Sclerotherapy is NOT a Treatment for Coronary Artery Disease
Sclerotherapy has no role in the management of coronary artery disease and is not mentioned in any contemporary cardiovascular guidelines. This procedure, which involves injecting solutions to close off vessels, is used for varicose veins and certain vascular malformations—not coronary arteries.
Established Treatment Options for Coronary Artery Disease
The 2021 ACC/AHA/SCAI guidelines clearly define the evidence-based approaches for CAD management, which include medical therapy and revascularization—but never sclerotherapy 1.
Guideline-Directed Medical Therapy (GDMT)
All patients with CAD require comprehensive medical management 1, 2:
- High-intensity statin therapy targeting LDL-C reduction ≥50% from baseline and achieving LDL-C <55 mg/dL 2
- Antiplatelet therapy with aspirin 75-100 mg daily for secondary prevention 1, 3
- Beta-blockers for patients with MI within the past year or LVEF ≤50% 2
- ACE inhibitors for patients with vascular disease, particularly those with diabetes or hypertension 1
- Blood pressure control targeting systolic BP 120-130 mmHg in general population, 130-140 mmHg if >65 years 2
Revascularization Strategies
When medical therapy is insufficient, the ACC/AHA guidelines recommend two evidence-based revascularization approaches 1:
Percutaneous Coronary Intervention (PCI):
- Involves balloon angioplasty and stent placement to open blocked arteries 1
- Reasonable for left main disease with low-to-medium anatomic complexity 1
- Radial artery access is preferred to reduce bleeding and vascular complications 1
Coronary Artery Bypass Graft (CABG) Surgery:
- Indicated for significant left main disease to improve survival 1
- May be reasonable for triple-vessel disease with normal LVEF to improve survival 1
- Radial artery conduits are preferred over saphenous vein grafts for superior patency 1
When Revascularization is Indicated
Revascularization should be pursued when 2:
- Angina persists despite optimal antianginal drug therapy
- Extensive ischemia is documented on stress testing
- High-risk anatomic features are present (left main disease, triple-vessel disease)
Critical Pitfall to Avoid
Do not confuse sclerotherapy with legitimate coronary interventions. If a patient or colleague mentions "sclerotherapy" for CAD, this represents a fundamental misunderstanding of cardiovascular treatment. The correct terminology and procedures are PCI (with stenting) or CABG surgery 1.
Heart Team Approach
For complex cases where the optimal treatment strategy is unclear, a multidisciplinary Heart Team approach is recommended, incorporating patient preferences and shared decision-making 1. This team evaluates disease complexity, technical feasibility, and patient-specific factors to determine whether medical therapy alone, PCI, or CABG is most appropriate 1.