Risks and Complications of PTCA

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Reasons for undergoing PTCA

Percutaneous transluminal coronary angioplasty is carried out for a variety of reasons. The procedure is usually used to treat people with one of the following coronary conditions:

  • Stable or unstable angina
  • Acute myocardial infarction (heart attack)
  • Conditions with coronary causes which lead to symptoms such as arrhythmia, dizziness and fainting, or dyspnea (difficulty breathing).

Another requirement is usually that the patient has test results which indicate their condition is reversible with PTCA. Tests carried out include resting electrocardiogram, exercise stress test, and Holter monitoring.

The PTCA Procedure

The main objective of a PTCA, or any kind of percutaneous coronary intervention (PCI), is to enlarge a partially or fully blocked artery so that normal blood flow can be restored to the heart.

During the procedure, a catheter with a balloon tip is inserted into an artery in the groin (the femoral artery). The catheter is thread through the arterial network to the site of the blockage near the heart. Once the catheter is in place the balloon is inflated. The inflation of the balloon serves to compress the plaque which blocks the artery, and at the same time inflates the artery itself, so that blood flow is restored.

Finally, a stent is put in place. The stent is made from expandable wire mesh, and is placed within the trouble spot in the artery so that it remains expanded once the balloon is deflated and the catheter is removed.

Possible Complications of PTCA

The risk of complications occurring after PTCA is fairly low, with risk of emergency bypass at less than 1%, and risk of non-fatal heart attack at 2 to 5%. Up to 5% of patients may experience a sudden vessel closure at the site where the procedure was carried out. Overall the mortality rate following the procedure is less than 1%.

If these rates seem high, bear in mind that these are complication risks following heart-related surgery, often on people who have advanced coronary disease. Advances in stent technology and the use of medication helps reduce the risk of complications of PTCA to a minimum.

Another possible risk of surgery is vessel damage, caused by over-inflation of the catheter balloon, or the use of a too-large balloon. Small amounts of damage may occur in up to 50% of people, but it is thought that this is normal and not dangerous. However, larger-scale damage can be problematic.

People who undergo PTCA routinely undergo several weeks of close follow-up care and testing to ensure they do not suffer complications. Even after this point regular check-ups are continued, as in rare cases stents may cause problems up to four years or more after placement.

References

American Heart Association: Percutaneous Coronary Interventions

George A. Stouffer III, MD: Percutaneous Transluminal Coronary Angioplasty