Angioplasty: Who Needs It, and Risks

What is an angioplasty?

Angioplasty is a medical procedure used to widen narrowed or blocked blood vessels, typically arteries. It is most commonly performed on arteries that have become narrowed due to atherosclerosis, a buildup of plaque made up of fat, cholesterol, and other substances. Angioplasty can improve blood flow to the affected area and alleviate symptoms such as chest pain (angina) or leg pain (claudication).

During angioplasty, a thin, flexible tube called a catheter with a deflated balloon at its tip is inserted into the narrowed or blocked artery. The catheter is usually threaded through a blood vessel in the groin or arm and guided to the site of the blockage using X-ray imaging (fluoroscopy).

Once the catheter reaches the narrowed or blocked area, the balloon is inflated, compressing the plaque against the artery wall and widening the artery. This process improves blood flow through the artery and restores circulation to the surrounding tissues. After the artery has been widened sufficiently, the balloon is deflated and removed, and the catheter may be withdrawn.

In some cases, angioplasty may be combined with the placement of a small metal mesh tube called a stent. The stent is inserted into the artery to help keep it open and prevent it from narrowing again after the balloon is removed.

Angioplasty is commonly used to treat coronary artery disease (in the heart), peripheral artery disease (in the legs or arms), and carotid artery disease (in the neck). It is often performed as a minimally invasive procedure, meaning it does not require surgery and is associated with shorter recovery times and fewer complications compared to open surgical procedures. However, like any medical procedure, angioplasty carries risks, and its suitability depends on individual circumstances and factors.

Who needs an angioplasty?

Angioplasty is typically recommended for individuals with narrowed or blocked arteries that cause symptoms or pose a risk of serious complications. For those with coronary artery disease, angioplasty may be considered if they experience angina that is not controlled with medications or lifestyle changes, or if they have acute coronary syndrome, such as a heart attack or unstable angina. In cases of peripheral artery disease, angioplasty might be advised for individuals suffering from claudication, which is pain or cramping in the legs during physical activity due to reduced blood flow, or for those with critical limb ischemia, where there are ulcers, gangrene, or tissue damage from poor blood flow. For carotid artery disease, angioplasty may be considered for individuals who have experienced a transient ischemic attack (TIA) or stroke due to a blockage in the carotid artery. Additionally, individuals with renal artery stenosis, where narrowed kidney arteries cause high blood pressure or kidney dysfunction, might need angioplasty. Other arterial conditions, such as mesenteric artery disease or subclavian artery stenosis, could also warrant angioplasty. The decision to undergo this procedure is made by a healthcare provider, often involving a cardiologist, interventional radiologist, or vascular surgeon, based on the individual’s specific condition and diagnostic results.

What risks are involved in an angioplasty?

Angioplasty is generally considered safe, but like any medical procedure, it carries certain risks. Some of the potential risks and complications associated with angioplasty include:

1. Bleeding: Bleeding can occur at the catheter insertion site, especially if the procedure involves accessing an artery in the groin or arm.
2. Infection: There is a risk of infection at the catheter insertion site or in the bloodstream.
3. Blood Vessel Damage: In rare cases, the blood vessel can be damaged during the insertion of the catheter.
4. Blood Clots: Angioplasty can dislodge plaque or blood clots, which may travel to other parts of the body and cause blockages.
5. Artery Narrowing (Restenosis): In some cases, the treated artery may narrow again after the procedure, requiring additional treatment.
6. Allergic Reaction: Some people may have an allergic reaction to the contrast dye used during the procedure.
7. Kidney Damage: The contrast dye used during angioplasty can sometimes cause kidney damage, particularly in individuals with pre-existing kidney problems.
8. Heart Attack or Stroke: Although rare, angioplasty can potentially lead to a heart attack or stroke, especially in individuals with underlying heart disease or atherosclerosis.
9. Arrhythmias: Some people may develop irregular heart rhythms (arrhythmias) during or after angioplasty.
10. Radiation Exposure: The X-ray imaging used during angioplasty exposes the patient to a small amount of radiation, which carries a minimal risk of harm.

It’s important to discuss these risks with your healthcare provider before undergoing angioplasty. The benefits of the procedure are weighed against the potential risks based on your individual circumstances and medical history. Most people who undergo angioplasty experience few complications, and the procedure is generally effective in improving blood flow and relieving symptoms.