CHAPTER 24 CORONARY ANGIOPLASTY AND INTERVENTIONAL CARDIOLOGY MICHAEL W. CLEMAN, M.D. tissue, and calcium, as well as arterial muscle cells, INTRODUCTION intrude into the vessels. The plaque deposits ulti-mately cause stenosis, a narrowing of the lumen, or inner orifice of the blood vessels, which limits the Patients with severe coronary artery disease have tra- ditionally been treated first with drug therapy and then, if necessary, with coronary artery bypass sur- gery. In the past decade, so-called interventional car- diology devices-angioplasty,atherectomy, lasers, and stents—have opened new vistas for successful treatment of heart disease symptoms with techniques that are far less invasive than traditional surgery. Rather than constructing a new route for blood flow, as in bypass surgery, these procedures open or widen existing ones. For patients in whom cardiovascular drugs are not effective, they offer a major advantage of being performed under local anesthesia, which greatly hastens recovery and as a result lowers cost. Atherosclerotic plaque is the culprit that creates candidates for these therapies, by virtue of narrowing the coronary arteries. Within the walls of the arteries, plaque deposits containing cholesterol, connective space available for blood circulation and, conse- quently, the amount of blood delivered to the heart muscle. Over time, as this process continues, the reduced delivery of blood means that the heart muscle does not get enough oxygen. This condition, called ischemia, may trigger chest pain, or angina pectoris —a major indicator of coronary artery disease. Ap- proximately 6 million Americans suffer from angina, which can range in severity from mildly annoying to the feeling of a viselike grip in the chest that radiates to the left shoulder, left arm, or jaw. Angina attacks are most often...
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