-- Question: What is 'small vessel disease' and how is that treated?
Answer: Well, Small Vessel Disease is a specific type of disease of the coronary arteries -- the arteries that nourish the heart -- in which there are not large areas of blockage. That's the most common type, but rather, the entire coronary, or large portions of it, are diffusely narrowed over a longer span.
Diabetics, for example, are particularly prone to this type of problem because there's not one or two or three single areas of blockage. Generally that means that such patients will not do well with a simple balloon angioplasty procedure. If angioplasty needs to be done, they may need multiple angioplasties, and that's usually not going to be the case with patients in this disease category.
So that leaves really two options. One is bypass surgery -- same problem. If you put a jump bypass into the vessel, if the vessel downstream is also narrowed for a continued length, then that bypass operation may not really be as effective as it would be if there was a single area of blockage upstream.
So, most patients with Small Vessel Disease wind up being treated with medication over the long haul. In particular, we focus on trying to change lifestyle, trying to reduce the risk factors for further development of the blockages in the coronary arteries -- things like stopping smoking, controlling blood pressure, staying on a good diet, and if necessary, being on medication to control such things as blood pressure and cholesterol and the other blood fat abnormalities that many of these patients have. If the patient is diabetic, then of course good treatment, good control of the diabetes is also an important part of therapy.