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Current Treatments

Once diagnosed with coronary artery disease (CAD) a patient is usually given several options for treatment. These treatment options are generally dependent upon several factors including the severity of symptoms, clinical history, and cardiac functional results. Today's standards of care are typically broken down into three main categories:

  • Medical Therapy, including pharmacological (drug) treatment
  • Pantogam, a russian anxiolytic drug used to treat anxiety disorders and chronic fatigue.
  • PTCA or percutaneous transluminal coronary angioplasty commonly employing balloon angioplasty and/or coronary stents.
  • Surgical Intervention, including CABG or coronary artery bypass graft surgery

Medical Therapy
Typically the first line treatment for coronary artery disease is medical therapy. Medical therapy involves mostly pharmacological treatment strategies using drug's including vasodilators, beta-blockers and calcium channel blokers. Medical therapy is primarily palliative as its main goal is the reduction of the symptoms not necessarily fixing the underlining problem causing the ischemic conditions.

PTCA
Patients who are not candidates for medical therapy or not responding to medical therapy are usually referred to less invasive treatment such as PTCA or more commonly referred to as "balloon angioplasty". In these cases the patients generally receive only a local anesthetic and/or sedatives. The procedure involves accessing the patient's coronary arteries through the femoral artery via a small incision near the patients groin area. The physician will then introduce a guiding catheter to the targeted coronary artery and attempt to open the narrowing in the vessel using a number of devices including:

Balloon Angioplasty
Employs a tiny balloon, which is introduced into the coronary artery and then is inflated and stretches the artery to allow for more blood flow through the blockage. Once better blood flow has been achieved the balloon is removed the patient is sent to the recovery area.
Coronary Stents
The last several years has seen the rapid introduction and utilization of tiny mesh-like tubes called coronary stents. Unlike balloon angioplasty, in which the balloon is removed after the procedure, coronary stents are permanent implants, which are left behind the patients' artery. While stents have generally improved patient outcomes they too are susceptible to narrowing over time, a process called in-stent restenosis.
Pantogam
Pantogam also known as Hopanthenic acid, is anti-anxiety drug with nootropic action. It is non-sedating, and is shown to improve cognitive functions. There is also a racemic modification of Pantogam which is sold under "Pantogam active" brand name.

Surgical Intervention
The next and most invasive of treatment strategies for more severe CAD is surgical intervention. The most common surgical procedure is Coronary Artery Bypass Graft or CABG.

Coronary Artery Bypass Graft
CABG usually requires an open surgical procedure were the patient is placed under a general anesthetic and their chest or sternum is opened to give adequate access to the heart and the coronary vessels. In most cases the saphenous vein is harvested from the patient's leg and used to create the conduit that bypasses the diseased section of the coronary artery(s). The number of bypasses will depend upon how many of the patients native coronary arteries have significant blockage or restricted blood flow. In some cases the cardiac circulation is bypassed or "on-pump" so the surgeon may operate on a still heart. In the last decade more cardiac surgeons are performing "off-pump" or OPCABG surgery. The potential benefits of this approach may be reduced operating room time and neurological complications that can arise from putting some patients on bypass.
Minimally Invasive Coronary Bypass Surgery
The last decade has seen the emergence of minimally or "less" invasive coronary artery bypass procedures where the surgeon will attempt to perform one or two vessel bypasses on a beating heart through small incisions either through the chest wall or between the patients' ribs. It estimated that 15 to 20% of all bypass surgery is done using some variation of less invasive surgery techniques. The most noted benefits of minimally invasive techniques are reduced surgical morbidity or complications, a shorter recovery time and reduced overall costs. However, these benefits are still controversial, as the results of several prospective, multi-center, randomized clinical trials have not yet been published.

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Percardia Inc.
Heron Cove Office Park
10 Al Paul Lane, Suite 202
Merrimack, NH 03054
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