An angioplasty procedure involves the insertion of a catheter into a patient’s blocked coronary artery and the inflation of a tiny balloon once in the artery to open it and restore blood flow to the heart.
Doctors often recommend the angioplasty procedure when plaque buildup in the coronary artery begins to cause symptoms like chest pain and chest pressure. Research shows that a stent will reduce the likelihood of a major cardiovascular event in the future.
Likely Candidates for an Angioplasty Procedure
Continue to have physical symptoms that are interfering with the quality of your life despite conventional and alternative therapies. Some of these symptoms include chest discomfort, shortness of breath and feeling profoundly weak upon exertion.
Have symptoms along with stenosis (when disease causes blockage in a major blood vessel that supplies blood to a large area of the heart and feeds many blood vessels).
Left main coronary artery is blocked 70 percent or more, in which case you should have surgery whether or not you are symptomatic.
Have had a recent heart attack and a positive nuclear treadmill test with profound EKG changes—with or without symptoms—showing your heart is at risk of further injury.
In less complicated terms, an angioplasty–stent procedure is warranted for patients showing signs of a heart attack or advancing unstable coronary disease. In the case of acute coronary artery syndrome (pre-infarction angina) or a heart attack especially, the angioplasty procedure should be done immediately and can be a real lifesaver.
However, if your disease is stable, I advise against the angioplasty procedure. A study published in the New England Journal of Medicine showed that patients who had angioplasty–stent procedures and took drugs to treat their coronary artery disease had the same risk of future cardiovascular events as the patients who only took the drugs. It’s clear to me in this situation that the risk associated with the angioplasty procedure isn’t worth the potential reward. You will be much better off making lifestyle changes that support cardiac health.
A Note About Stents
A key component of the angioplasty procedure is the use of stents, sheath devices placed in the coronary artery after balloon expansion to prevent reclosure. Stents hold promise for reducing the rate of thrombosis of arteries after angioplasty.
With new stent placements, angioplasty has become a high-tech procedure, raising issues about the economic impact of the surgery itself. Both the long-term savings in reducing bypass and the long-term costs of untreated coronary disease make the angioplasty procedure a reasonable approach.
I also suggest that if your cardiologist recommends the angioplasty procedure—or even a stent procedure—that you check his/her experience with this intervention. I recommend that if you do need an angioplasty procedure, you have it done by a physician who performs at least two or three a week, or more.
One final note about stents. If you must have one and your cardiologist recommends the drug-eluting type, ask if you can switch to a time-tested titanium stent. Drug-eluting stents have a downside: You have to take a blood thinner for the rest of your life. A titanium stent is the only kind of stent that I would have, myself, because blood thinners are not necessary with titanium.
Get a Second—Even Third—Surgical Opinion
In many cases, the decision to undergo the angioplasty procedure is easy—particularly if you are symptomatic with a high-risk profile, you have left main coronary artery disease, and your quality of life is poor. But if you are asymptomatic, the decision to have an angioplasty procedure may be a difficult one.
Consider “Fred,” a 56-year-old man who came to me for a second opinion. Fred's doctor recommended that he undergo bypass surgery immediately. His angiogram indicated two coronary vessels about 70 percent blocked, and his stress test revealed a small area of what cardiologists call ischemia.
No doubt about it: his heart was vulnerable to an attack. But Fred was satisfied with the quality of his life. He was not symptomatic. He could walk three to four miles a day without experiencing symptoms of angina, such as shortness of breath, profuse sweating or other symptoms of coronary disease.
So I recommended that he delay surgery, take beta blockers and nitrates, enrich his diet to include vitamins, minerals, amino acids, D-ribose, L-carnitine and CoQ10—key ingredients in my core nutritional program for healing heart disease. I also kept him on a walking program.
I told Fred, "You have time. We don't have to rush into surgery. Let's see if these treatments eliminate the potential need for surgery."
If, like Fred, you have documented heart disease but no symptoms and a good quality of life, I don't think you should have surgery unless it is truly necessary or an emergency.
That said, people—especially women—can be in denial about their symptoms and how they affect quality of life. For example, maybe you've gotten used to breathing very heavily every time you climb the stairs, which shouldn't be the case. That's why I recommend getting an exercise stress test, so that you can get in touch with your body and determine how significant your symptoms really are.
Which Interventional Option Is Best for You?
Instead, I strongly recommend delaying invasive procedures and open heart surgery until you have an opportunity to heal yourself. By that I mean trying alternative approaches to improving your heart health—whether it's changing your diet, incorporating exercise into your life or taking nutritional supplements. The key is in being open to helping yourself to heal.
Finally, I urge you to have periodic exercise stress tests and be aware of any unusual symptoms you may be experiencing. If the nuclear stress test shows improvement in your blood flow compared to the previous results, then you should continue to put off the decision to have surgery. I can't tell you how many of my patients have healed themselves, and have never had to have an angioplasty procedure.
Whatever option you choose, you must continue on the path to a healthy lifestyle—not only to help prevent coronary heart disease but also to limit its progression. Unfortunately, I have had to recommend second surgical interventions to patients who considered an angioplasty procedure an instant "cure" for their heart disease, only to return to an unhealthy lifestyle.
We physicians do our best to offer options, prescribe medications, and perform cardiac interventions and surgery, but you, and only you, have the power to truly heal yourself and make the most of the "second chance" that heart surgery, including bypass and an angioplasty procedure, gives you.
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