Heart health solutions: Angioplasty and stents explained

In his latest online article, Dr Dwayne Conway delves into the common reasons behind cardiologists' recommendations for angioplasty and stents. Whether it's addressing acute coronary syndromes like heart attacks or managing the persistent discomfort of stable angina, these interventions offer tangible relief and renewed hope.

What are the common reasons that cardiologists recommend coronary angioplasty and stents?

In simple terms, coronary angioplasty involves widening a narrowed coronary artery by inflating a balloon inside it. A stent, typically made of chromium alloys nowadays rather than steel, is a scaffold to keep the artery open after the balloon stretching.

Cardiologists recommend this procedure to address coronary artery disease (narrowed or blocked arteries that hinder blood flow to the heart muscle). This condition can manifest as an acute coronary syndrome, such as a heart attack, which demands immediate attention due to sudden and urgent onset.

Alternatively, it may present as stable angina or exertional angina, where individuals experience chest discomfort, like tightness or squeezing, during physical activity. This discomfort occurs because the heart muscle isn't receiving sufficient blood flow to meet increased demands.

How does coronary angioplasty and stent differ from other heart procedures? 

In the field of cardiology, we perform numerous invasive procedures, it a highly procedural specialty. However, cardiologists are not surgeons; we are physicians who also perform invasive treatments.

Much of our work involves evaluating patients, exercising clinical judgment, and understanding the diseases we treat. Some common procedures in cardiology include pacemaker implantation and ablation therapy for heart rhythm disorders, both of which are minimally invasive and typically performed without general anaesthesia. Within cardiology, there are various subspecialties focusing on specific procedures. For example, while I specialise in coronary angioplasty and stenting, my colleagues may specialise in ablation procedures or pacemaker implantation.

On the other hand, open surgical procedures, such as coronary artery bypass surgery or valve replacement, fall under the domain of cardiothoracic surgeons. These operations necessitate general anaesthesia and involve significant chest incisions, lengthy procedures lasting several hours, and extended hospital stays with intensive care unit monitoring. Recovery from open heart surgery is typically prolonged, often taking weeks to months before patients feel fully recovered.

In contrast, coronary angioplasty and stenting, performed under local anaesthesia, are relatively quick procedures, from 10 minutes to 3 hours. Patients undergoing these interventions can often return home the same day after a brief observation period. This approach is much less invasive and disruptive compared to open heart surgery, but there are specific cases where open surgery remains the preferred option despite the advantages of stenting in the short term.

What are the potential risks and benefits associated with coronary angioplasty and stents?

The reassuring aspect is that the procedure carries a relatively low risk. The perception of what constitutes high risk may differ among individuals, but when considering major adverse outcomes associated with elective angioplasty and stenting, the likelihood is less than one in a hundred cases. Like any medical procedure, there are risks, but the vast majority, approximately 99%, of patients do not experience significant complications.

Among the minor risks, the most common occurrence is a small bruise. If the procedure involves accessing the radial artery in the wrist, some individuals may not develop any bruising, but most will have a small bruise. Accessing the femoral artery in the groin area may result in larger bruises or more extensive bleeding, due to the deeper and larger nature of the artery, hence the preference for wrist access whenever feasible. Serious bleeding is rare, especially from the wrist, as pressure can effectively control bleeding; however, in approximately one in a hundred cases from the groin, additional procedures may be necessary to address bleeding, either through vascular surgery or radiological intervention.

To prevent blood clots from forming in the arteries during the procedure, antiplatelet drugs and heparin are administered. Although these medications reduce the risk of clotting, they may slightly increase the risk of bleeding, particularly in individuals with other bleeding disorders.

During the procedure, patients may experience minor discomfort in the chest or arm, which can be managed with pain relief if needed. Rare but important risks, such as heart attack, stroke, or bleeding around the heart, stem from the invasive nature of the procedure, which temporarily disrupts blood flow and physically alters the heart's arteries. While these risks are extremely rare, they are important to acknowledge due to their seriousness.

Emergency bypass surgery, once relatively common where angioplasty procedures failed, is now exceedingly rare, required in only about one in 2,000 cases. Other uncommon but noteworthy risks include allergic reactions to the contrast agent used during the procedure and potential worsening of kidney function, particularly in individuals with pre-existing kidney issues.

Despite the range of potential complications, from minor to severe, the benefits of angioplasty and stenting are substantial. These procedures effectively unblock heart artery blockages, alleviating symptoms and improving quality of life. For individuals experiencing a heart attack, early intervention can prevent further heart damage by restoring blood flow, while those suffering from angina can regain normal activity levels post-procedure. Overall, the chance of death due to a complication of an angiogram, angioplasty, or stent placement is less than one in a hundred, highlighting the procedure's overall safety and efficacy.

Dr Dwayne Conway is an esteemed cardiologist. You can schedule an appointment with Dr Conway on his Top Doctors profile.