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Coronary Artery Disease

Coronary artery disease (CAD) involves narrowed, blocked or damaged blood vessels that supply your heart with blood. Deposits of fat and cholesterol plaque, inflammation and weakening of the artery walls are the leading causes of coronary artery disease.

  • Aneurysm occurs when a weakened part of a blood vessel expands like a balloon. If an aneurysm gets large enough, it may burst.
  • Atherosclerosis is a gradual buildup of fat and cholesterol plaque in your arteries that can restrict or completely block blood flow.
  • Chest pain (angina) is your heart muscle's way of warning you that it is not getting enough blood and oxygen. This can be triggered by exertion (although you may have angina at rest), emotional distress or excitement, eating a large meal or extreme temperatures.
    Related reading: Is it heart burn…or a heart attack
  • Heart attack or myocardial infarction (MI) occurs when the blood supply to part of the heart muscle is stopped. That area is not able to do its job and permanent damage to your heart can occurs.

Many of the causes of coronary artery disease can be prevented by embracing a heart-healthy lifestyle.

Treatments we offer for coronary artery disease

Gundersen's team of heart specialists can help you modify your risk factors for coronary artery disease (CAD) and medical management:

  • Lifestyle changes, such as increases in physical activity, tobacco cessation, stress reduction and a heart-healthy diet.
  • Medications may include aspirin therapy, beta-blockers, cholesterol lowering agents (statins), nitroglycerin and possibly anticoagulants (blood thinners).

When your CAD can no longer be managed well, one or more of these procedures may be your next best option:


Angioplasty improves blood flow to your heart. A catheter with a balloon at its tip is put into your blocked or narrowed vessel. The balloon is expanded to open the blocked blood vessel and the catheter and balloon are then removed. In some cases, a stent is used to keep the vessel from re-narrowing.


Rotoblator is used to remove calcified or hardened plaque that is blocking an artery and the blood supply to the heart. A diamond-tipped burr, called a rotoblator, is inserted using a catheter. An abrasive burr near the tip of the catheter grinds the plaque into small particles that float harmlessly away in the bloodstream. This procedure is usually followed by stent placement.


Stents are tiny, expandable tubes made of metal mesh. They can be placed and expanded to fit the size, shape and bend of the artery. The stent remains in the artery after the procedure to help keep the artery open. Over time, the artery wall heals around the stent. There are two kinds of coronary artery stents:

  • Uncoated bare-metal stent
  • Drug-eluting stent coated with a special drug and polymer to help reduce the chance of the artery becoming blocked again. The drug is released from the stent over a period of time when re-blockage is likely to occur.

Coronary artery bypass graft (CABG)

Coronary artery bypass graft (CABG) is used to create a detour or "bypass" around the blocked part of a coronary artery to restore the blood supply to the heart muscle. The surgery is commonly called a coronary artery bypass graft, or CABG (pronounced "cabbage").

Minimally invasive cardiac surgery coronary artery bypass graft (MICS-CABG)

Minimally invasive cardiac surgery coronary artery bypass graft (MICS-CABG) is a technique used to perform heart bypass (coronary artery bypass grafting or CABG) through a small incision between the ribs, without having to cut open the chest as is done with traditional open heart surgery. It offers many advantages:

  • It's as safe and effective as traditional bypass operation
  • Less pain, blood loss and scarring
  • Shorter hospital stay
  • Easier recovery with restrictions lifted sooner (2-4 weeks instead of 6-8 weeks with traditional open heart surgery)
  • Cardiac rehabilitation can begin sooner
Gundersen heart surgeon Prem Rabindra, MD, and his team now routinely perform the MICS-CABG whenever possible. Gundersen is one of only a handful of places in the country performing up to quadruple bypasses using this minimally invasive surgery technique through a three- to four-inch incision between the ribs.

