Percutaneous coronary intervention
Encyclopedia
Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty or simply angioplasty
, is one therapeutic procedure used to treat the stenotic
(narrowed) coronary arteries of the heart
found in coronary heart disease
. These stenotic segments are due to the build up of cholesterol
-laden plaques that form due to atherosclerosis
. PCI is usually performed by an interventional cardiologist
.
Coronary artery bypass grafting (CABG), which bypasses stenotic arteries by grafting vessels from elsewhere in the body, is an alternative treatment. Most studies have found that CABG is better than PCI for reducing death and myocardial infarction
. However, PCI does improve quality of life. PCI has proven to be as effective and less costly than CABG in patients with medically refractory myocardial ischemia.
transluminal coronary angioplasty (PTCA), because it's done through the skin and through the lumen of the artery, was first developed in 1977 by Andreas Gruentzig
. The first procedure took place Friday Sept 16, 1977 at Zurich
, Switzerland
. Adoption of the procedure accelerated subsequent to Gruentzig's move to Emory University
in the United States. Gruentzig's first fellow at Emory was Merril Knudtson
, who, by 1981, had already introduced it to Calgary
, Alberta
, Canada
. By the mid-1980s, many leading medical centers throughout the world were adopting the procedure as a treatment for coronary artery disease
(CAD).
Angioplasty is sometimes erroneously referred to as Dottering, after Interventional Radiologist
, Dr Charles Theodore Dotter
, who, together with Dr Melvin P. Judkins, first described angioplasty in 1964. As the range of procedures performed upon coronary artery lumens
has widened, the name of the procedure has changed to percutaneous coronary intervention (PCI).
, and in some specific cases it may reduce death
.
Angioplasty is less invasive than coronary artery bypass surgery
(CABG). However, CABG has better results in terms of death, myocardial infarction
, and the need to repeat the procedure. This was demonstrated in repeated studies.
A 2002 randomized controlled trial
found that bare metal stents had no benefit over CABG.
A 2008 randomized controlled trial found that drug-coated stents did not reduce death in non-acute cases. The COURAGE trial concluded that treating with PCI for stable coronary artery disease did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to standard medical treatment.
A 2008 retrospective study found a lower death rate for CABG.
PCI did have a small effect on improving quality of life.
Other procedures that are done during a percutaneous coronary intervention include:
Sometimes a small mesh tube, or "stent
", is introduced into the blood vessel or artery to prop it open using percutaneous methods. Angioplasty with stent
ing is a viable alternative to heart surgery
for some forms of non-severe coronary artery disease. It has consistently been shown to reduce symptoms due to coronary artery disease and to reduce cardiac ischemia
, but has not been shown in large trials to reduce mortality due to coronary artery disease, except in patients being treated for a heart attack acutely (also called primary angioplasty). In acute cases, there is a small but definite reduction of mortality
with this form of treatment compared with medical therapy, which usually consists of the administration of thrombolytic
("clot busting") medication.
s provide a mechanical framework that holds the artery wall open, preventing stenosis, or narrowing, of coronary arteries. PTCA with stenting has been shown to be superior to angioplasty alone in patient outcome by keeping arteries patent for a longer period of time.
Newer drug-eluting stent
s (DES) are traditional stents that are coated with drugs, which, when placed in the artery, release certain drugs over time. It has been shown that these types of stents help prevent restenosis of the artery through several different physiological mechanisms, which rely upon the suppression of tissue growth at the stent site and local modulation of the body's inflammatory and immune responses. Five drugs,
Biolimus A9
,
Zotarolimus, sirolimus
, everolimus
and paclitaxel
, have demonstrated safety and efficacy in this application in controlled clinical trials by stent device manufacturers. However, in 2006 three broad European trials seem to indicate that drug-eluting stents may be susceptible to an event known as "late stent thrombosis", where the blood-clotting inside the stent can occur one or more years post-stent. Late stent thrombosis occurs in 0.9% of patients, and is extremely dangerous and is fatal in about one-third of cases when the thrombosis occurs. New generation DES products, such as the BioMatrix stent marketed by Biosensors International
since January 2008 in Europe, seek to eliminate this risk by using a biodegradable coating.
-based procedures.
