Angioplasty & Stents

Risks

Angioplasty and stenting offers life-enhancing—and sometimes lifesaving—treatment for people with certain conditions such as a heart attack, angina, and stroke. A blocked artery can cause serious health problems, especially if it prevents one of the body’s most critical organs—for example, the heart, brain, or kidneys—from getting the oxygen needed to keep you alive and functioning. But, like any medical procedure, angioplasty and stenting has risks, so it’s important that you take the time to weigh the risks to decide if this procedure is the right treatment for you.

Many risks can be managed. For example, your doctor will most likely implant a drug-eluting stent rather than a bare-metal stent to help prevent scar tissue from forming that could block the artery again. Any stent can potentially close due to the formation of a blood clot within it. And you can greatly reduce the risk of blood clots by taking medication exactly as prescribed by your doctors. If you have a bare-metal stent, you will have to take medications for at least one month to prevent blood clots from forming. For drug-eluting stents, medication will be required for at least as long as one year. You should take aspirin for the rest of your life with either type of stent.

Your level of risk also depends on your circumstances, but it can include the following:

• An artery collapsing or closing again, especially when stenting is not an option
• Bleeding or damage to the blood vessel where the catheter is inserted or in the inner lining of the artery
• An allergic reaction to the dye
• Having to stop the procedure and instead perform coronary bypass surgery (CABG) if the blockages are too numerous and severe to treat adequately with angioplasty and stenting
• Scar tissue that can grow within a stent (restenosis), requiring a repeat procedure
• A blood clot forming inside the stent (stent thrombosis), which may require immediate medical treatment
• A heart attack, stroke, or death—the more arteries involved, the greater the risk
• Side effects from medication

Groin (femoral) vs. wrist (transradial) risks

If you’re treated with angioplasty and stenting, the catheter used to open a block or narrowed artery, and in some cases to place a stent, is inserted in one of two arteries: the radial artery, which is in the wrist (also called transradial angioplasty) and the femoral, which is in the groin area.

Both approaches are considered safe and effective for most patients in most circumstances. However, as with any medical procedure, the best approach largely depends on your unique medical and personal circumstances.

Groin/femoral angioplasty

Advantages:

• This procedure has a long history of success—first used in the 1960s.
• More doctors are trained and experienced in this approach.
• This procedure is better for patients with small radial arteries, for procedures requiring the placement of large catheters, or in those patients where the transradial approach failed.

Disadvantages:

• You must lie flat for four to six hours after the procedure.
• It may involve a lengthy compression process following your procedure that requires a nurse.
• There’s a risk of bleeding, which is higher than if the procedure is performed from the radial approach.
• It can be difficult to reach the artery to perform the procedure and, if necessary, stop bleeding, especially in patients with obesity.
• The femoral artery is the only source of blood to the leg.

Wrist/transradial/angioplasty

Pros:

• This procedure has a history of success—first used in the 1980s.
• Your risk of bleeding will be significantly reduced—an important consideration for women*, the elderly, and people taking blood-thinning medications.
• You’ll experience less discomfort due to bleeding but can experience some pain/pressure due to the friction of the catheter within a smaller blood vessel.
• You do not have to lie flat for hours.
• You can move around as soon as the effects of anesthesia allow it.
• You can eat and drink soon after the procedure.
• The radial artery isn’t the only source of blood to the hand.

Cons:

• The procedure is technically more difficult than the femoral approach because the radial artery is smaller.
• Not as many doctors are trained and experienced with this approach.

As the equipment used for angioplasty and stenting has become smaller, and doctors have gained the training and experience to handle the more challenging technical aspects of working with the smaller artery in the wrist, the transradial approach is becoming the first choice approach for many doctors and patients.

Talk with your doctor to decide which access location is right for you. And if you decide that the transradial approach is right for you, ensure your doctor has experience performing it before giving your consent.