Introducing the Latest Information and Development of Angioplasty and Bypass Surgery
HONG KONG, Dec. 11, 2012 /PRNewswire/ -- Heart disease is the number 1 "Killer" in the world and ranks the second in Hong Kong just after cancer. 70% of the heart disease patients are suffering from coronary heart disease. At the peak season of heart attack, the attack rate is very much higher than in summer. Patients need to pay extra attention on diet control and keeping warm, and closely monitor the physical condition to prevent Acute Myocardial Infraction (Heart Attack).
Cardiac Patients Mutual Support Association Care For Your Heart in Hong Kong indicated that most of the cardiac patients in Hong Kong do not have enough knowledge of coronary artery disease. They seem dazed, confused and overwhelmed when encountering attack and different treatment options, delay in treatment could be life-threatening. This winter, Care For Your Heart invited Dr. Andy Chan Wai Kwong, Cardiology Specialist to be the speaker of a public health talk, introducing the two treatments for coronary artery disease - Angioplasty and Coronary Artery Bypass Graft Surgery. Dr. Chan also educated the public of the basic knowledge of heart attack, latest development in treatments, stent choices and important before and after care for patients.
Coronary Heart Disease is the result of the accumulation of fat and cholesterol caused stenosis or occlusion in the coronary arteries, this process is called "coronary atherosclerosis". Poor blood flow may lead to myocardial hypoxia, myocardial necrosis or sudden death in more serious cases. The main causes of coronary heart disease including high cholesterol, high blood pressure, smoking, life stress, too much pressure, obesity, lack of exercise, diabetes, and familial, etc.
Dr. Chan indicated that there are 3 different types of treatments for treating coronary heart disease. At initial stages, patients are usually placed under medical treatment using aspirin or nitroglycerin tablets to relieve symptoms; in terms of surgical treatments there are Angioplasty and Bypass Surgery.
Angioplasty is also known as Percutaneous Coronary Intervention (PCI), is the most common treatment for coronary heart disease. Angioplasty is a non-invasive and less traumatic procedure, recovery is relatively faster than invasive surgery. A long and thin steel wire is inserted, and the balloon catheter is put to enter into cardiac artery through femoral artery or hand radial artery, it is advanced through the site of arterial stenosis, then distended and dilate the artery to restore the blood flow. Following by implantation of coronary stent to provide scaffolding to the arterial wall, this ensures the artery remains open and will prevent future re-narrowing or blockage of the artery. Dr. Chan said that currently there are 3 types of stent available in most of the medical institutions in Hong Kong, includes Bare Metal Stent (BMS), Drug Eluting Stent (DES) and also Bio-engineered Stent, some of the private institutions also provide Bioresorbable Vascular Scaffold (BVS) as option. "There will be a new type of stent available in Hong Kong early next year, named Dual Therapy Stent (DTS). This stent combines the characteristics and advantages of Bio-engineered Stent and Drug Eluting Stent, it has the function to control neointimal proliferation and accelerate natural healing process, shorten the time of the stent exposed to the blood vessels, it may reduce the chance of early and late thrombosis formation," said Dr Chan.
The Bypass Surgery is a thoracic surgery, patients with more complex lesions such as stenosis involving the left main trunk in the left coronary artery, or multi-vessel disease would need to undertake this surgery. The operation requires a segment of the patient's vessel (i.e. saphenous vein, left/right internal mammary artery or radial artery) to be extracted and used as a new bridged channel from the aorta to the distal part of the diseased coronary artery. After the surgery, the bridged channel is like a new blood vessel, the advantage is that the effect of maintaining the condition is relatively longer, reduces the risk of requiring repeat surgery. However, as the operation requires thoracotomy, recovery will be longer than non-invasive surgery, doctors need to consider the endurance and resilience of the patient before the surgery.
In fact, most of the patients realize the various treatments of coronary heart disease. However, in terms of the details of the treatments, including the principles, processes, techniques and post-operative medication therapy, there is still lack of awareness and knowledge, some of the patients showed that they do not have much idea of and not quite understand the surgeries that they have received. Dr. Chan said, "it would be great help in rehabilitation and relapse prevention if the patients and families have enough knowledge about the surgeries, comply with doctor's advises, do not follow others' opinion blindly when choosing the treatments, also pay extra attention to the post-operative care."
Dr. Chan emphasised that "To maintain heart health, good and healthy lifestyle is still the key. Minimizing the intake of food containing high fat, high cholesterol and salt, do not smoke, reduce stress and maintain regular exercises are the elements of protecting your heart."
Care For Your Heart focuses on public health education, strengthen public health awareness and knowledge of heart disease through health talks and seminars, as well as patient materials like brochures and website, for patients to better understand the treatment options and after-surgery care. Care For Your Heart recommends patients to consult their doctors about their health condition, the available and the most appropriate treatments before undertaking any procedures or surgeries.
Types of Stent Available in Hong Kong
| Bare Metal Stent (BMS) |
Drug Eluting Stent (DES) | Bio-engineered Stent | Bioresorbable Vascular Scaffold (BVS) | Dual Therapy Stent (DTS) | |
| Properties | Metallic structure with no additional drug or antibodies over its inner surface | A layer of polymer embedded with a drug coated on the outer stent surfaces which reduces cell proliferation | Antibodies coated on inner stent surface that promotes accelerated natural healing process | Drug on bioabsorbable stent platform which reduces cell proliferation | Combining drug release on the abluminal surface for the control of neointimal proliferation and antibody on the luminal surface for pro-healing effect with accelerated endothelial coverage |
| Advantages | 1. Longest available and most traditional stent type in the market 2. Relatively lower cost 3. Recommended 1 month prescriptions of DAPT (ie. Plavix and Aspirin) |
1. Reduces chance of in-stent restenosis (re-narrowing) | 1. Accelerates the natural healing process and stent coverage, thus reduces chance of late stent thrombosis and vessel re-narrowing 2. Relatively shorter DAPT duration (1-month) |
1. Coated with an anti-proliferative drug that is released from a biodegradable polymer to minimize re-narrowing 2. The scaffold will be fully dissolved after two years |
1. Reduces restenosis through intimal hyperplasia inhibition whilst promoting stent coverage that effectively reduces risk of stent thrombosis |
| Disadvantages | Relatively higher chance of vessel re-narrowing from excessive cell growth at injured site | Higher chance of thrombosis due to delayed healing | Chance of vessel re-narrowing is higher than DES due to lack of drug to suppress hyperplasia | May not be suitable in patients with calcified, tortuous and bifurcation lesions due to scaffold material | DAPT duration is longer than the period of Bare Metal Stent and Bio-engineered Stent |
| DAPT recommendation after procedure | 1 month | 12 months | 1 month | 12 months | 6 months (as recommended in REMEDEE Trial Protocol) |
About Care For Your Heart
Care For Your Heart is a registered charity organization formed by cardiac patients and families, since 1995. They are committed to help one another to relieve from the confusion and fear brought by heart disease, and to face rehabilitation hand in hand with the members towards a positive life. The organization established the first Cardiac Patients Resource Centre in Hong Kong in 1998, provides assistance and support to members, and also help to raise public awareness of heart health through educational activities. Care For Your Heart has provided more than 1,570 services for over 125,285 persons in 2011/12.
Website: www.careheart.org.hk
Facebook: http://www.facebook.com/CFYH.HK
