Coronary Angioplasty (cont.)
What are the complications of PCI?
PCI, using balloons, stents, and/or atherectomy can achieve effective relief of coronary arterial obstruction in 90% to 95% of patients. In a very small percentage of patients, PCI cannot be performed because of technical difficulties. These difficulties usually involve the inability to pass the guide wire or the balloon catheter across the narrowed artery segments. The most serious complication of PCI results when there is an abrupt closure of the dilated coronary artery within the first few hours after the procedure. Abrupt coronary artery closure occurs in 5% of patients after simple balloon angioplasty, and is responsible for most of the serious complications related to PCI. Abrupt closure is due to a combination of tearing (dissection) of the inner lining of the artery, blood clotting (thrombosis) at the balloon site, and constriction (spasm) or elastic recoil of the artery at the balloon site.
To help prevent the process of thrombosis during or after PCI, aspirin is given to prevent platelets from adhering to the artery wall and stimulating the formation of blood clots. Intravenous heparin is given to further prevent blood clotting; and combinations of nitrates and calcium blockers are used to minimize vessel spasm. Individuals at an increased risk for abrupt closure include:
- women,
- patients with unstable angina, and
- patients having heart attacks.
The incidence of abrupt occlusion after PCI has declined dramatically with the introduction of coronary stents, which essentially eliminate the problem of flow-limiting arterial dissections, elastic recoil, and spasm. The use of new intravenous "super aspirins", which alter platelet function at a site different from the site of aspirin-inhibition, have dramatically reduced the incidence of thrombosis after balloon angioplasty and stenting. Examples of these newer agents include abciximab (Reopro) and eptifibatide (Integrilin); these agents represent a major advance in enhancing the safety and efficacy of PCI in selected patients.
When despite these measures, a coronary artery cannot be "kept open" during PCI, emergency CABG surgery may be necessary. Before the advent of stents and advanced anti-thrombotic strategies, emergency CABG following a failed
PCI was required in as many as 5% of patients. In the current era, the need for emergent CABG following PCI is less than 1-2%.The overall acute mortality risk following PCI is less than one percent; the risk of a heart attack following PCI is only about 1-2%. The degree of risk is dependent on the number of diseased vessels treated, the function of the heart muscle, and the age and clinical condition of the patient.
Next: How do patients recover after PCI? »
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