Issues in Angioplasty and Bypass Surgery

Bypassing Angioplasty

When it comes to heart disease, surgical intervention is expensive, invasive, and largely ineffective.

Studies show that traditional surgical interventions, such as angioplasty with stent placement and coronary artery bypass grafting (CABG) do not benefit stable patients. These treatments target stable plaques that is not in danger of rupturing to form a clot and ignore the dangerous, unstable plaque that doesn’t show up in tests.

For years, doctors thought that the main cause of heart attacks was the buildup of fatty plaque. They believe that over time the vessel would become so narrow that flow would be compromised, and eventually the vessels would close up or be clogged.

Now we know that the facts are much different. Most of the large clots that create heart attacks occur in parts of the heart where the arteries are not severely narrowed. Instead, they occur in areas where the plaque is soft and has a thinner cap, sitting on an unstable, cholesterol-laden base. The propensity of plaque to rupture and create a complication or infarct depends on two other important criteria: the tensile stress (destabilizing pressure) on the fibrous cap, and the amount of inflammatory white blood cells that have infiltrated the lipid segment.

The older, more stable plaques are larger and more likely to obstruct blood flow, leading to angina. Those are the plaques typically treated with angioplasty and stenting, yet they are not vulnerable plaques and not likely to initiate a clot that can cause an infarction.

Now we know that a certain type of plaque and a certain type of biochemical event most often trigger a heart attack. These plaques are often not visible to conventional cardiac testing, such as stress tests and angiograms, because they do not obstruct blood flow, or impinge on the vessel lumen sufficiently to be visualized by such tests.

Plaque can become stable with dietary excellence, and it can become unstable relatively quickly with dangerous eating. It is the more recently deposited, and more recently modified, plaque, resulting from eating dangerously, that can create vulnerable plaque and make semi-vulnerable plaque more vulnerable, precipitating a cardiac event.

Angioplasty and bypass surgery do not address or fix the vulnerable plaque in a person’s coronary circulation. These procedures address the least dangerous (old) plaque and therefore have no effect on reducing the risk of future cardiac events. However, eating carefully can immediately make plaque less vulnerable by reducing inflammatory cells, reducing soft plaque, and reducing tensile stress. Superior nutrition stabilizes both the base of the plaque, to keep it from rupturing, and the cap of the plaque, to keep it from cracking.

Coronary artery bypass grafting (CABG), commonly known as heart-bypass surgery, is the most common heart surgery in the United States. A healthy artery or vein is connected to the obstructed coronary artery creating a new path for the blood to flow to the heart muscle. The blood bypasses the obstructed vessel, with a resulting relief in angina.

The serious risks of CABG include an increased risk of stroke and overall death rate compared with percutaneous coronary intervention (PCI) (or angioplasty with stent placement), loss of mental function in the elderly, atrial fibrillation, and other more unusual events, such as failure of the sternum to close properly after surgery.

Percutaneous coronary intervention is a nonsurgical procedure during which the physician feeds a thin flexible tube, or catheter, from the groin or arm into the heart. The catheter has a deflated balloon on the end, and when the tube reaches the blockage, it is forced though. The balloon is then inflated to open the artery, allowing blood to flow better. Then a stent, or short metal wire tube, is placed to prevent the stretched vessel from closing up again quickly.

The most serious risks of PCI include death, heart attack, stroke, ventricular fibrillation and aortic dissection. Ons study showed that 1.2 patients out of every 100 died in the hospital undergoing PCI.

The tactic of using surgical intervention as a substitute for a healthy diet is doomed to fail. Whenever CAD is present and surgical intervention occurs, the vast bulk of plaque is still left untreated. Atherosclerosis is a dietary-induced disease that spreads throughout the heart, not only in those areas visualized by angiograms. The vast majority of patients who undergo these interventions do not have fewer new heart attacks or live longer.

The procedures themselves expose patients to more risk of new heart attack, strokes, infection, encephalopathy (disease in the brain), and death. Angioplasty, with or without stenting, also damages the treated blood vessel. It increases inflammation in the treated vessel and raises levels of C-reactive protein, which creates restenosis and increases the risk of recurrent coronary events. Restenosis is more resistant to regression with nutritional approaches than native atherosclerosis.

Once an individual has a stent placed that foreign body in the vessel wall increases inflammation at the edge of the stent. This can enhance the potential for the treated area to generate a clot, leading to a future heart attack.

These medical interventions do not address the cause of the disease; they treat only the symptoms-an approach that lessens pain for a limited period.

Getting tested and treated for coronary obstructive disease won’t help. Individuals without major blockages of their great vessels are just as likely to have a fatal cardiac event as those with more significant blockages. Nd yet, stress tests and angiography don’t even show these individuals as having heart disease. Stress tests identify only those blockages that obstruct more than 85 percent of the vessel lumen.

70-80 percent of all myocardial infarctions are caused by plaques that is not obstructive or visible on angiography or stress tests.

If you just have high blood pressure and high cholesterol and are overweight or diabetic, we recommend aggressive nutritional intervention and an exercise program customized to your fitness level and tolerance.

If you have symptoms suggestive of angina with exertion, then we recommend you also use aggressive nutritional intervention to reduce the plaque burden and stabilize the plaque so that it doesn’t form a clot. You should monitor your blood pressure and undergo blood tests. We also recommend that you get a noninvasive test to monitor heart output and wall motion, such as a cardiac ultrasound along with a carotid ultrasound, with can include measurements of the intima-media thickness, as well as an accurate determination of body fat to monitor the lowering direction of plaque burden and body fat stores.

Even if someone has chest pain with light exertion, with documented left main disease (disease in the left main coronary artery) with a reduction in ejection fraction, we still recommend nutrition as the primary treatment in a stable patient. This is because my experience has shown that in two or three months, ejection fraction can improve dramatically and angina can already be significantly improved. I do not recommend angiography and stenting or bypass unless acute coronary syndrome is present, worsening ejection fraction on repeat ultrasounds is demonstrated, or ventricular arrhythmias are severe or worsening. There is an emergency diet approach in chapter 8 that starts patients with serious disease on an aggressive dietary intervention for maximizing results.

All the symptoms of heart disease, as well as blockages, can melt away with superior nutrition – without any cardiac intervention. The risks and complications of cardiac interventions and bypass surgeries are simply not necessary when people adopt an effective nutritional strategy. Instead of prescribing drugs and recommending expensive and invasive medical procedures, doctors need to educate themselves and then educate and motivate patients to take charge of their own health.