Coronary Artery Disease | Miami Cardiac and Vascular Institute
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Coronary Artery Disease

Miami Cardiac & Vascular Institute provides coronary artery disease screening, diagnosis, prevention and treatment services. Our physicians work with you to help you manage and treat the disease before it has serious consequences. Our goal is to improve your health and quality of life.

Minimally Invasive Treatments

The Institute offers a number of minimally invasive treatments including:

Angioplasty. Physicians may perform percutaneous (“through the skin” using a needle) intervention to open a narrow or blocked artery. This procedure involves insertion of a thin catheter into the area of blockage. Next, the physician opens and closes a tiny balloon. This procedure compresses plaque against your artery wall and restores blood flow.

Stents. Often in combination with angioplasty, Institute physicians may place a stent - a tiny device that supports the artery wall from the inside. Stents strengthen and keep open a previously blocked or narrowed portion of the artery to maintain blood flow.

Total Chronic Occlusion Treatment. People with coronary artery disease can develop a complete blockage (total occlusion) in a coronary artery. When fatty material and plaque restrict all or nearly all blood flow through your artery for at least three months, doctors consider it chronic. Treatment includes traditional coronary artery bypass surgery. In addition, some people are candidates for percutaneous coronary intervention. An interventional cardiologist makes a small incision in your groin or arm and guides a catheter to the precise location of the blockage. The catheter contains a stent, balloon or grinding instrument to clear the blockage and restore blood flow.

Rotablator Plaque Removal. You might develop blockages in your arteries that are too hard or calcified to treat with balloon angioplasty. In these cases, Institute physicians might recommend rotablation. The Rotablator (Boston Scientific Corp.) is a tiny drill with a burr on the end coated in diamond dust. The device is designed to break apart the plaque without damaging the artery wall. The tiny pieces of plaque can be safely carried away in your bloodstream. This treatment allows blood to flow again through your artery and supply your heart with oxygen and vital nutrients.

Surgery Options

The Institute also offers multiple heart surgeries for coronary artery disease, including:

Coronary artery bypass grafting (CABG). A cardiac surgeon creates a detour around a narrow or blocked portion of your artery by attaching a blood vessel taken from somewhere else in your body. Institute surgeons can perform both on and off pump surgery – meaning with or without the support of an external machine to pump your blood during the procedure.

Beating-Heart and Bloodless Surgery. Surgery can be performed on a portion of your heart while it’s still beating. This means your heart continues to pump blood to the heart muscle during surgery. Beating-heart surgery avoids some potential complications associated with stopping the heart for traditional bypass surgery.

Bloodless heart surgery is an operation without blood transfusions. Patients unwilling to accept blood products (for religious or other reasons) might be candidates. Special preoperative and postoperative care is required. Institute cardiac surgeons employ special techniques during this heart surgery to minimize blood loss.

Heart Attack Unit

Rapid Response Saves Lives
When a heart attack strikes, time is not on your side. The American Heart Association recommends an angioplasty procedure to open blocked heart vessels within 90 minutes of a patient’s arrival in the emergency room. The 90-minute goal to start treatment is based on guidelines from the American College of Cardiology and the American Heart Association. In addition, the Miami-Dade STEMI (ST-elevation myocardiac infarction) Network goal is door-to-balloon time in 60 minutes or less. Miami Cardiac & Vascular Institute is among the top 10 percent of hospitals nationwide to meet and exceed this standard. The Heart Attack Units at Miami Cardiac & Vascular Institute consistently provides treatment for heart attack patients in less than 60 minutes.

The care team at Miami Cardiac & Vascular Institute encourages all patients and their family members to learn more about conditions and diseases that affect the heart and overall cardiovascular system. The links below provide more information about coronary artery disease.

Atherosclerosis
Atherosclerosis is a type of thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery.

Coronary Heart Disease
Coronary heart disease occurs when cholesterol builds up within the walls of the heart’s arteries (coronary arteries), forming what is called plaque.

To help in the diagnosis of your coronary artery disease, your physician may request that you have one or more of the following tests:

  • Heart CT (computed tomography) with iCT 256 slice scanner
  • MRI (magnetic resonance imaging)
  • Magnetic resonance angiogram
  • Cardiac catheterization
  • Angiography
  • Blood flow studies
  • Echocardiography and transesophageal echocardiography (TEE)
  • Exercise stress test

Following diagnosis, Institute physicians will recommend a specific treatment for you depending on a number of factors, including your age, overall health and the progression of your coronary artery disease. For example, medication and lifestyle changes may be recommended for early-stage disease or in combination with other treatments.

