Coronary artery disease (CAD) is one of the leading cause of mortality and morbidity in the whole world. It is condition where the arteries supplying blood to the muscle of the heart are clogged. The most serious form of CAD is a ‘Heart Attack’. The basic treatment includes optimal medications like blood thinners, cholesterol lowering drugs and others. In addition, some patients may need a procedure to open the clogged arteries. These procedures are known as ‘angioplasty’ or ‘ bypass surgery’. Through Angioplasty, the clogged arteries are opened using balloons and stents. Some patients with extensive disease may need to undergo open heart surgery inform of ‘Bypass grafting’.
Most of the patients will experience relief in their symptoms after the procedure. The important point to remember is that the procedure is only the beginning of treatment. Successful angioplasty procedure does not mean that you are ‘cured for life’. It may be associated with some short and long term complications.
The most dangerous complication associated with angioplasty is known as ‘ Stent Thrombosis’(ST), where the stent would get blocked with clots resulting in a major heart attack. To avoid this complication, such patients have to routinely take the blood thinners prescribed by the cardiologist. The incidence ST in patients not taking these medicines is around 10-30% compared to <1 % in those who are taking them. Hence basically ST is an avoidable complication for which proper patient counselling regarding the importance of drug compliance is required.
About 5-10% of stents will get blocked after 2 years of the procedure. This problem is known as ISR ( In-Stent Restenosis). Such patients may need repeated interventions. There are multiple predictors of ISR like uncontrolled blood sugars, high blood pressure, high cholesterol levels, active smokers, obesity, kidney disease, poor adherence to medications, non-medicated stents and complex disease. The rate of ISR is more in non-medicated stents (about 20-30%) as compared to medicated stents. The recent generation of medicated stents are designed to further reduce the ISR rate.
Can we completely prevent these complications? The answer is ‘NO’. All the stents have an inherent risk of these complications. But we can reduce their incidence to a bare minimum in most of the patients by strictly controlling our blood sugar , blood pressure and cholesterol levels. Lifestyle modifications like exercise, avoiding tobacco smoking and proper diet are also absolutely crucial. Proper adherence to medications is very important. Last but not the least, by using the newer generation medicated stents, we can further reduce the risk of re-interventions. Nowadays we have sophisticated imaging techniques like OCT, IVUS and FFR to further optimise the result of angioplasty , specially in complex diseases . A demonstration of OCT( Optical coherence Tomography) can be seen below where we can precise analyse the result of angioplasty and correct it if required. Some experts refer it as ' PRECISION ANGIOPLASTY'.
Hence we must remember that ‘Angioplasty is only the beginning of treatment’ .