3) Surgical and invasive options
Invasive options are usually needed in case of stable angina which is not relieved by rest nor controlled by medications. They offer a more permanent but invasive solution to the primary pathology of angina through bypassing the narrowing. They include:
A. Percutaneous intervention or (PCI)
PCI replaced open-heart procedures in many instances, decreasing the morbidity and mortality associated with it and improving patient’s outcome. It involves inserting a catheter, which is a thin tube-like structure, through your forearm or leg vessels. Then, the catheter goes up till reaching your coronaries at the site of narrowing. After that, the doctor will inflate a balloon to dilate the vessel. He may or may not leave a “stent.” A stent is a wire mesh-like structure that keeps the arteries open and wide to prevent the recurrence of narrowing and is usually “absorbed” into the wall of your artery. It is called “percutaneous” because it is done through a small incision over your arteries in your leg or forearm, without the need to have large incisions nor major surgeries.
B. Coronary artery bypass surgery/graft or (CABG)
It is another option for the management of unstable angina when a PCI fails, in cases of narrowing of multiple vessels, and when there’s a significant narrowing of a primary vessel. It involves bypassing the narrowed vessel or vessels using grafts taken from elsewhere in the body, thus creating a new “route” rather than trying to widen an existing one. Most grafts are taken from vessels of your calves (saphenous veins) or your chest (internal mammary artery) and rarely, your forearm (radial artery). It is an open heart procedure that carries some risks and thus, reserved for particular cases.
