For those in whom clot-busters and stents have not worked, there is the Coronary Artery Bypass Graft (CABG), or ‘cabbage’ – although doing a cabbage in an acute situation is pretty much the last resort of last resorts. Or TOTS, which stands for Tatties Over The Side (a tatty is a potato), a reference to the point in a storm when the crew has to ditch the very last bit of cargo to save the ship.
Ergo, a CABG in an acute MI, when clot-busters or angioplasty has not worked, is TOTS time. You see, the jargon is quite simple once you get the hang of it. Quite how much impact all of this cleverness has had on overall mortality rates from having a heart attack is a moot point. Around fifty per cent of people die before reaching hospital, so they can not be saved.
Another forty per cent, or so, were always going to survive no matter how badly the hospital cocked up. So, at very best, these techniques can improve survival after a heart attack by about ten per cent, and we are nowhere near achieving this yet. Perhaps two or three per cent more people survive a heart attack now than about ten or twenty years ago. Do not get me wrong.
If I had a heart attack I would want a cardiologist warming up the cath lab, ready to stick a stent right up the old femoral artery. No question about it. Nothing but the best for me, thank you very much. But when it comes to heart attacks, cure is always going to be very much less impressive than prevention.
Even if it is much less sexy. Before we move on, I need to provide a little more information about ‘infarctions’ elsewhere in the body. Because although plaques most often develop in the arteries supplying blood to the heart (coronary arteries), plaques are perfectly capable of developing elsewhere in the body too. Quite often, big plaques form in the arteries in the neck (carotid arteries).
As these arteries supply blood to the brain, this is clearly a danger spot. However, the carotid arteries very rarely block completely. What most often happens is that a clot forms over the carotid plaque, then a bit breaks off and travels up into the brain through ever-smaller arteries. Once the clot reaches an artery that is too narrow for it it gets stuck. and this dams up blood supply to an area of the brain, leading to a cerebral (brain) infarction.
This is the commonest version of a stroke: The other type of stroke occurs when an artery in the brain bursts, causing a bleed into the brain tissue. This is called a cerebral haemorrhage.