Dr Abhay Tidake, Cosultant Interventional Cardiologist, Associate Professor, LTMMC and LTMGH, Sion, Mumbai highlights the role of technology in the management of coronary artery disease
Through the pandemic, people learnt many critical lessons and changed their priorities in life. Although, they were overwhelmed by fear of the coronavirus, the situation still gave them the time to ponder upon and start valuing what matters most in life – living a healthy life. This realisation has been even more acute for Indians who have been reeling under the burden of cardiovascular diseases (CVDs) for decades.
Amongst all CVDs, coronary artery disease (CAD) has become the major cause of morbidity and mortality in India. This fact can be inferred from the increasing number of angioplasties being carried out – in 2016 alone, 478,770 coronary interventions were performed in India. The good news is that to manage the rising cases of CAD, India is today endowed with cutting edge technologies such as drug eluting stents which provide a better quality of life to patients. Let us now understand the condition better along with ways to diagnose and treat it.
Understanding coronary artery disease
When the coronary arteries become narrowed due to accumulation of cholesterol containing deposits called plaques, it is known as CAD. This condition interrupts the flow of blood, oxygen, and nutrients to the heart. Eventually, the reduced blood flow can cause shortness of breath, chest pain or angina, and a complete blockage can cause a heart attack.
On experiencing such signs and symptoms, one should visit a doctor without any delay. The doctor will ask questions regarding the medical history, carry out a physical exam, and order some blood tests or more diagnostic tests including electrocardiogram, echocardiogram, exercise stress test, nuclear stress test, cardiac catheterization and angiogram, and cardiac CT scan.
How is a clogged coronary artery treated?
Based on the results of the diagnostic tests, the doctor suggests treatment options. Patients are advised to make lifestyle changes and if necessary, drugs and medical procedures. Taking certain lifestyle measures like quitting smoking, eating healthy foods, exercising regularly, losing excess weight, and reducing stress helps combat CAD.
At times certain procedures such as angioplasty and stent placement are required to treat severe blockages. Stents are small expandable tubes used to open clogged arteries that restore the normal functioning of the artery, reduce symptoms like chest pain and prevent the chances of heart attack. Such stents are referred to as cardiac or coronary stents and the procedure of heart stent implantation is known as percutaneous coronary intervention (PCI) or angioplasty. There are three types of stents commonly used to treat CAD – drug eluting stent (DES), bioresorbable vascular scaffold and bare metal stent (BMS).
The promise of drug eluting stents to patients
Today, mostly doctors prefer new and improved versions of DES that are considered safe and effective for most patients. High-quality DES are less likely to cause a blockage in the future as compared to BMS. The DES is a metal stent that is coated with a drug and is known for preventing restenosis – the repeat blockage of an artery after angioplasty due to excess tissue growth inside or at the edges of the stent. The newer DES are made of high-quality metals such as alloys, which allow for a slender profile without sacrificing strength. The drug molecules in these newer DES are carefully positioned towards the outer side only so as to have fewer off-target effects. Advancements in biopolymer design – substances that attach the drug molecules to the stent metal, have allowed us to minimise the body’s immune reaction to the stent, therefore decreasing chances of failure. A study by the American Family Physician medical journal revealed that about 40 percent of people who underwent angioplasty without a stent experienced restenosis. The number dropped to approximately 30 percent for patients who got BMS implanted and further to less than 10 percent for the ones who opted for DES.  DES have now overtaken BMS for all indications of coronary stenting.
During PCI, the doctor will insert a small catheter with a balloon and stent on the tip through an incision in the arm or groin. Using advanced imaging techniques such as optical coherence tomography, the catheter will be guided through the body and into the narrowed artery. Then the balloon will be inflated to push plaque aside. As the balloon inflates, it will expand the stent which holds the artery open. The balloon and catheter are removed once the doctor ensures the right placement of the stent, leaving the stent behind. People who are treated with DES do not require more invasive procedures such as coronary artery bypass surgery.
Living with a stent
When DES is used during the procedure, it releases medication directly into the artery that will prevent scar tissue formation within the stent and restenosis. The procedure entails fewer complications, quicker recovery, and a better quality of life for patients. After the procedure, the patient with a stent does not have to live differently. Eating healthy, being active and adherence to medications prescribed by the doctor are the only precautionary measures to be followed.