease Control and Prevention. The good news is many CAD risk factors can be controlled through lifestyle changes and medications.
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