The patient is usually awake during angioplasty, and chest discomfort may be experienced during the procedure; the reporting of symptoms indicates the procedure is causing ischemia
and the cardiologist may alter or abort part of the procedure. Bleeding from the insertion point in the groin is common, in part due to the use of anti-platelet
clotting drugs. Some bruising is therefore to be expected, but occasionally a hematoma
may form. This may delay hospital discharge as flow from the artery into the hematoma may continue (pseudoaneurysm) which requires surgical repair. Infection at the skin puncture site is rare and dissection
(tearing) of the access blood vessel is uncommon. Allergic reaction to the contrast dye used is possible, but has been reduced with the newer agents. Deterioration of kidney function can occur in patients with pre-existing kidney disease, but kidney failure requiring dialysis is rare. Vascular access complications are less common and less serious when the procedure is performed via the radial artery.
The most serious risks are death, stroke
, VF
(non-sustained VT
is common), myocardial infarction
(heart attack) and aortic dissection
. A heart attack during or shortly after the procedure occurs in 0.3% of cases; this may require emergency coronary artery bypass surgery
. Heart muscle injury characterized by elevated levels of CK-MB, troponin I
, and troponin T
may occur in up to 30% of all PCI procedures. Elevated enzymes have been associated with later clinical outcomes such as higher risk of death, subsequent MI and need for repeat revascularization procedures. Angioplasty carried out shortly after a myocardial infarction
has a risk of causing a stroke
of 1 in 1000, which is less than the 1 in 100 risk encountered by those receiving thrombolytic drug therapy.
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:
Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
, is one therapeutic procedure used to treat the stenotic
Stenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
(narrowed) coronary arteries of the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
found in coronary heart disease
Coronary heart disease
Coronary artery disease is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium with oxygen and nutrients. It is sometimes also called coronary heart disease...
. These stenotic segments are due to the build up of cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...
-laden plaques that form due to atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
. PCI is usually performed by an interventional cardiologist
Interventional cardiology
Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist, Dr. Charles...
.
Coronary artery bypass grafting (CABG), which bypasses stenotic arteries by grafting vessels from elsewhere in the body, is an alternative treatment. Most studies have found that CABG is better than PCI for reducing death and myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
. However, PCI does improve quality of life. PCI has proven to be as effective and less costly than CABG in patients with medically refractory myocardial ischemia.
History
Coronary angioplasty, also known as percutaneousPercutaneous
In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed .The percutaneous approach is commonly used in vascular procedures...
transluminal coronary angioplasty (PTCA), because it's done through the skin and through the lumen of the artery, was first developed in 1977 by Andreas Gruentzig
Andreas Gruentzig
Andreas Roland Grüntzig was a German cardiologist who first developed successful balloon angioplasty for expanding lumens of narrowed arteries.-Angioplasties:...
. The first procedure took place Friday Sept 16, 1977 at Zurich
Zürich
Zurich is the largest city in Switzerland and the capital of the canton of Zurich. It is located in central Switzerland at the northwestern tip of Lake Zurich...
, Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
. Adoption of the procedure accelerated subsequent to Gruentzig's move to Emory University
Emory University
Emory University is a private research university in metropolitan Atlanta, located in the Druid Hills section of unincorporated DeKalb County, Georgia, United States. The university was founded as Emory College in 1836 in Oxford, Georgia by a small group of Methodists and was named in honor of...
in the United States. Gruentzig's first fellow at Emory was Merril Knudtson
Libin Cardiovascular Institute of Alberta
The Libin Cardiovascular Institute of Alberta is a partnership between the Calgary Health Region and the University of Calgary. Its mandate comprises all cardiovascular research, education and service delivery, with a service area extending from Saskatchewan, Southern Alberta and Eastern British...
, who, by 1981, had already introduced it to Calgary
Calgary
Calgary is a city in the Province of Alberta, Canada. It is located in the south of the province, in an area of foothills and prairie, approximately east of the front ranges of the Canadian Rockies...
, Alberta
Alberta
Alberta is a province of Canada. It had an estimated population of 3.7 million in 2010 making it the most populous of Canada's three prairie provinces...
, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
. By the mid-1980s, many leading medical centers throughout the world were adopting the procedure as a treatment for coronary artery disease
Coronary heart disease
Coronary artery disease is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium with oxygen and nutrients. It is sometimes also called coronary heart disease...
(CAD).
Angioplasty is sometimes erroneously referred to as Dottering, after Interventional Radiologist
Interventional radiology
Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...
, Dr Charles Theodore Dotter
Charles Theodore Dotter
Charles Theodore Dotter was a US vascular radiologist who is generally credited with developing interventional radiology. Dotter, together with his trainee Dr Melvin P. Judkins, described angioplasty in 1964....
