What Are the Risks of Coronary Angioplasty?

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.

Angioplasty complications can include:

• Discomfort and bleeding at the catheter insertion site.
• Blood vessel damage from the catheters.
• An allergic reaction to the dye used during the angioplasty.
• An arrhythmia (irregular heartbeat).
• The need for emergency coronary artery bypass grafting during the procedure (less than 3 percent of people). This may occur if an artery closes down instead of opening up.
• Kidney damage caused by the dye used during the angioplasty.  
• 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 be fatal. However, this is rare with coronary angioplasty. Less than 2 percent of people die during the procedure.

The risk of complications is higher in:

• People aged 65 and older
• People who have chronic kidney disease
• People who are in shock
• 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 and to prevent treated arteries from narrowing again.

Complications From Stents

Restenosis

Another problem that can occur after angioplasty is too much tissue growth within the treated portion of the artery. This can cause the artery to become narrow or blocked again, often within 6 months. This complication is called restenosis (RE-sten-o-sis).

When a stent (small mesh tube) isn't used during angioplasty, 30 percent of people have restenosis. When a stent is used, 15 percent of people have restenosis.

Stent Restenosis

Figure A shows the coronary arteries located on the surface of the heart. Figure B shows a stent-widened artery with normal blood flow. The inset image shows a cross-section of the stent-widened artery. In figure C, tissue grows through and around the stent over time. This causes a partial blockage of the artery and abnormal blood flow. The inset image shows a cross-section of the tissue growth around the stent.

Stents coated with medicine (drug-eluting stents) reduce the growth of scar tissue around the stent. These stents further reduce the risk of restenosis. When these stents are used, about 10 percent of people have 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 with bare metal stents. However, no firm evidence shows that these stents increase the chance of having a heart attack or dying if used as recommended. Researchers continue to study medicine-coated stents.

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 antiplatelet medicines, such as clopidogrel and aspirin, for up to a year or longer.

As with all procedures, you should talk with your doctor about your treatment options, including the risks and benefits.

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