From the Guidelines
Angioplasty is a high-risk procedure that should only be performed in patients with severe coronary artery disease, as it is associated with a 1% in-hospital mortality rate and an incidence rate of non-fatal myocardial infarction of approximately 4% 1. The procedure involves the use of a catheter with a small balloon at its tip to compress plaque against the artery wall, widening the vessel and improving blood flow. However, this can result in localized trauma to the coronary artery wall, leading to complications such as arterial wall damage, thrombus formation, and coronary occlusion 1. Some of the key complications associated with angioplasty include:
- Arterial or venous obstructions
- Vessel perforations
- Bleeding
- Hypersensitivity reactions
- Infection
- Myocardial infarction
- Stroke
- Death In the event of coronary occlusion, emergency surgical revascularization may be necessary, which is associated with a high probability of myocardial infarction and increased mortality 1. The use of intraaortic balloon counterpulsation and thrombolytic or vasodilator agents may help to reestablish coronary artery patency and relieve ischemia, but prolonged maneuvers are discouraged to avoid delaying emergency surgical revascularization 1. It is essential to carefully weigh the risks and benefits of angioplasty and to only perform the procedure in patients who are likely to benefit from it, as the risks of complications and mortality are significant 1.
From the Research
Angioplasty Overview
- Angioplasty is a medical procedure used to widen narrowed or blocked arteries, typically performed to treat coronary artery disease.
- The use of drug-eluting stents (DES) has become a common practice in angioplasty procedures.
Antiplatelet Therapy
- Dual antiplatelet therapy (DAPT) with a thienopyridine (such as clopidogrel) and aspirin is used to reduce the risk of late stent thrombosis and complications after DES placement 2.
- The combination of clopidogrel and aspirin has been shown to be effective in reducing the risk of major adverse cardiovascular and cerebrovascular events after coronary artery bypass grafting 3.
- Clopidogrel monotherapy after 12-month DAPT has been associated with a reduced risk of recurrent ischemic events in patients receiving DES 4, 5.
Comparison of Antiplatelet Therapies
- A systematic literature review and meta-analysis found that clopidogrel was associated with a 28% reduction in the risk of major adverse cardiovascular events compared with aspirin after DAPT in patients with acute coronary syndrome receiving a DES 5.
- High platelet reactivity on clopidogrel has been independently associated with definite or probable stent thrombosis, myocardial infarction, and all-cause mortality after DES placement 6.
Treatment Considerations
- The choice of antiplatelet therapy after angioplasty should be individualized based on patient characteristics and clinical presentation.
- The use of triple antiplatelet therapy (e.g., clopidogrel, cilostazol, and aspirin) may be beneficial in certain high-risk patients, but its effectiveness and safety need to be further evaluated 2.