The ancient Egyptians thought the heart, not the brain, was the center of thought and intelligence. Although they misunderstood human physiology, in one respect the Egyptians were correct: human life is dependent on a healthy and properly functioning heart.
In the past few decades, the field of cardiology has made enormous progress in the diagnosis and treatment of cardiovascular disease, especially the removal of blockages in blood vessels around the heart. In particular, the advances in interventional cardiology have been especially innovative.
"Interventional cardiologists are physicians who can treat coronary artery and peripheral vascular disease (blockage of the heart arteries and other blood vessels) with interventional but non-surgical methods," explains King White, MD, a board certified interventional cardiologist who practices at CHRISTUS St. Patrick Hospital. "Interventional cardiologists have had additional years of training to perform certain 'minimally invasive' procedures, which are done while the patient is awake and not under general anesthesia."
A brief history of interventional cardiology includes the following procedures and techniques:
- Balloon angioplasties. Introduced in 1979, this procedure was the first "minimally invasive" treatment for cardiovascular disease. In the procedure, a small, flexible tube is inserted into an artery in the groin and threaded up to the vessels in the heart. Then, a catheter with a small balloon is inserted through the tube, and the balloon is opened at the site of the blockage, allowing for much improved blood flow in that vessel. However, in many patients, blockages eventually return.
- Stenting procedures. The next generation of interventional cardiology procedures involved stents, which are small, expandable metal tubes that are inserted and left in place after a balloon angioplasty. These help hold the blood vessel open. Still, about 25-30% of patients have scar tissue grow through the stents, causing another blockage.
- Coated stents. One of the latest evolutions in interventional cardiology is the use of stents coated with medications that prevent scaring at the sight of the blockage. These have been extremely successful, and coated stents are something of a "gold standard" of care, as less than 5% of patients treated with coated stents have blockages recur at the same sight.
- Carotid stents. Using the same minimally invasive approach, these stents are used to treat blockages in the large blood vessel (the carotid) on the side of the neck that sends blood to the brain. Blockages in the carotid are the most common cause of strokes.
- Atherectomy. Using a special device which "shaves" plaque out of leg arteries and removes blockage, thus relieving pain and improving exercise capacity.
"Since interventional cardiology procedures are done without surgery under general anesthesia, we can avoid the complications that can accompany surgery," says Dr. White. "Surgery is still required if a bypass is needed, meaning blockages in the arteries are 'bypassed' with grafts of healthy arteries. However, in the past 5 years, there have been twice as many angioplasties and stents performed as compared to bypass surgeries. We are able to treat more and more patients without surgery."