Miami Cardiac & Vascular Institute clinical trials advance coronary artery disease diagnosis and treatment for our present and future patients.

Acute Coronary Syndrome (Coronary Artery Disease)

ABSORB Randomized Controlled Trial – Clinical Evaluation of the Absorb™ Bioresorbable Vascular Scaffold (BVS) in the Treatment of Subjects with De Novo Native Coronary Artery Lesions Principal Investigator: Ramon Quesada, M.D. (Active Enrollment)
Co-investigators: Jonathan Roberts, M.D., Ramon Lloret, M.D., Marcus St. John, M.D.

BioFreedom US IDE Feasibility Trial-
To collect additional safety and effectiveness data on the Biosensors BioFreedom™ BA9 Drug Coated Coronary Stent in patients with native, de novo coronary artery disease. Principal Investigator: Ramon Quesada, M.D. (Active Enrollment)
Co-investigators: Jonathan Roberts, M.D., Ramon Lloret, M.D., Marcus St. John, M.D.

CARES, Cardiac Arrest Registry to Enhance Survival
The CARES Program is a collaborative effort of the Centers for Disease Control and Prevention (CDC), the American Heart Association (AHA) and the Emory University Department of Emergency Medicine. CARES is an ongoing model national out-of-hospital cardiac arrest surveillance registry that is capable of identifying and tracking out-of-hospital cardiac arrest events in a defined geographic area. Because CARES is a registry, not a research database, there is technically no specific study hypothesis, but the ultimate goal of CARES is to improve survival from sudden cardiac death. The registry is designed to help a community identify who is affected, when and where cardiac arrest events occur, which elements of the system are functioning properly and which elements are not, and how changes can be made to improve cardiac arrest outcomes. Principal Investigator: John Braden, M.D.

Graftmaster RX Coronary Stent Graft
Graftmaster Rx Stent Graft is a humanitarian-use device indicated for the treatment of free perforations, defined as free contrast, extravasation into the pericardium, native coronary vessels or saphenous vein bypass grafts > or equal to 2.75 mm in diameter.
Principal Investigator: Daniel Krauthamer, M.D.
Physician-User: Romeo Majano, M.D., Eric Schroeder, M.D., Rajesh Dhairyawan, M.D., Roger Galvez, M.D., Jaime Ghitelman, M.D., and Stratego Castanes, M.D.
***Not Research (Humanitarian Device)

IMPROVE IT Study
A multicenter, double-blind, randomized Study to Establish the Clinical Benefit and Safety of Vytorin (ezetimibe /simvastatin vs. Simvastatin Monotherapy in High-risk Patients Present with Acute Coronary Syndrome.
Principal Investigator: Theodore Feldman, M.D. (Active but enrollment closed)

Antiplatelet Therapy:

DAPT Study: A prospective, multi-center, randomized, double-blind trial to assess the effectiveness and safety of 12 versus 30 months of dual antiplatelet therapy (DAPT) in subjects undergoing percutaneous coronary intervention (PCI) with either drug-eluting stent (DES) or bare metal stent (BMS) placement for the treatment of coronary artery lesions.
Principal Investigator: Ramon Quesada, M.D. (Active Follow-up)
Co-investigators: Marcus St. John, M.D., Dean Heller, M.D., Rajesh Dhairyawan, M.D.

Congestive Heart Failure

ISCHEMIA-
Primary objective is to determine whether an invasive (INV) strategy of routine early cardiac catheterization with intent for optimal revascularization in addition to optimal medical therapy in patients with stable ischemic heart disease (SIHD) and at least moderate ischemia on stress imaging reduces the incidence of the composite of cardiovascular death or nonfatal myocardial infarction compared with a conservative (CON) strategy of optimal medical therapy alone with cardiac catheterization and revascularization reserved for patients with refractory angina, acute coronary syndrome, acute ischemic heart failure or resuscitated cardiac arrest.
Principal Investigator: Ramon Quesada, M.D.

Co-investigators: Marcus St. John, M.D., Bernardo Lopez-Sanabria, M.D., Jonathan Roberts, M.D., Alvaro Gomez, M.D., Ramon Lloret, M.D. (Active Enrollment)