Frequently Asked Questions: Angioplasty

Here are some frequently asked questions related to angioplasty.

Q: My doctor has told me I should have an angioplasty. How do I choose who should do it and where it should be done?

A: As with other medical procedures, practice makes perfect, and the volume of procedures done, both by the physician and the hospital where the procedure is performed, is important. According to joint guidelines set by the American Heart Association and the American College of Cardiology, the hospital itself should be the site of at least 200 angioplasties each year, so that the entire angioplasty team becomes expert in doing angioplasty.

Q: My doctor recommends I have an angioplasty, but also warns me that they sometimes need to be redone over the next several months. So wouldn’t it make more sense to have coronary bypass surgery instead?

A: Because angioplasty restores blood flow to the heart without the need for major surgery, most doctors are inclined to try it at least once, unless there are clear indications it is unsuitable. Even if a repeat angioplasty is needed to achieve lasting results, this is still less stressful on the body than coronary bypass surgery.

Q: I had angioplasty, but my doctor still recommends that I lower my cholesterol and stop smoking. Since I feel fine, why do I need to do this?

A: An angioplasty treats the result of coronary artery disease, but doesn’t cure the underlying cause. Coronary artery disease is a progressive disease, so you need to attack the factors that led to it – by lowering blood cholesterol levels, exercising, and quitting smoking, for example. This will reduce the probability that you’ll need another angioplasty, or possibly even coronary bypass surgery, in the future.

Q: My doctor says I have coronary artery disease that requires surgical treatment. I would like to have an angioplasty, but my doctor says it won’t work for me. Why not?

A: Not all plaques respond to the angioplasty technique; some are too long or too hardened, or out of reach of the catheter. Or the artery may have so many blockages that coronary bypass surgery would be better. Also, the condition of the heart may play a role. In some cases, if the heart is weak, angioplasty is not the right choice.

Q: I had an angioplasty performed and I’m concerned about the vessel reclosing. How do I know whether or not this is happening?

A: Usually, the return of chest pain (angina) is the chief symptom of reclosure, or restenosis. About 60% to 70% of patients who develop restenosis will experience chest pain. Contact your doctor if you begin suffering chest pain. However, not everyone who develops restenosis experiences chest pain, which is why you should contact your doctor if you experience unusual fatigue, shortness of breath, chest pressure, or any of the other symptoms you may have had before your angioplasty. About 10% to 20% of patients who develop restenosis experience no symptoms at all.

Q: I am a diabetic. Should I have an angioplasty?

A: Major studies have found that the death, complication, and restenosis rates for diabetics who have angioplasty is significantly higher than for those who have coronary bypass surgery. This doesn’t necessarily rule angioplasty out. It may still be the best procedure for you. Your doctor will take your diabetes into consideration, along with other factors, to determine the best treatment.

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