Angioplasty and Stents - Complications

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What are the complications of percutaneous coronary intervention?

Percutaneous coronary intervention, 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 individuals, percutaneous coronary intervention 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 percutaneous coronary intervention 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 percutaneous coronary intervention. 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.

When stents are placed patients are started on aspirin as well as a second agent for up to a year or more depending on the type of stent. These agents are clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta) may be given as an IV agent when the stent is placed for patients who cant take pills.

To help prevent the process of thrombosis during or after percutaneous coronary intervention, aspirin is given to prevent platelets from adhering to the artery wall and stimulating the formation of blood clots. Intravenous heparin or synthetic analogues of part of the heparin molecule 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,
  • individuals with unstable angina, and
  • individuals having heart attacks.

The incidence of abrupt occlusion after percutaneous coronary intervention 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.

When despite these measures, a coronary artery cannot be "kept open" during percutaneous coronary intervention, emergency CABG surgery may be necessary. Before the advent of stents and advanced anti-thrombotic strategies, emergency CABG following a failed percutaneous coronary intervention was required in as many as 5% of patients. In the current era, the need for emergent CABG following percutaneous coronary intervention is less than 1% The overall acute mortality risk following percutaneous coronary intervention is less than one percent; the risk of a heart attack following percutaneous coronary intervention is only about 1% to 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.

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Comment from: beachnut, 75 or over Male (Patient) Published: June 16

I was told that my heart beat was slightly elevated. I was given medication to slow it down, which it did. I never received instructions on how to proceed once I left the hospital. I was given medications to take that gave me tremendous headaches (Plavix and Imdur) and a cholesterol pill that I cannot take (kidney pain). The 325 mg aspirin does not relieve my headache. I will probably find out how to proceed after I see the doctor in two weeks.

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Comment from: SECOND LIFE, 65-74 Female (Patient) Published: July 28

I had an angioplasty procedure through my right arm in 2014. Because of the results I had quadruple bypass in July 2014. In 2015 I went to the emergency room for COPD problems and they admitted me due to my medical background. They wouldn't release me from the hospital because they couldn't find a pulse in my right arm. When I saw the cardiac doctor she said in many cases when you have an angioplasty in the arm you will have a decreased radial pulse. So maybe the admitting doctors should be told this so patients don't have to wait 2 extra days in the hospital unnecessarily.

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