Elective coronary angioplasty gives patients the chance to address blocked arteries and possibly prevent a heart attack from ever occurring.

Last October, on one of her walks with her dog, Emmett, 76-year-old Eileen Aviss felt tightness in her chest. She went home and Googled the symptoms to try to figure out what was going on in her bod, but the feeling went away, and she let. But on another walk—one of the hilly ones—she felt the tightness again, but this time she also felt nauseous. “My husband, John, looked over with concern and said, ‘Do you think you’re having a heart attack?’” she recalls.

With a sense of worry and dread, Aviss made an appointment with her doctor at Capital Health, Shaismy Kudakachira, DO, who thought it sounded serious enough to connect her to a cardiologist for a series of tests. The doctor ordered an electrocardiogram (EKG) to measure the electrical efficiency of her heart, which was inconclusive. That was followed by an echocardiogram (echo), an ultrasound of the heart, which didn’t show anything ominous. But then the doctor performed a nuclear stress test, which uses a small amount of radioactive material (tracer) and an imaging machine to show blood flow to your heart while you exercise. That’s when the doctor could see three blocked arteries. Without intervention, they told Aviss, she could have a heart attack.

Doctors wanted to do a procedure called a coronary angioplasty with stenting, in which a tiny balloon catheter is inserted into a blocked blood vessel to help widen it and improve blood flow to the heart. Prior to angioplasty, open-heart bypass surgery was the main option for patients Angioplasty—especially the refined version available at Capital Health today—offers a much faster recovery time since it’s non-invasive.

First introduced in 1974, balloon angioplasty with stenting has become the most frequently used treatment in vascular emergencies of the heart. However, to help patients avoid cardiac emergencies, Capital Health endeavored to offer elective coronary angioplasty for more than a decade. The good news for Aviss was that Capital Health was approved last February, which meant she didn’t have to wait to schedule the procedure and could have it all done by the time she and her husband, John, planned to head to Florida this February.“

To gain approval, hospitals have to demonstrate that they can do emergency coronary angioplasty and stent placement safely, and we did that,” says Harit Desai, MD, director of the cardiac catherization lab at Capital Health.

Stents in today’s day and age are a marvel of engineering. Think of it like this: You have a pipe in the house that has garbage built up. You put in a stent and blow up the balloon, and the stent expands so it can allow the water to flow through, and then you avoid a burst pipe.

Harit Desai, MD

WHAT IS ANGIOPLASTY PLUS STENTING?

Doctors insert a tiny balloon wrapped in a metal mesh tube (stent) into a blood vessel, typically in the groin or the wrist, and guide it into the heart. Doctors inflate the balloon, which opens the artery by flattening the plaque that was restricting blood flow. Then it’s deflated and removed, but the stent remains to keep the artery open.

HEADS UP

HEART DISEASE is the leading cause of death for women in the United States, killing almost 300,000 women a year. The disease exacts an even larger toll on Black American women. Almost half of Black women over 20 in the United States have some form of cardiovascular disease, according to the American Heart Association, even though only one in five Black women think they are personally at risk.

While those numbers are daunting, Dr. Desai says he worries about women because they sometimes have atypical symptoms of a heart attack, which can easily be ignore. “Women should pay close attention to symptoms, even when they can be vague. Symptoms such as chest heaviness, increased fatigue, discomfort between shoulder blades, forearm heaviness, left shoulder or right shoulder, pain just below the breastbone, jaw discomfort, and breaking out into sweat out of nowhere,” he says. “Those symptoms may seem odd or even unrelated, but they can be signs of a heart attack.”

CATHETERS, STENTS, AND WIRES

Heart disease is still the number one killer in the world. In fact, a person dies every 36 seconds in the United States from cardiovascular disease. About 659,000 people in the United States die from heart disease each year—that’s one in every four deaths.

Despite those astronomical numbers, enormous effort, resources, and research go into the constant fine-tuning of tools and treatments each year. Angioplasty is safer than it’s ever been, which is why Capital Health doctors can perform it on an outpatient basis, says Dr. Desai. “Once we had a good grasp on how to make it safer, it just kept jumping leaps and bounds,” he says. “Stents in today’s day and age are a marvel of engineering. It has come a long way—when I was in training, we were going through the groin—the femoral artery. Now we do most of our procedures through the radial artery in the wrist. It’s more technically challenging, but it’s better because complication rates are lower, patients can sit up right away, and they can go home.

“This procedure has become quite normal for us at CapitalHealth. Within 6 hours, our patients are home with their loved ones.”

Aviss says she was anxious about the procedure beforehand but was pleasantly surprised how quickly she was up and moving. “It is a surreal experience in there because you are awake, and they are showing your heart. And after I got home, I felt really good. I called the doctor’s office to ask if I could go for a walk, and they said I could,”she recalls. “I went back to those spots where I had the initial symptoms, and it was such a relief to feel normal.”

According to the American Heart Association, cardiovascular disease accounts for 17.3 million deaths per year, a number that is expected to grow to more than 23.6 million by 2030. Dr. Desai says that makes tools for treating the disease that much more important. “Unfortunately, heart disease being the number one killer won’t likely change in the near future until we, as a nation, stop smoking and control diabetes,” he says. “But I think we can change the trajectory of it with these refined tools.”

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