Ask the Expert: Angioplasty vs. Drug Treatment

Dr. David Ostrander, a cardiologist affiliated with Sharp, answers a few questions about angioplasty and drug treatment.

What is an angioplasty?
Angioplasty is a procedure wherein we advance a very small catheter into one of the arteries that brings blood to the heart muscle, the coronary arteries. The catheter is a small flexible tube that’s about a millimeter and a half in diameter. And this very small catheter has a balloon attached to the wall that we can inflate and stretch the artery and open it up. And in almost all cases at the same time we place a stent in the artery. A stent is a stainless steel tube that is a mesh there … it becomes a permanent scaffolding that keeps the artery propped open.

When would someone need an angioplasty?
You have an angioplasty when you’ve had a high grade or severe narrowing in a coronary artery that was causing symptoms of chest pain. These are people very likely to have a heart attack if we don’t do something.

Are there any alternatives to angioplasty?
The alternatives to angioplasty have existed for a long time. And there’s been an ongoing debate about which patients benefit from these invasive procedures and which ones will do just fine with medical therapy and a healthy lifestyle. 

How effective are drug options?
Cholesterol-lowering drugs lower your risk of having a heart attack or stroke by 35 to 40 percent, but there’s a 1 percent chance that your liver might become inflamed. But those risks which people are understandably concerned about are offset by a substantial 35 to 40 percent reduction in death or stroke or heart attack.

When is surgery the best option?
For the patient who doesn’t have that very severe left main narrowing or perhaps severe disease in all of the coronary arteries there’s a choice. If the patient’s symptoms of chest pain, shortness of breath are well controlled on medical therapy it’s perfectly reasonable to continue to treat them with medicine and not do any intervention, understanding that if those symptoms change, if the patient begins to have chest pain at rest, or notices that their exercise tolerance has suddenly plummeted, then it’s time to consider perhaps now having an angioplasty or bypass surgery.

How should I go about determining which treatment is right for me?
First of all you have to have a doctor who is willing to talk to you, and in whom you have faith. Number two, you need to educate yourself, and there are great opportunities to do that by listening to podcasts, by going on the Internet and going to trusted websites and learning about heart disease, and then having a very frank discussion with your cardiologist about what the options are, what the risks are, and what your choices are.

For More Information
For more information about heart and vascular care at Sharp or to find a Sharp-affiliated doctor, search for a San Diego cardiologist or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm. To find general information about heart and vascular care, visit Cardiovascular Diseases in Adult Health or read the Heart and Cardiovascular News archive.