, who, together with Dr Melvin P. Judkins, first described angioplasty in 1964. As the range of procedures performed upon coronary artery lumens
Lumen (anatomy)
A lumen in biology is the inside space of a tubular structure, such as an artery or intestine...
has widened, the name of the procedure has changed to percutaneous coronary intervention (PCI).
Indications
Percutaneous coronary intervention can be performed to reduce or eliminate the symptoms of coronary artery disease, including angina (chest pain), dyspnea (shortness of breath) on exertion, and congestive heart failure. PCI is also used to abort an acute myocardial infarctionMyocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
, and in some specific cases it may reduce death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
.
Angioplasty is less invasive than coronary artery bypass surgery
Coronary artery bypass surgery
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease...
(CABG). However, CABG has better results in terms of death, myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
, and the need to repeat the procedure. This was demonstrated in repeated studies.
A 2002 randomized controlled trial
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
found that bare metal stents had no benefit over CABG.
A 2008 randomized controlled trial found that drug-coated stents did not reduce death in non-acute cases. The COURAGE trial concluded that treating with PCI for stable coronary artery disease did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to standard medical treatment.
A 2008 retrospective study found a lower death rate for CABG.
PCI did have a small effect on improving quality of life.
Controversy
The value of angioplasty in rescuing someone having a heart attack (by immediately alleviating an obstruction) is clearly defined in multiple studies, but studies have failed to find reduction in hard endpoints for angioplasty vs. medical therapy in stable angina patients. The artery-opening procedure can temporarily alleviate chest pain, but does not contribute to longevity. The "vast majority of heart attacks do not originate with obstructions that narrow arteries".Procedures
The term balloon angioplasty is commonly used to describe percutaneous coronary intervention, which describes the inflation of a balloon within the coronary artery to crush the plaque into the walls of the artery. While balloon angioplasty is still done as a part of nearly all percutaneous coronary interventions, it is rarely the only procedure performed.Other procedures that are done during a percutaneous coronary intervention include:
- Implantation of stentStentIn the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
s - Rotational or laser atherectomyAtherectomyAtherectomy is a minimally invasive surgical method of removing, mainly, atherosclerosis from a large blood vessel within the body. Today, it is generally used to effectively treat peripheral arterial disease of the lower extremities...
- BrachytherapyBrachytherapyBrachytherapy , also known as internal radiotherapy, sealed source radiotherapy, curietherapy or endocurietherapy, is a form of radiotherapy where a radiation source is placed inside or next to the area requiring treatment...
(Use of radioactive source to inhibit restenosisRestenosisRestenosis literally means the reoccurrence of stenosis, a narrowing of a blood vessel, leading to restricted blood flow. Restenosis usually pertains to an artery or other large blood vessel that has become narrowed, received treatment to clear the blockage and subsequently become renarrowed...
.)
Sometimes a small mesh tube, or "stent
Stent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
", is introduced into the blood vessel or artery to prop it open using percutaneous methods. Angioplasty with stent
Stent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
ing is a viable alternative to heart surgery
Coronary artery bypass surgery
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease...
for some forms of non-severe coronary artery disease. It has consistently been shown to reduce symptoms due to coronary artery disease and to reduce cardiac ischemia
Ischemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
, but has not been shown in large trials to reduce mortality due to coronary artery disease, except in patients being treated for a heart attack acutely (also called primary angioplasty). In acute cases, there is a small but definite reduction of mortality
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
with this form of treatment compared with medical therapy, which usually consists of the administration of thrombolytic
Thrombolysis
Thrombolysis is the breakdown of blood clots by pharmacological means. It is colloquially referred to as clot busting for this reason...
("clot busting") medication.
Technique
The angioplasty procedure usually consists of most of the following steps and is performed by physicians, physician assistants, nurse practitioners, nurses, radiological technologists and cardiac invasive specialist; all of whom have extensive and specialized training in these types of procedures.- Access into the femoral arteryFemoral arteryThe femoral artery is a general term comprising a few large arteries in the thigh. They begin at the inguinal ligament and end just above the knee at adductor canal or Hunter's canal traversing the extent of the femur bone....
in the leg (or, less commonly, into the radial arteryRadial arteryIn human anatomy, the radial artery is the main blood vessel, with oxygenated blood, of the lateral aspect of the forearm.-Course:The radial artery arises from the bifurcation of the brachial artery in the cubital fossa. It runs distally on the anterior part of the forearm...
or brachial arteryBrachial arteryThe brachial artery is the major blood vessel of the arm.It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries...
in the arm) is created by a device called an "introducer needle". This procedure is often termed percutaneousPercutaneousIn surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed .The percutaneous approach is commonly used in vascular procedures...
access. - Once access into the artery is gained, a "sheath introducer" is placed in the opening to keep the artery open and control bleeding.
