Peek Into the Playbook — Understand How Doctors Treat Clogged Arteries March 13, 2025 If you are like most people, you don’t know if you have coronary artery disease (CAD). CAD occurs when fatty deposits, or plaque, build up in the arteries that supply oxygen-rich blood to the heart muscle. This plaque can form blockages within the artery, restricting the flow of blood and oxygen to the heart muscle. These blockages can lead to symptoms such as chest discomfort or shortness of breath. “Coronary artery disease may go undetected for several years,” said William Stoutt, DO, who specializes in cardiovascular disease and interventional cardiology at Samaritan Cardiology – Corvallis. “It is usually not until symptoms arise that coronary artery disease is diagnosed. However, symptoms of CAD can vary quite a bit from person to person, so it’s not always easy to recognize.” There are a variety of ways to diagnose CAD, including blood tests, electrocardiograms, CT scans, stress tests, MRI, and more. If early tests suggest the presence of CAD, a coronary angiogram—special imaging that uses X-rays to visualize the coronary arteries—may be recommended for further evaluation. Cardiologist Considerations Extent of CAD When determining the best treatment approach for coronary artery disease (CAD), cardiologists consider several factors, including the number of blockages present, the number of affected arteries, the location of the blockages, and the type of blockage (such as a heavily calcified one). Urgency of Symptoms Patients with stable blockages typically experience stable symptoms and do not require urgent intervention. However, rapidly progressing symptoms can indicate an unstable blockage, which demands more immediate attention—especially if there is evidence of heart muscle injury, such as in the case of a heart attack. Personal Factors Other personal factors that may influence treatment decisions include a patient’s overall health, such as the presence of kidney disease, diabetes, stroke risk, bleeding risk, and age. Additionally, if future medical procedures are anticipated, this can also affect the treatment plan. Treatment Options Common options for a patient diagnosed with CAD include the following: Medication Management/Lifestyle Changes “For all patients with coronary artery disease, we recommend medications and healthy lifestyle changes,” said Dr. Stoutt. Medications will typically include a blood thinner (such as aspirin) and a cholesterol-lowering drug (such as a statin). These treatments, along with lifestyle changes, can help reduce the risk of disease progression and heart attack. In addition, medications may be effective in controlling angina (chest discomfort caused by coronary artery blockages). For patients with stable coronary artery disease, a combination of medications and lifestyle changes may be a sufficient treatment strategy. Stents A stent is a small wire mesh tube inserted into an artery to reopen a blockage. Stents are typically used to treat blockages that narrow the artery by 70% or more. Stents are often preferred in cases where coronary disease is less complex. Stents are also commonly used in emergency situations, such as a heart attack caused by a completely blocked artery, where restoring blood flow quickly is crucial. “If we are performing an invasive angiogram and notice the issue can be fixed without much added risk, we will often place a stent during the procedure,” said Dr. Stoutt. Coronary Artery Bypass Graft (CABG) In cases where CAD is more complex, coronary bypass graft surgery (CABG) may be the preferred treatment. This is typically recommended when multiple blockages are present across multiple arteries or when stenting poses a high risk. Coronary artery bypass graft surgery is a type of open-heart surgery where an artery (usually within the chest or taken from the arm) or vein (commonly taken from the leg) is used to reroute blood around the coronary artery blockage. However, not all patients are candidates for open-heart surgery. In these cases, more complex and higher-risk stenting procedures may be considered as an alternative. CAD Is Largely Preventable Stents and CABG do not fix the underlying conditions that lead to CAD. Healthy lifestyle choices and the right medications are essential in reducing your risk of needing future procedures. “Smoking, high blood pressure, high cholesterol, diabetes, and obesity are all associated with the development of coronary artery disease. Appropriately addressing each of these risk factors can do wonders for coronary artery disease prevention,” said Dr. Stoutt. Read more about your heart health. You can also learn about Samaritan’s heart program at samhealth.org/Heart.
