Angioplasty is a surgical procedure often recommended after an arterial blockage has been found in the heart muscle. Your heart requires a strong oxygen and nutrient supply, like other muscles in your body. There are two major coronary arteries that supply the left and right sides of your heart. By branching into smaller arteries they are able to supply the entire muscle with blood.
The goal of coronary artery angioplasty is to repair or unblock the blocked artery. During the procedure the surgeon inserts a thin expandable balloon that is inflated to flatten the blockage against the arterial wall. After the balloon is removed, the surgeon often places a stent with the intention of keeping the artery open and blood flowing freely.
There are currently five types of coronary artery stents available, each with different advantages and disadvantages to placement. However, while the different types of stents offer options for those for whom a stent is absolutely necessary, research shows those with stable coronary artery disease, stable angina, do not require stents.
In a recent study published in The Lancet, researchers from Imperial College London investigated the difference between patients who had received a stent for stable angina and those who underwent a placebo intervention.
The researchers recruited 200 participants with severe single vessel blockage. During the initial six weeks, all patients underwent an exercise test followed by intensive medical treatment. At that point they were randomly assigned to two groups. The first underwent a percutaneous intervention (PCI) during which coronary angioplasty was performed and a stent was placed. The second group also underwent a PCI procedure with an angiogram but without a balloon angioplasty or stent placement.
For the following six weeks, neither the patient nor the physician knew if the patient received the stent. At the conclusion of the six weeks, patients again underwent an exercise test and were questioned about their symptoms. The researchers found both groups experienced nearly identical improvements in exercise tolerance and no difference in reported improvements of their symptoms.
The results were presented at the Transcatheter Cardiovascular Therapeutics symposium in Denver. Not surprisingly, the Society for Cardiovascular Angiography and Interventions (SCAI) questioned the conclusions, believing the surgical PCI is the preferred treatment.
The president of SCAI, Dr. Kirk Garratt, commented on the study, saying, “In 2017, we don’t subject stable patients without symptoms to PCI, so this study doesn’t properly reflect current PCI practice. Convenience and medication side effects are also big concerns for patients.”
Previous analysis of the benefits of stent procedures supports findings from the featured study. Most stent placements, up to 50 percent may be done unnecessarily based on current medical guidelines, which is inconsistent with Garratt’s assertion the procedure is done only when necessary.
In one study involving over 140,000 patients across more than 1,000 hospitals, researchers found nearly half of the stent procedures were unnecessary. Researchers found 7.6 percent of those undergoing angioplasty experienced at least one serious side effect during hospitalization. More recent reports indicate serious complications may be experienced by up to 5 percent of individuals undergoing angioplasty.
Thus, while the featured study called into question the effectiveness of most angioplasty and stent insertions, many hospitals are also performing these procedures in unnecessarily large numbers. It is recommended that angioplasty and potential stent placement be done if you are experiencing consistent chest discomfort or pain, or if the blockage puts you at immediate risk of heart attack or death.
This study hopes to reduce the knee-jerk reaction physicians and patients have that any blockage should automatically require the placement of a stent.
A noninvasive alternative treatment covered by Medicare and used in University settings is enhanced external counterpulsation (EECP). This is a painless treatment used to help develop collateral circulation in your heart muscle. If you have blockage in your left anterior descending artery the procedure is not recommended. During the treatment, long inflatable cuffs are wrapped around your legs and buttocks. An electrocardiogram is used to time the inflation of the cuffs with the rhythm of your heart.
While your heart is at rest between beats, the cuffs inflate and squeeze blood from your legs toward your core. Physicians use this procedure to treat stable and unstable angina, chronic heart failure, coronary artery disease and ischemic cardiomyopathy. The additional pressure from the treatment triggers your body to form new blood vessels and thereby improve collateral circulation in your heart. This improved flow often eliminates angina pain and can improve your physical function up to 40 percent.
Each session lasts approximately an hour and you may need up to 35 sessions to achieve the desired results. The effects of the procedure typically last five to eight years. However, this noninvasive procedure is far preferable to the potential side effects from a PCI or the long-term side effects after placement of a stent. The treatment is very effective, not as costly as the invasive PCI, and is covered by insurance.
This procedure encourages the growth of new vessels in the way that high intensity strength training does. However, those with heart disease are physically unable to do this type of exercise to grow the strength of their heart. EECP does the work for them, so their exercise capacity improves and they can then do more of their own strength training.