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Home Healthcare Services Coronary Heart Disease Treatment Options

Treatment Options

There are several interventional and surgical treatments available for patients with coronary artery disease.

Interventional treatment

  • AngioJet™
    The AngioJet is a safe, minimally invasive procedure used to eliminate clots that can lead to heart attacks and stroke. The AngioJet produces immediate results by "vacuuming" medium to large clots, rather than dislodging them, which can sometimes occur during angioplasty. Dislodged clots can lead to bleeding, stroke or other problems. In most patients, the catheter-like AngioJet has successfully reduced the length of hospital stays and repeat catheterizations. It also works much faster than clot-busting medications.

  • Coronary artery stent
    Using a catheter, the coronary artery stent and angioplasty balloon are guided to the site of the narrowed vessel. The balloon is inflated to expand the stent and then removed from the artery. The expanded stent remains in place, keeping the artery open. Tissue will completely grow over it within two to three weeks.

  • Coronary radiation therapy
    The Beta-Cath™ procedure, called vascular brachytherapy, is designed to use a localized dose of beta radiation to stop cell growth inside the stented artery. Radiation therapy is applied from within the heart vessel to potentially prevent blockages from recurring. This procedure was first offered in Jacksonville by University of Florida physicians at the Shands Jacksonville Cardiovascular Center.

  • Directional atherectomy
    Using a shaving device, directional atherectomy slices plaque from the vessel wall. This option may be particularly useful for repairing vein grafts from prior bypass surgery and for removing plaque from large coronary vessels.

  • Drug-eluting stents
    Antibiotic-coated stents can dramatically reduce the incidence of restenosis-the re-clogging of arteries-in patients with heart disease. The device is currently being studied to treat and prevent excessive tissue growth and prevent arteries from re-narrowing after balloon angioplasty or stent placement.

    The stent is coated with the drug Sirolimus, a natural antibiotic and immune-system suppressant, which is released into the vessel over a short period of time. Sirolimus is commonly used to prevent the body from rejecting organ transplants. Sirolimus halts the reproduction of certain cells that, as part of the body's response to injury, are involved in the proliferation of scar tissue. The Sirolimus-eluting stent is the first drug-eluting stent to be approved by the Food and Drug Administration for the treatment of blocked coronary arteries. Shands Jacksonville was one of only 53 medical centers nationwide that participated in the drug-eluting stent clinical trial.

  • Laser ablation
    Laser ablation uses laser technology to reduce obstructive tissue and restore blood flow to the heart through a minimally invasive procedure. The laser system uses a fiberoptic delivery device to emit ultraviolet light in controlled energy pulses that ablate, or vaporize, blockages. This technology is used as an alternative, or in addition, to angioplasty procedures.

  • Percutaneous transluminal coronary angioplasty
    Percutaneous transluminal coronary angioplasty widens or expands narrowed coronary arteries with the use of a special balloon that is inserted from the tip of a catheter. When the balloon is inflated, it compresses the plaque and enlarges the diameter of the opening within the blood vessel. Once this is completed, the balloon is deflated and removed.

What to expect during and after interventional treatment

You'll be given a mild sedative and a local anesthetic before your procedure. An IV line is inserted into one of the blood vessels in your arm or groin. A catheter is then inserted through the IV and into your blood vessel. The catheter is carefully threaded into the heart guided by an X-ray machine. Once the catheter is in place, contrast material is injected and pictures are taken. Depending on the therapy, different types of catheters will be inserted through the IV to complete the procedure.

After the treatment, you will need to remain in a flat position until the IV in the groin is removed. You will stay overnight in our Coronary Care Unit and discharged the next day after your physician meets with you.

You can resume normal activities three days after discharge as long as there are no complications.

Surgical treatment

  • Beating heart (off-pump) surgery
    Many patients can successfully undergo heart surgery without the use of a heart-lung machine, a procedure also called the cardiopulmonary bypass. This technique holds the heart in place to keep it beating and reduces complications such as stroke, bleeding and heart attack. Through the avoidance of cardiopulmonary bypass, patients have fewer complications, recover faster and are able to leave the hospital sooner and return to full activity within a few weeks. Off-pump procedures are routinely offered to all patients who are appropriate candidates, as well as high-risk individuals for whom cardiopulmonary bypass may pose significant additional risk.

  • Minimally invasive coronary valve surgery
    This new technique involves a smaller incision resulting in less pain and a quicker recovery with successful results. It is offered to patients with less severe heart disease when conventional heart surgeries can be avoided. A variety of mechanical valve prostheses, as well as valves from donors, are used in this procedure.

  • Multiple artery revascularization
    In this pioneering procedure, heart bypasses are performed using arteries from other areas of the body. Arteries stay open longer than veins, which may reduce the need for additional surgery.

  • Transmyocardial Laser Revascularization (TMR)
    Transmyocardial laser revascularization is a procedure in which a laser is used to create channels through the heart wall to improve blood flow to the myocardium. It provides relief for patients suffering from angina who have exhausted all other means of myocardial revascularization. TMR may decrease or eliminate angina as well as increase survival in these patients. TMR has resulted in reduced lengths of hospital stay and has greatly improved patients' quality of life. Approximately 90 percent experience pain relief from symptoms of acute angina or chest pain after TMR.

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