- Through this sheath, a long, flexible, soft plastic tube called a "guiding catheter" is pushed. The tip of the guiding catheter is placed at the mouth of the coronary artery. The guiding catheter also allows for radiopaque dyes (usually iodine based) to be injected into the coronary artery, so that the disease state and location can be readily assessed using real time x-ray visualization.
- During the x-ray visualization, the cardiologist estimates the size of the coronary artery and selects the type of balloon catheter and coronary guidewire that will be used during the case. HeparinHeparinHeparin , also known as unfractionated heparin, a highly sulfated glycosaminoglycan, is widely used as an injectable anticoagulant, and has the highest negative charge density of any known biological molecule...
(a "blood thinner" or medicine used to prevent the formation of clots) is given to maintain blood flow. - The coronary guidewire, which is an extremely thin wire with a radio-opaque flexible tip, is inserted through the guiding catheter and into the coronary artery. While visualizing again by real-time x-ray imaging, the cardiologist guides the wire through the coronary artery to the site of the stenosis or blockage. The tip of the wire is then passed across the blockage. The cardiologist controls the movement and direction of the guide wire by gently manipulating the end that sits outside the patient through twisting of the guidewire.
- While the guidewire is in place, it now acts as the pathway to the stenosis. The tip of the angioplasty or balloon catheter is hollow and is then inserted at the back of the guidewire—thus the guidewire is now inside of the angioplasty catheter. The angioplasty catheter is gently pushed forward, until the deflated balloon is inside of the blockage.
- The balloon is then inflated, and it compresses the atheromatous plaque and stretches the artery wall to expand.
- If an expandable wire mesh tube (stentStentIn the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
) was on the balloon, then the stent will be implanted (left behind) to support the new stretched open position of the artery from the inside.
Coronary stenting
Traditional ("bare metal") coronary stentCoronary stent
A coronary stent is a tube placed in the coronary arteries that supply the heart, to keep the arteries open in the treatment of coronary heart disease. It is used in a procedure called percutaneous coronary intervention...
s provide a mechanical framework that holds the artery wall open, preventing stenosis, or narrowing, of coronary arteries. PTCA with stenting has been shown to be superior to angioplasty alone in patient outcome by keeping arteries patent for a longer period of time.
Newer drug-eluting stent
Drug-eluting stent
A drug-eluting stent ' is a peripheral or coronary stent placed into narrowed, diseased peripheral or coronary arteries that slowly releases a drug to block cell proliferation. This prevents fibrosis that, together with clots , could otherwise block the stented artery, a process called restenosis...
s (DES) are traditional stents that are coated with drugs, which, when placed in the artery, release certain drugs over time. It has been shown that these types of stents help prevent restenosis of the artery through several different physiological mechanisms, which rely upon the suppression of tissue growth at the stent site and local modulation of the body's inflammatory and immune responses. Five drugs,
Biolimus A9
Biolimus A9
Umirolimus , is a macrocyclic lactone, a highly lipophilic derivative of sirolimus, an immunosuppressant. This drug is proprietary to Biosensors International, which uses it in its own drug-eluting stents, and licenses it to partners such as Terumo.Umirolimus inhibits T cell and smooth muscle...
,
Zotarolimus, sirolimus
Sirolimus
Sirolimus , also known as rapamycin, is an immunosuppressant drug used to prevent rejection in organ transplantation; it is especially useful in kidney transplants. A macrolide, sirolimus was first discovered as a product of the bacterium Streptomyces hygroscopicus in a soil sample from Easter...
, everolimus
Everolimus
Everolimus is the 40-O- derivative of sirolimus and works similarly to sirolimus as an mTOR inhibitor....
and paclitaxel
Paclitaxel
Paclitaxel is a mitotic inhibitor used in cancer chemotherapy. It was discovered in a U.S. National Cancer Institute program at the Research Triangle Institute in 1967 when Monroe E. Wall and Mansukh C. Wani isolated it from the bark of the Pacific yew tree, Taxus brevifolia and named it taxol...
