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Left Main Disease

What is left main disease?:

Have you been told you need bypass surgery? Are your blockages too complex to bypass?:

  • Have you been told that there is nothing else that can be done for you heart disease?
  • Are your blockages too complex to bypass?
  • Is your quality of life limited by your heart disease and blockages?

Coronary artery disease occurs when the coronary arteries become narrowed or blocked as a result of atherosclerosis. Atherosclerosis is the build-up of fatty deposits and plaque on the inner walls of the arteries that restricts blood flow to the heart. Without adequate blood flow, the heart is starved of the oxygen and vital nutrients it needs to function properly. The most common symptom of coronary artery disease is angina or chest pain.

But today, if you have been diagnosed with left main disease, you have options. The physicians on the medical staff at Baylor Hamilton Heart and Vascular Hospital have successfully treated patients with left main disease using percutaneous coronary intervention (PCI) techniques with stents, providing a rapid, less-invasive procedure, and a faster hospital discharge and return to daily activities.

Angioplasty and Stent Placement for Left Main Disease

Arteries can become narrowed or blocked by deposits called plaque. Plaque consists of fat and cholesterol that builds up on the inside of the artery walls, a condition is called atherosclerosis. Angioplasty is an interventional procedure used to open narrowed or blocked coronary arteries that carry blood to the heart.

A coronary artery stent, which is often placed during or immediately angioplasty, is a small, metal mesh tube that expands once inside a coronary artery. Its purpose is to prevent the artery from becoming blocked again. A drug-eluting stent is coated with medicine to help prevent the artery from closing.

Other terms commonly associated with angioplasty are percutaneous coronary intervention (PCI), balloon angioplasty, coronary angioplasty, coronary artery angioplasty, percutaneous transluminal coronary angioplasty and heart artery dilatation.

Angioplasty may be used to treat:

  • Blockage in a coronary artery during or after a heart attack
  • Blockage of one or more coronary arteries that puts you at risk for a heart attack
  • Persistent chest pain (angina) not controlled by medication

How Angioplasty is Performed

Before the beginning of the angioplasty procedure, you will be given pain medication. You may also be given blood thinners to prevent blood clots from forming.

Once you are lying on a padded table, your physician will insert a flexible tube or catheter through a needle puncture into an artery. The catheter may be inserted through an artery in your groin or in your arm or wrist.

Your physician will use live X-rays to carefully guide the catheter into your heart and arteries. Dye that is injected into your body will provide a picture of the blood flow through your arteries and will let your physician see any blockages in the blood vessels.

A guide wire is moved into and across the blockage. A balloon catheter is then advanced over the guide wire and into the blockage. The balloon is then inflated to open the blocked vessel and restore sufficient blood flow to the heart. A stent may then be placed in the area of the blockage. The stent also expands when the balloon is inflated. The stent will be left in your artery to help keep it open. Click Here to Launch Coronary Angioplasty Animation

Risks of Angioplasty

Angioplasty is generally safe, but as with any interventional procedure, complications are possible. Risks of angioplasty and stent placement include:

  • Allergic reaction to the drug used in a drug-eluting stent, the stent material or the X-ray dye
  • Bleeding or clotting in the area where the catheter is inserted
  • Blood clot
  • Clogging of the inside of the stent (in-stent restinosis)
  • Damage to a heart valve or blood vessel
  • Heart attack
  • Kidney failure (The risk is higher in people who already have kidney problems)
  • Arrhythmias (irregular heartbeats)
  • Stroke (This is rare)

Your Prognosis After Angioplasty

For most people, angioplasty greatly improves blood flow through the coronary arteries and the heart. But since angioplasty does not cure the underlying condition that caused the blockage in your arteries, your arteries may become blocked again.

To lower your risk, follow a heart-healthy diet, exercise, stop smoking if you smoke and reduce stress to lower your chances of having another blocked artery. Your physician may prescribe medication to help lower your cholesterol.

Angioplasty vs. CABG: The Advantages and Disadvantages

Procedure Advantages Disadvantages
Angioplasty Less invasive (avoids the risks of surgery)

Can be repeated in the future if necessary
Greater chance that the artery will become narrowed again (restenosis) within the first year

May be less effective for people with diabetes who have significant coronary disease affecting two or more arteries
Coronary artery bypass graft (CABG) surgery Can bypass blockages in several arteries

May benefit people with many blocked arteries or weakened heart muscle
Higher risk of complications in the short term after surgery, including death and stroke

Longer stay in the hospital and longer recovery time

Clinical Trials

Left Main Disease

SYNTAX Trial - A study to determine whether comparable outcomes can be achieved with coronary artery bypass grafting (CABG) and percutaneous coronary interventions with drug-eluting stents in patients with left main coronary artery disease.

EXCEL Trial - A study to evaluate the safety and effectiveness of the XIENCE PRIME/XIENCE V Everolimus Eluting Coronary Stent Systems compared to coronary artery bypass grafting (CABG in select patients with left main coronary artery disease.

To learn more about our clinical trials or to enroll, please call the Soltero Cardiovascular Research Center 214.820.2273 or visit our online trial listing.

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