Aortic surgery

The aorta is the major artery that carries blood from the heart to the rest of the body. Diseased or damaged aortic tissue or an aneurysm may require an endovascular repair (a repair done from within the vessel) using a stent-graft. A stent graft is a fabric tube supported by metal wire stents (also called a scaffold) that reinforces the damaged spot in the vessel. With the passage of time the body deposits its own tissue to the graft. The durability of these grafts exceeds the human life span.

  • Aortic dissection occurs when the inner layer of the aorta's artery wall splits open (dissects). This is more likely to occur where pressure on the artery wall from blood flow is high.
  • Aortic aneurysm is a bulge in a blood vessel, much like a bulge on an over-inflated inner tube. This can happen if the wall of the aorta becomes weakened by a build-up of fatty deposits called plaque or from chronic uncontrolled high blood pressure.

Intra-aortic balloon pump (IABP)

An intra-aortic balloon pump (IABP) helps your heart pump more blood and may be used to allow your heart to rest and recover after a heart attack or prior to and during open heart surgery. The device consists of a catheter with a long balloon at its tip (intra-aortic balloon or IAB). The catheter is attached to a computer console that inflates and deflates the balloon at the proper time during your cardiac (heart) cycle. The IABP allows blood to flow more easily and allows your heart to pump more blood with each contraction.

Transmyocardial revascularization (TMR)

Transmyocardial revascularization (TMR) helps reduce the pain of chronic angina. Generally, the best treatment for chronic angina is heart bypass surgery, but for some patients, this may be too risky. With TMR a laser is used to make tiny channels through the heart muscle and into the heart's main pumping chamber (the left ventricle). Then when oxygen-rich blood enters the left ventricle, some of that blood flows through the channels to deliver much-needed oxygen to the heart muscle.

Enhanced external counter pulsation (EECP)

Enhanced external counter pulsation (EECP) is used to control chronic angina. During EECP, compression cuffs inside special pants inflate and deflate in a wave-like motion up your legs to your waist, timed to your heartbeats. The heart's efficiency improves as the waves of compression assist your heart in pumping blood throughout the body.

Why choose Gundersen?

  • Experience - Gundersen has the largest and most comprehensive heart program in the Tri-state Region, providing a full range of exceptional heart care for patients of all ages.
  • Gundersen's Priority One Heart Attack Program - A team approach is used to quickly assess, stabilize, transport and treat heart attack patients within 90 minutes of their first medical contact anywhere in our 19-county service area—well below the national average.
  • World renowned heart surgeons - Our surgeons are skilled in a variety of procedures for the treatment of cardiovascular disease. Gundersen is one of only a few hospitals to offer minimally invasive heart bypass surgery on up to four vessels in a single procedure or in combination with valve surgery.
  • Cardiovascular Prevention Clinic - This clinic specializes in the prevention, early detection, treatment and management of cardiovascular problems.
  • Calcium scoring - This screening test helps determine the presence, location and thickness of calcified plaque in the arteries—an indication of coronary artery disease. Calcium scoring helps measure the extent of CAD and your risk for a heart attack or stroke.
  • Research and clinical trials - Dedicated to continually improving care, our heart specialists participate in national and international research studies. We also participate in many clinical trials giving you access to cutting-edge treatments.
  • Outreach and telemedicine services - Gundersen heart specialists provide cardiology and cardiothoracic surgery services closer to home for many patients via telemedicine and outreach in a dozen locations throughout our service area.
  • Cardiac rehab and exercise programs - Gundersen's Exercise Physiology team helps you after heart surgery, heart attack or other heart problems. Cardiac rehab includes medically supervised activity, ongoing monitoring, and education about risk factor modification and heart-healthy lifestyle. With a combination of exercise, education and socialization, we help you achieve and maintain your highest level of function, health and independence.
  • Diagnostic, testing and cardiac imaging services - Gundersen offers a variety of services to help diagnose, evaluate, treat and monitor coronary artery disease, such as:
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