Revascularization is a set of surgical procedures aimed at restoring blood circulation. Impaired blood circulation, partial or total, can be a consequence of coronary syndrome.

Revascularization includes several techniques used to treat coronary syndrome. These are surgical procedures aimed at restoring blood circulation. The alteration of blood circulation can be partial or total. Revascularization has contributed in recent years to improving the quality of life and the length of life of patients suffering from cardiovascular disease. There are different types of coronary syndrome in which revascularization can be used.

Acute coronary syndrome

Acute coronary syndrome is caused by partial or total blockage of an artery. This obstruction is due to the presence of plaques of atheroma, which is a deposit of different elements such as fat, blood, fibrous tissue or lime deposits, on part of the inner wall of an artery. Atheroma plaques are most often the consequences of bad cholesterol, diabetes, tobacco, hypertension or obesity. Sometimes a piece of the plaque breaks off, causing a blood clot to form, blocking the artery. Acute coronary syndrome encompasses two distinct cardiovascular events:

• Angina, or angina pectoris, is the partial obstruction of an artery. The main symptom is pain in the sternum, like a tightness, a vise in the chest. Angina can occur at rest or be caused by exercise or emotion, and go away when resting. It is important to call 15 in both cases;
• Myocardial infarction, or heart attack, is the complete blockage of an artery. The myocardium is the heart muscle responsible for the contraction. The heart attack is felt like a vise in the chest and needs to be treated urgently.

Chronic coronary syndrome

Chronic coronary syndrome is stable heart disease. It may be a stabilized angina pectoris requiring despite any follow-up including treatment of symptoms and prevention to avoid another attack. In 2017, it affected 1,5 million people in France.

In the case of an acute coronary syndrome, doctors will urgently perform revascularization in order to restore blood circulation as much as possible in the partially or completely blocked artery.

In the case of chronic coronary syndrome, revascularization is performed if the expected benefit outweighs the risk for the patient. It can be carried out for two purposes:

• decrease or disappearance of symptoms of angina;
• reducing the risk of a serious cardiovascular event such as infarction or heart failure.

Revascularization can be done by two methods: coronary bypass surgery or angioplasty.

Coronary bypass surgery

Coronary bypass surgery involves creating a bypass in the blood flow to provide the heart with sufficient blood supply. For this, an artery or vein is implanted upstream of the blocked area to allow blood circulation to bypass the obstacle. The artery or vein is usually taken from the patient. The obstructed segment can also be bypassed with a vascular prosthesis.

Angioplasty

Angioplasty involves the introduction of a catheter or small probe into an artery in the wrist or groin. The probe then makes it possible to introduce a small balloon which will be inflated at the level of the obstruction. The balloon enlarges the diameter of the artery and dislodges the clot. This maneuver restores blood circulation once the balloon is removed. In most cases, angioplasty is accompanied by the placement of a stent. This is a small spring that is inserted into the artery to keep it open.

In the case of angina or angina pectoris, revascularization will be carried out within 6 to 8 hours after the obstruction in order to avoid the release of toxins in the area in question and to avoid a possible impact on the queens.

Blood circulation resumes as normally as possible, with a shorter or longer delay depending on the severity of the obstruction. Treatment is put in place to reduce symptoms and prevent the onset of another attack or worsening of the cardiovascular disease. In all cases, regular monitoring by a cardiologist is also recommended.

To limit the risk of a new obstruction, it is important to control the risk factors as much as possible:

• smoking cessation;
• diabetes control;
• control of bad cholesterol;
• balanced arterial hypertension.

The undesirable effects of revascularization depend on the technique used, as well as the nature of the treatment implemented by the cardiologist. If you experience one symptom or another, the most important thing is to talk to the doctor.