What Are the Risks of Coronary Angioplasty?

Coronary angioplasty is a common medical procedure. Although angioplasty is normally safe, there is a small risk of serious complications, such as:

• Bleeding from the blood vessel where the catheter was placed.
• Damage to blood vessels from the catheter.
• 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 when 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).

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

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

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

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

There is a chance that the artery will become narrowed or blocked again in time, often within 6 months of angioplasty. This is called restenosis.

Stent Restenosis

The illustration shows the restenosis of a stent-widened coronary artery. The coronary artery is located on the surface of the heart. 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, the plaque grows (over time) 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 plaque around the stent.

When a stent isn't used, 4 out of 10 people have restenosis. When a nonmedicine-coated stent is used, 2 out of 10 people have restenosis.

The growth of scar tissue in and around the stent also can cause restenosis. Medicine-coated stents reduce the growth of scar tissue around the stent and lower the chance of restenosis. When medicine-coated stents are used, the chance of restenosis is lowered even more, to around 1 in 10 people.

Other treatments, such as radiation, can help prevent tissue growth within a stent. For this procedure, the doctor puts a wire 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

Recent studies suggest that there is a higher risk of blood clots forming in medicine-coated stents compared to bare metal stents (nonmedicine-coated). The Food and Drug Administration (FDA) reports that medicine-coated stents usually don't cause complications due to blood clots when used as recommended.

When medicine-coated stents are used in people with advanced CAD, there is a higher risk of blood clots, heart attack, and death. The FDA is working with researchers to study medicine-coated stents, including their use in people with advanced CAD.

Taking medicine as prescribed by your doctor can lower the risk of blood clots. People with medicine-coated stents are usually advised to take an anticlotting drug, 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 to your doctor about your treatment options, including the risks and benefits to you.