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Is Angioplasty safe and effective?

Saturday, 31 May 2008
Answered by: Dr. O.P. Yadava
Consultant Cardiac Surgeon, CEO
National Heart Institute and Research Centre
New Delhi
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Q. I am a 49 years old male suffering from chest pain (on climbing or exertion) for the last 2 months and after ECG/Echo/TMT, I have been diagnosed for stress-induced IHD due to ST-depression. My cholesterol levels were 269 mg/dl, last month and I am currently on medication for the same. My doctor has asked me to undergo angiography to rule out coronary artery disease (CAD). How safe is angioplasty? How long will the stent survive and will it need to be replaced? With lifestyle changes, can we rule out further blocks? And are there alternative remedies, better than angioplasty?

A.  Angioplasty is safe. However, minor complications in the form of swelling at the site of puncture in the groin or clot formation in the groin occurs in 3-5% of cases, and are usually of trivial nature and settle with conservative management. Survival of the stents depends on lot of factors like the type of stent used, the type of the lesion in which the stent has been placed and risk factors operating in an individual and the degree of their control etc. In general however, 30% of the non-medicated stents and 7-10% of medicated stents block within the first three months. Thereafter the blockage is dependent on the progression of the basic disease process and control of the risk factors. With life style changes, we can definitely retard the progression of cholesterol deposition. However, it is not possible to rule out further blocks. I don't think one can decide on alternatives to angioplasty till such time that an angiography has been performed. Some times with minor blockages, one does not need any intervention and one can be managed with medical management and risk factor control. However, if there are multiple blockages, long segment blockages, heavily calcified blockages and such other technical factors, then bypass surgery may become mandatory. Therefore the decision whether to offer conservative management or angioplasty or bypass surgery will be taken by your cardiologist in consultation with you after the angiography has been performed.

A.  Angioplasty is safe. However, minor complications in the form of swelling at the site of puncture in the groin or clot formation in the groin occurs in 3-5% of cases, and are usually of trivial nature and settle with conservative management. Survival of the stents depends on lot of factors like the type of stent used, the type of the lesion in which the stent has been placed and risk factors operating in an individual and the degree of their control etc. In general however, 30% of the non-medicated stents and 7-10% of medicated stents block within the first three months. Thereafter the blockage is dependent on the progression of the basic disease process and control of the risk factors. With life style changes, we can definitely retard the progression of cholesterol deposition. However, it is not possible to rule out further blocks. I don't think one can decide on alternatives to angioplasty till such time that an angiography has been performed. Some times with minor blockages, one does not need any intervention and one can be managed with medical management and risk factor control. However, if there are multiple blockages, long segment blockages, heavily calcified blockages and such other technical factors, then bypass surgery may become mandatory. Therefore the decision whether to offer conservative management or angioplasty or bypass surgery will be taken by your cardiologist in consultation with you after the angiography has been performed.

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