, have demonstrated safety and efficacy in this application in controlled clinical trials by stent device manufacturers. However, in 2006 three broad European trials seem to indicate that drug-eluting stents may be susceptible to an event known as "late stent thrombosis", where the blood-clotting inside the stent can occur one or more years post-stent. Late stent thrombosis occurs in 0.9% of patients, and is extremely dangerous and is fatal in about one-third of cases when the thrombosis occurs. New generation DES products, such as the BioMatrix stent marketed by Biosensors International
Biosensors International
Biosensors International Group is a company that specializes in developing, manufacturing and marketing innovative medical devices for use in interventional cardiology and critical care procedures. The company was established in 1990 and was listed on the Singapore Stock Exchange in May 2005...
since January 2008 in Europe, seek to eliminate this risk by using a biodegradable coating.
Risks
Coronary angioplasty is widely practised and has a number of risks; however, major procedural complications are uncommon. Coronary angioplasty is usually performed by an interventional cardiologist, a medical doctor with special training in the treatment of the heart using invasive catheterCatheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
-based procedures.
The patient is usually awake during angioplasty, and chest discomfort may be experienced during the procedure; the reporting of symptoms indicates the procedure is causing ischemia
Ischemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
and the cardiologist may alter or abort part of the procedure. Bleeding from the insertion point in the groin is common, in part due to the use of anti-platelet
Platelet
Platelets, or thrombocytes , are small,irregularly shaped clear cell fragments , 2–3 µm in diameter, which are derived from fragmentation of precursor megakaryocytes. The average lifespan of a platelet is normally just 5 to 9 days...
clotting drugs. Some bruising is therefore to be expected, but occasionally a hematoma
Hematoma
A hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...
may form. This may delay hospital discharge as flow from the artery into the hematoma may continue (pseudoaneurysm) which requires surgical repair. Infection at the skin puncture site is rare and dissection
Dissection
Dissection is usually the process of disassembling and observing something to determine its internal structure and as an aid to discerning the functions and relationships of its components....
(tearing) of the access blood vessel is uncommon. Allergic reaction to the contrast dye used is possible, but has been reduced with the newer agents. Deterioration of kidney function can occur in patients with pre-existing kidney disease, but kidney failure requiring dialysis is rare. Vascular access complications are less common and less serious when the procedure is performed via the radial artery.
The most serious risks are death, stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, VF
Ventricular fibrillation
Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. Ventricular fibrillation is a medical emergency and most commonly identified arrythmia in cardiac arrest...
(non-sustained VT
Ventricular tachycardia
Ventricular tachycardia is a tachycardia, or fast heart rhythm, that originates in one of the ventricles of the heart...
is common), myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
(heart attack) and aortic dissection
Aortic dissection
Aortic dissection occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the wall of the aorta and force the layers apart. The dissection typically extends anterograde, but can extend retrograde from the site of the intimal tear. Aortic dissection is a medical...
. A heart attack during or shortly after the procedure occurs in 0.3% of cases; this may require emergency coronary artery bypass surgery
Coronary artery bypass surgery
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease...
. Heart muscle injury characterized by elevated levels of CK-MB, troponin I
Troponin I
Troponin I is a part of the troponin complex. It binds to actin in thin myofilaments to hold the actin-tropomyosin complex in place. Because of it myosin cannot bind actin in relaxed muscle...
, and troponin T
Troponin T
Troponin T is a part of the troponin complex. It binds to tropomyosin, interlocking them to form a troponin-tropomyosin complex.The tissue specific subtypes are:* Slow skeletal troponin T1, TNNT1 * Cardiac troponin T2, TNNT2...
may occur in up to 30% of all PCI procedures. Elevated enzymes have been associated with later clinical outcomes such as higher risk of death, subsequent MI and need for repeat revascularization procedures. Angioplasty carried out shortly after a myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
has a risk of causing a stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
of 1 in 1000, which is less than the 1 in 100 risk encountered by those receiving thrombolytic drug therapy.
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
See also
- AngioplastyAngioplastyAngioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
- Cardiac catheterizationCardiac catheterizationCardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done for both investigational and interventional purposes...
- Coronary artery bypass surgeryCoronary artery bypass surgeryCoronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease...
- Cutting balloonCutting balloonA cutting balloon is an angioplasty device invented by Barath et al. used in percutaneous coronary interventions. It has a special balloon tip with small blades, that are activated when the balloon is inflated...
- Fractional flow reserveFractional Flow ReserveFractional flow reserve is a technique used in coronary catheterization to measure pressure differences across a coronary artery stenosis to determine the likelihood that the stenosis impedes oxygen delivery to the heart muscle .Fractional flow reserve is defined as the pressure behind a...
External links
- Angioplasty.Org news and education
- European Association of Percutaneous Cardiovascular Interventions (EAPCI)
- Q&A: Primary angioplasty, 18 Oct 2008