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What Are the Risks of Percutaneous Coronary Intervention?

Coronary angioplasty is a common medical procedure. Serious complications don't occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure. Serious complications include:

  • Bleeding from the blood vessel where the catheters were inserted.
  • Blood vessel damage from the catheters.
  • An allergic reaction to the dye given during the angioplasty.
  • An arrhythmia (irregular heartbeat).
  • The need for emergency coronary artery bypass grafting during the procedure (2–4 percent of people). This may occur if an artery closes down instead of opening up.
  • Damage to the kidneys caused by the dye used.
  • Heart attack (3–5 percent of people).
  • Stroke (less than 1 percent of people).

Sometimes chest pain can occur during angioplasty because the balloon briefly blocks blood supply to the heart.

As with any procedure involving the heart, complications can sometimes, though rarely, cause death. Less than 2 percent of people die during angioplasty.

The risk of complications is higher in:

  • People aged 75 and older
  • People who have kidney disease or diabetes
  • Women
  • People who have poor pumping function in their hearts
  • People who have extensive heart disease and blockages in their coronary (heart) arteries

Research on angioplasty is ongoing to make it safer and more effective, to prevent treated arteries from closing again, and to make the procedure an option for more people.

Complications From Stents

Restenosis

After angioplasty, the treated coronary artery can become narrowed or blocked again, often within 6 months of angioplasty. This is called restenosis (RE-sten-o-sis). When a stent (small mesh tube) isn't used during angioplasty, 4 out of 10 people have restenosis.

The growth of scar tissue in and around a stent also can cause restenosis. When a stent is used, 2 out of 10 people have restenosis.

Stent Restenosis

The illustration shows the restenosis of a stent-widened coronary artery. In figure A, the expanded stent compresses plaque, allowing normal blood flow. The inset image on figure A shows a cross-section of the compressed plaque and stent-widened artery. In figure B, over time, tissue grows through and around the stent, causing a partial blockage and abnormal blood flow. The inset image on figure B shows a cross-section of the growth of the tissue around the stent.

The illustration shows the restenosis of a stent-widened coronary artery. In figure A, the expanded stent compresses plaque, allowing normal blood flow. The inset image on figure A shows a cross-section of the compressed plaque and stent-widened artery. In figure B, over time, scar tissue grows through and around the stent. This causes a partial blockage of the artery and abnormal blood flow. The inset image on figure B shows a cross-section of the tissue growth around the stent.

Stents coated with medicine reduce the growth of scar tissue around the stent and lower the chance of restenosis even more. When these stents are used, about 1 in 10 people has restenosis.

Other treatments, such as radiation, can help prevent tissue growth within a stent. For this procedure, a wire is put through a catheter to where the stent is placed. The wire releases radiation to stop any tissue growth that may block the artery.

Blood Clots

Studies suggest that there's a higher risk of blood clots forming in medicine-coated stents compared to bare metal stents. However, no conclusive evidence shows that these stents increase the chances of having a heart attack or dying, if used as recommended.

When medicine-coated stents are used in people who have advanced CHD, there is a higher risk of blood clots, heart attack, and death. Researchers continue to study medicine-coated stents, including their use in people who have advanced CHD.

Taking medicine as prescribed by your doctor can lower your risk of blood clots. People who have medicine-coated stents usually are advised to take anticlotting medicines, such as clopidogrel and aspirin, for months to years to lower the risk of blood clots.

As with all procedures, it's important to talk with your doctor about your treatment options, including the risks and benefits.

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August 28, 2014