Now let’s look at a slightly different angle. Because Dr. Schaeffer doesn’t consider Bigger’s condition immediately threatening, and because Bigger is a cooperative and smart patient, the doctor has decided to begin treatment with methods that aren’t invasive. If after a few months the improvement isn’t what Dr. Schaeffer has hoped for, he still has several resources he can turn to instead of surgery. Remember that coronary disease means that the arteries are dogged and therefore the heart isn’t getting enough oxygen-rich blood. Whatever the treatment, it must address that basic problem. In the case of a patient for whom exercise, diet, and stress- relief measures don’t bring about the necessary improvements or stability, there remain several options for nonsurgical treatment. These include angioplasty, stenting of an artery, and atherectomy.

Angioplasty

The most common of the treatments we’ve named is angioplasty. It’s an outpatient procedure-that is, you usually go home the same day the procedure is performed or the next morning-pc formed by a cardiologist, in the cardiac catheterization lab 0= hospital.

The procedure itself begins with the insertion of a sn: wire, called a catheter, into the blocked coronary arteries. A c. loon is attached to the end of the catheter and the catheter advanced into the arteries that surround the heart. The cardio. gist can monitor the progress of the catheter on a TV sere called a fluoroscope. With the heart and the blood vessels t. surround it always in view, the cardiologist steers the balloor; the center of the blocked artery. Then the balloon is infla.. causing the blocked vessel to reopen.How does the catheter find its way to the blood vessels of the heart? \Nell, it’s a little bit like following the yellow brick road. The catheter is inserted in any large blood vessel-usually in the groin area-that leads to the heart. From there, the catheter just follows the path back to the heart.
Angioplasty is usually recommended for patients who have one, or sometimes two, severely blocked coronary arteries. It is also performed in situations where, for whatever reason, heart surgery is considered dangerous or impractical. Generally, angioplasty is painless and straightforward. The patient is mildly sedated with a local anesthetic (that is, the area to be treated is numbed, just as it is in your dentist’s office). Angioplasty is a common procedure, performed in university hospitals, teaching hospitals, and community hospitals all over the country.
Naturally, in this treatment as in all medical treatments, there can be a downside. In this case, the risk is that the blood vessel that’s been opened can close again, or the blood vessels can tear open (rupture). You can playa significant part in raising your odds of having a successful procedure by finding out as much as you can about the product,
which, in this case, is your doctor’s competence and experience, and the reputation of the hospital in which the procedure will be performed.
You need to ask your doctor how many angioplasties he or she has done and the success rate of these procedures. Don’t be embarrassed. You have an absolute right to know. So ask the following questions, politely but firmly, and expect answers:

•    How many angioplasties have you personally perform- .
•    In what percentage of the angioplasties you perform d
the arteries close again?
•    What is your success rate?
•    What happens if the angioplasty doesn’t work?
•    What complications are possible, and how do you deal
with them?

Most well-trained board-certified cardiologists will have no tr: ble answering these questions freely and openly. If your docto: defensive, refuses to answer your questions, or seems offended, t should raise a red flag. You need to what you can to keep the commun.: tion going, and that means asking: questions again, if necessary, in most friendly and unthreatenin~ ” you can. If you still don’t get a satisf: tory response, you’d be wise to ref the procedure with that particular c. diologist. You can find a better more open to his or her patients, more likely to win your cor dence. You want no less. After all, next to God, the cardiologis: the person who will carry your life in his or her hands.

Stenting

A second nonsurgical procedure for opening blockages in a y;; sel, and which is used in conjunction with angioplasty, is stenti A stent is a very small coil that keeps a blood vessel open once has been cleared by angioplasty. The cardiologist first locates t. “culprit” artery-the one where the trouble is. He or she opens that vessel with an angioplasty procedure. The cardiologist then inserts the stent. It’s that simple. Although the results vary, depending on the extent of the damage and on the cardiologist’s experience, in general, angioplasty with stents works even better
than angioplasty alone.

Atherectomv

Finally, your cardiologist may suggest, rather than angioplasty or stenting, a procedure called atherectomy. Here, a small device is inserted into the blocked artery and cuts through the blockage. Atherectomy is only performed by the most experienced cardiologists and, in general, it’s less effective than angioplasty or angie-
plasty with a stent.

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