Coronary Angioplasty (cont.)
What are the long-term results of PCI?
Long-term benefits of PCI depend on the maintenance of the newly-opened coronary artery(ies). 30-50% of patients with successful balloon angioplasty (no stent) may develop recurrent narrowing (restenosis) at the site of the balloon inflation, usually within six months following PCI. Patients may complain of recurrence of angina or may have no symptoms. Restenosis is often detected by exercise stress tests performed at four to six months after PCI. Restenosis occurs with a significantly higher frequency in patients with diabetes. The rate of restenosis is greater in vein grafts, at the origins of vessels, in the beginning part of the left anterior descending coronary artery, and in those with suboptimal initial results. The widespread use of intracoronary stents has reduced the incidence of restenosis by as much as 50% or more; this is due to prevention of "elastic recoil" in the artery, as well as providing a larger initial channel in the treated artery. With the newer medicated stents, the restenosis rate is well under 10%.
Restenosis can simply be observed or treated with medications if the narrowing is not critical and the patient is not symptomatic. Some patients undergo a repeat PCI to increase coronary artery blood flow. Second PCI procedures have similar initial and long-term results as first procedures, although certain patterns of restenosis have a very high repeat recurrence rate. Sometimes, CABG surgeries are recommended for those patients who have developed more extensive disease in the restenosed artery as well as in the other coronary arteries. Patients may also choose CABG surgery to avoid the uncertainty of restenosis after the second PCI. In patients with restenosis after balloon angioplasty or stents, the use of intracoronary radiation (brachytherapy) may reduce the risk of future restenosis. If no evidence of restenosis is observed after
six to nine months, studies have demonstrated that the treated arterial segment is likely to remain open for many years. "Late restenosis" after one year or more is very uncommon. Symptoms developing more than one year after successful PCI are usually due to blockage in a different segment of the artery, or in a different artery from that which was treated in the initial
PCI.
- Coronary
angioplasty is accomplished using a balloon-tipped catheter
inserted
through an artery in the groin or arm to enlarge a narrowing in
a coronary
artery.
- Coronary
artery disease occurs when cholesterol plaque builds up
(arteriosclerosis)
in the walls of the arteries to the heart.
- Angioplasty
is successful in opening coronary arteries in well over 90% of patients.
- Up
to 30-40% of patients with successful coronary angioplasty will
develop
recurrent narrowing at the site of balloon inflation.
- The use of newer devices such as intracoronary stents and atherectomy, as
well as newer pharmacologic agents has resulted in higher success rates,
reduced complications, and reduced recurrence after PCI.
Last Editorial Review: 5/29/2007
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