How We Treat Coronary Artery Disease

If you have coronary artery disease, we'll customize a plan of care to restore blood flow to your heart and put you on the road to a heart-healthy life. Your treatment may include one or more of these approaches:

Medical Therapy

Most people with coronary artery disease benefit from medications such as statins to lower cholesterol and medications to reduce triglyceride levels. Doing so can reduce the amount of atherosclerosis in your heart arteries and widen the channel through which blood flows. You may also benefit from drugs to treat high blood pressure and diabetes. People with angina may receive medication to relieve chest pain.

Interventional Cardiology

Often, someone with a blocked heart artery may benefit from cardiac catheterization techniques, such as balloon angioplasty with stent placement. Angioplasty is used to re-open coronary arteries that have become narrowed by atherosclerosis. You'll typically need local anesthesia and sometimes mild sedation (relaxing medications), and in many cases, you can be discharged to home the same day of the procedure. In more complex cases, you may spend the night in the hospital, and will usually be able to return to your normal activities in a day or two. NewYork-Presbyterian has Cardiac Catheterization Laboratories on site, staffed by world-renowned interventional cardiologists and other staff with experience performing these procedures.

  • Balloon angioplasty. During balloon angioplasty, a thin tube (catheter) is inserted into an artery in your groin. The doctor passes a tiny balloon through the catheter and guides it to the narrowed area(s), where the balloon is expanded to stretch the artery open and restore blood flow.
  • Stent placement. Most people having balloon angioplasty have a small metal mesh tube called a stent inserted and expanded in the newly opened artery. The stent is left in place permanently as a scaffold to support the artery and maintain blood flow. We use the latest in stent technology, including drug-coated stents whenever possible to reduce the risk of another blockage developing in the artery. In fact, every drug-coated stent now available in the United States was approved through studies conducted by our interventional cardiologists. Our doctors were also co-leaders of a clinical trial which led to the approval of a precision-guided robotic-assisted system that enhances the accuracy of stent placement, and we were the first center in the nation to use this system to perform this procedure.
  • Intravascular Imaging and Physiology. As part of the management advancing the care of patients with complex coronary artery disease, our physicians frequently employ cutting-edge technologies for intravascular imaging (with ultrasound or optical coherence tomography) and physiology (fractional flow reserve, instantaneous wave-free ratio or iFR) during the care of these patients.
  • Complex Higher-Risk and Indicated Patients (CHIP). Our physicians have particular expertise in managing more complex and higher risk patients, including those with complex coronary artery disease including chronic total occlusions, patients with weak hearts or heart failure, and other comorbid conditions, including kidney disease. These cases are collaboratively discussed between our interventional cardiology and surgical teams. Our physicians are facilitating educational initiatives and training in these areas through the creation of a CHIP national interventional training program, which trains physicians around the country in these newer approaches, and with their recent position paper “Treatment of Higher-Risk Patients with an Indication for Revascularization: Evolution within the Field of Contemporary Percutaneous Coronary Intervention.”

Heart Surgery

Some people whose coronary artery disease cannot be effectively treated with medication alone or interventional therapies need coronary artery bypass graft (CABG) surgery. During this operation, the surgeon takes a blood vessel from another part of your body and uses it to reroute blood around blockages in your coronary arteries to restore blood flow. NewYork-Presbyterian offers two types of CABG surgeries: traditional CABG and minimally invasive CABG.

  • CABG. During this open-heart surgery, the surgeon operates through a large incision in your chest while your heart is stopped and your body is supported by a heart-lung machine. In today’s healthcare environment, a measure of the sophistication of a cardiac surgery program is the proportion of these surgeries performed with mammary arteries (blood vessels in the chest wall). While the standard approach is to use one mammary artery, our cardiac surgery program uses two of these arteries — a more complicated procedure, but a better operation for patients. Nationally, 6 percent of all CABG surgeries are performed using two mammary arteries; at NewYork-Presbyterian, that number is70 percent, placing our program among the top in the country.
  • Minimally invasive heart surgery. The surgeon makes a small (2-3 inch) incision in the tissue layer between your ribs. This method—made possible by a specialized surgical robot and a heart stabilizer developed by our surgeons—results in less chest trauma, less discomfort after surgery, shorter hospital stays, and a faster recovery time than traditional CABG. We are leaders in the use of minimally invasive surgery to perform CABG.
  • Robotic heart surgery. Our teams include experts in the use of totally robotic endoscopic surgery to perform CABG. Robotic heart surgery is a form of minimally invasive heart surgery that uses the more dexterous robotic instruments and a robotically controlled 3D camera to perform surgery through very small incisions—with a degree of precision and visualization that would be difficult or impossible without them.
  • "Off-pump" heart surgery. We can often perform CABG without using a heart-lung machine. With this "off-pump" (also called "beating heart") technique, the surgeon uses a mechanical stabilizing device to restrict the movement of your heart so the surgery can be done while your heart is still beating. Off-pump surgery can reduce the risk of stroke and bleeding associated with coronary bypass surgery in some patients.
  • "Hybrid" heart surgery. Our doctors are developing and evaluating new therapies that combine elements of bypass surgery with interventional cardiology approaches to treating certain patients. This allows some people to receive the benefits of minimally invasive treatment, such as stent placement, along with those of CABG.

Transmyocardial Revascularization for Angina

NewYork-Presbyterian was the first hospital in the greater New York area to have cardiothoracic surgeons trained in transmyocardial revascularization (TMR), a technique that offers relief for people with severe angina. People with reasonably good heart function who are not candidates for traditional angioplasty, stent placement, or bypass surgery and who still have chest pain while taking angina medications are ideal candidates for TMR.

During TMR, your doctor applies a laser device to create multiple tiny channels (about 1 mm in diameter) in areas of the wall of your heart's ventricle that are not receiving enough blood. Tiny new blood vessels that help increase blood flow to your heart grow near these channels. Studies have shown that 70 percent of people with severe angina who were treated with TMR have less pain and a better quality of life.



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