Coronary Artery Disease - Treatment

Treatment of Coronary Artery Disease

A combination of approaches is typically used to treat coronary artery disease, including lifestyle changes, medications, interventional procedures, and surgery. The type of therapy chosen depends on several factors: the extent of cardiovascular disease, the severity of symptoms, the patient’s age, and the presence of other medical conditions.

Lifestyle changes

Changes in lifestyle can slow the progression of coronary artery disease. We recommend that patients quit smoking, control their diabetes, lower their blood pressure, check their cholesterol levels, exercise, eat a balanced diet, maintain a healthy weight, and manage their stress.

Medications

Various medications can be used to treat coronary artery disease, including cholesterol-lowering drugs, aspirin, beta blockers, nitroglycerin, ACE (angiotensin-converting enzyme) inhibitors, and calcium-channel blockers. 

Coronary Artery Bypass Surgery (CABG)

If several coronary arteries have significant obstructions, coronary artery bypass graft (CABG) surgery may be needed. In CABG surgery, blood vessels taken from another part of the patient’s body (the chest, arm, or leg) are used to reroute, or “bypass,” blood around the clogged arteries, thereby improving the flow of blood and oxygen to the heart. Studies show that arterial grafts last longer and improve long-term survival, compared to vein grafts. At NYU Langone Medical Center, nearly all CABG patients receive one internal mammary artery graft, and many receive a second internal mammary artery graft or a radial artery graft (taken from the arm).

Minimally Invasive Coronary Bypass Surgery

Whenever possible, CABG surgery at NYU Langone Medical Center is performed using minimally invasive techniques. Our staff is experienced with all minimally invasive techniques, including MID-CAB (minimally invasive direct coronary artery bypass) surgery, port-access (“keyhole”) surgery, and robotic surgery.

We also offer OP-CAB ( off-pump, or beating-heart, surgery). In traditional CABG surgery, the heart is stopped and connected to a heart-lung machine (which oxygenates the blood and pumps it around the body), allowing the surgeon to operate on a stationary surface. To reach the heart and connect the heart-lung machine, the surgeons makes an incision in the chest and then divides the breast bone — the most traumatic aspect of the operation.

Today, it is possible to perform CABG surgery without putting the patient on the heart-lung machine. In off-pump surgery, certain areas of the heart are immobilized with cardiac stabilizers, allowing the surgeon to operate while the heart is still beating. Studies (including a study conducted by physicians at NYU Langone Medical Center and the Veterans Administration) show that off-pump surgery is advantageous for patients at high risk for complications from heart-lung bypass, including those with vascular disease, a history of stroke or transient ischemic attacks, heavily calcified aortas, carotid artery stenosis, and heart or kidney problems, and those over age 70.