What are the potential benefits of having a coronary angioplasty ?

Coronary angioplasty is a myocardial revascularization method. The heart is a muscle fed by the coronary arteries. If one or more of your coronary arteries become narrowed or occluded, it is preferable to treat them.

During coronary angioplasty, a small balloon catheter is advanced on a metallic wire and placed in the narrowed segments of the artery. The balloon is inflated in order to dilate the artery, it is then deflated and removed. In the vast majority of cases, a stent is also inserted. A stent is a small metal mesh tube which is used to scaffold the artery wall and is left in place. Other devices, such as the Rotablator, may also be used.

Angioplasty procedure :

Are there any risks inherent in coronary angioplasty ?

Despite considerable technical advances in the manufacturing of catheters, balloons and stents and operator experience, a coronary angioplasty, like any invasive procedure, cannot be performed without an element of risk. The potential complications are as follows:

• Allergic reaction to the dye (contrast medium) used or local anesthetic drug. It is very important that you inform your doctor of any previous allergic reaction that you may have experienced.
• Complications associated with the puncture site. These complications are more frequently observed after an angioplasty than a coronary angiogram because of the use of anticoagulants. The most common complication is the occurrence of a haematoma (bruising under the skin). This may take several days to disappear but is generally without consequences.  In rare instances, an artery may be occluded or damaged and require surgical repair and/blood transfusion.
• Cardiac and vascular complications. During the procedure, you may experience chest pain or irregular heart beats. Formation of a blood clot, artery damage or any other complication may result in another angioplasty or cardiac surgery being performed on an emergency basis. The procedure also carries a risk of myocardial infarction or death. Other rare or less serious complications have been observed.

Failure of the angioplasty procedure: the narrowing or occlusion of the artery may be impossible to cross or dilate and stent placement is not always feasible.

Incidence (frequency) of procedural success and complications: The success of the procedure or the occurrence of complications depend mainly on your personal circumstances (health status) (stable or unstable angina, recent myocardial infarction, diabetes…) and on the nature and aspect of your coronary narrowing (short or long, presence of tortuous segments, calcification, bifurcation, feasibility of stenting). The complication and failure rates are around 2%.

Restenosis: a scar will form in the dilated area. There is a risk of recurrent stenosis (restenosis). A gradual re-narrowing of the artery may occur (one out of every 5 or 6 cases) generally within the first six months. This may be treated with a repeat angioplasty procedure.

A new stent technology was developed a few years ago. Stents may now be coated with a drug which prevents excessive scarring. The recurrence risk of 1 out of 5 or 6 cases associated with bare metal stents has fallen to 1 out of 13 or 14 with the latest generation of stents. During the procedure, the cardiologist will select the most appropriate stent according to your anatomy and previous history.

What benefits can be expected from having a coronary angioplasty?

By increasing the supply of blood to the heart muscle, coronary angioplasty improves the long-term outcome of angina.