1. Medical Management
Most of them receive aspirin and statins to reduce Lipids (cholesterol) for life long, along with other drugs which will be decided by physician / cardiologist.
2. Coronary angioplasty ( PTCA )
Here the significant atheromatous (block) lesion is tackled by passing a wire across the lesion, ballooning it to open up the artery and deploy a metal tube (stent) across it, so that the lesion is opened fully and blood flow restored.
a. What is a stent ?
A stent is slotted metal tube with laser cut to make it more trackable, taking the shape of the artery and holding the block to the wall so that the lumen fully opened for blood flow.
b. Is ‘stent’ a must during PTCA ?
Yes, > 90 % a PTCA procedure needs ‘ stent ’ to open up the artery.
c. What are different types of stents available now ?
There are mainly 2 types of stents
- Bare Metal Stent ( BMS )
- Drug Eluting Stents ( DES )
- Bioabsorbable Vascular Scaffold (BVS)
d. What is the difference between BMS & DES ?
BMS can be of two varieties
- Stainless steel stent
- Cobalt chromium stent
- They have no coated drug.
DES has drug coated inside the metal stents. These drugs are usually antiproliferative in nature which prevents cell growth after stent deployment.
BMS came to clinical usage from 1991 and DES from 2002 onwards.
Newer type of “stent”,available in India now, which helps in preventing restenosis as well as disappears by the end of 2 years.Its advantage is no metal and maintain vasomotion of the artery as before. However they are expensive( about Rs 2.5 lakhs per stent).
Chance of restenosis ( Reblockage ) within the stent usually within 6 months is about :
- 15 - 20 % for BMS - Stainless steel stents
- 10 - 15 % for BMS - Cobalt chromium stents
- < 5 % for DES - Cobalt chromium stents