Is Angioplasty Best for You?

Angioplasty 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 this procedure when plaque buildup in the coronary artery begins to cause chest pain. They maintain that a stent will reduce the likelihood of a major cardiovascular event in the future.

You are probably a candidate for angioplasty if:

• You 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.
• You have stenosis—disease of a major blood vessel that supplies blood to a large area of the heart and feeds many blood vessels.
• Your left main coronary artery is blocked 70 percent or more, in which case you should have surgery whether or not you are symptomatic.
• You 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 procedure should be done immediately and can be a real lifesaver.

However, if your disease is stable, I advise against this 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 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 angioplasty 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 this approach a reasonable one.

I also suggest that if your cardiologist recommends angioplasty—or even a stent procedure—that you check his/her experience with this surgery. I recommend that if you do need angioplasty, have it done by a physician who performs at least one a week.

One final note about stents. If you must have one, steer clear of the drug-eluting type. These much-heralded innovations have been nothing but trouble since their introduction. Instead, insist on a time-tested titanium stent. It’s the only kind of stent that I would have, myself.

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