From the Guidelines
Yes, you can have a PCI with only a balloon and not the stent, known as plain old balloon angioplasty (POBA), which involves inflating a balloon within a narrowed coronary artery to improve blood flow. This procedure may still be used in specific situations such as in very small vessels, certain bifurcation lesions, or when antiplatelet therapy required for stents is contraindicated, as supported by the acc/aha 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery 1.
Key Considerations
- The decision to perform a balloon-only PCI is made by the interventional cardiologist based on the specific clinical scenario and coronary anatomy.
- Balloon-only PCI carries a higher risk of restenosis (re-narrowing) and acute vessel closure compared to stenting, and therefore, the timing of noncardiac surgery after balloon angioplasty is crucial, with a recommended delay of at least 2 to 4 weeks to allow for healing of the vessel injury at the balloon treatment site 1.
- Daily aspirin antiplatelet therapy should be continued perioperatively to reduce the risk of perioperative ischemia or MI, with the risk of stopping the aspirin weighed against the benefit of reduction in bleeding complications from the planned surgery 1.
Clinical Implications
- The choice between balloon-only PCI and stenting depends on various factors, including the patient's clinical presentation, coronary anatomy, and the need for antiplatelet therapy.
- In cases where balloon-only PCI is performed, close monitoring and follow-up are essential to detect any potential complications, such as restenosis or acute vessel closure.
- The acc/aha 2007 guidelines provide valuable guidance on the management of patients undergoing PCI, including those with balloon-only procedures, and emphasize the importance of careful planning and timing of noncardiac surgery to minimize risks 1.
From the Research
PCI with Balloon and No Stent
- It is possible to have a PCI with only a balloon and not a stent, as seen in the study 2 which compared the outcomes of only-balloon-angioplasty to stenting in primary PCI in patients with ST elevated myocardial infarction (STEMI) who required a subsequent CABG.
- The study 2 found that in-hospital and 5-year mortality rates were similar between the ballooning and stenting groups, suggesting that PCI with only a balloon can be a viable option in certain cases.
- However, the use of stents has become more common due to their lower restenosis rate compared to balloon angioplasty alone, as mentioned in the study 3.
- The decision to use a balloon alone or with a stent depends on various factors, including the patient's condition and the specific circumstances of the PCI procedure.
Antiplatelet Therapy
- Antiplatelet therapy is an important aspect of PCI, regardless of whether a stent is used or not, as it helps to prevent thrombotic complications, as discussed in the studies 3, 4, and 5.
- Dual antiplatelet therapy (DAT) with aspirin and a thienopyridine (such as clopidogrel) is commonly used after PCI to prevent platelet activation and thrombosis, as mentioned in the studies 3, 4, and 5.
- The duration of antiplatelet therapy can vary depending on the type of stent used and the patient's individual risk factors, as discussed in the studies 4 and 5.