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Angioplasty & Stents - Risks

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Angioplasty & Stents
Angioplasty vs. Clot Busters
Angioplasty After Clot Busters
Other Devices
Artery Re-narrowing
Angioplasty for Mild Heart Attack
Choosing a Hospital & Doctor
The Angioplasty Procedure

What are the risks of dying after balloon angioplasty or stent placement?

Balloon angioplasty and stent placement are very safe procedures for women. On average, less than 1% of women undergoing routine angioplasty or stent placement die.9 The risks are slightly higher when the procedure is performed in an emergency situation such as during a heart attack, when as many as 5% of women may die. Death rates have fallen dramatically over the years as techniques have improved. Women undergoing modern procedures have a lower rate of death, heart attack, or need for bypass surgery than they did in the past, despite that fact that patients today are typically older and sicker.10, 11

Are women more likely to die after balloon angioplasty or stent placement?

When men and women are directly compared, women are more likely to die in the hospital. In general, balloon angioplasty and stent placement are riskier procedures for patients who are older or sicker, and those with smaller blood vessels. When these factors are considered, some studies find that women are no more likely to die in the hospital than men, whereas others continue to find a small gender difference.12-14

Very few women younger than 50 years need to undergo angioplasty or stent placement because of the low rates of heart disease and heart attack in women of this age. However, when younger women have these procedures they are more than twice as likely to die in the hospital than younger men.15-17 In most studies, this gender difference remains even after risk factors and smaller size are taken into account. Why younger women are at a higher risk is not fully understood. It may be that younger women who lose their natural protection against heart disease are at especially high-risk compared with older women who develop heart disease after menopause.

Women who survive the hospital period do as well as men in the long-term. Studies consistently show that women who undergo angioplasty procedures are as just as likely to survive for 5 years.11, 18, 19

Why do women have a higher risk of dying?

Angioplasty and stent placement are trickier to perform in smaller blood vessels, and there is an increased risk of tearing the artery. Women have smaller blood vessels than men, mostly because their bodies are typically smaller than men's. But research also shows that women have smaller blood vessels even when compared with men of a similar size.20, 21 In addition, smaller patients are more prone to bleeding problems during angioplasty and stenting.

Do women have more bleeding problems?

Women consistently experience more bleeding problems than men after angioplasty. In studies from the 1990s women were 2 to 3 times more likely than men to experience such complications during angioplasty procedures. In the early days of balloon angioplasty and stent placement, high doses of blood thinning medications were used—increasing the risk of bleeding problems particularly among women, the elderly, and petite patients. Now, doses of blood thinning medications are adjusted according to the patient's body weight, which reduces the risk of bleeding complications.22

After angioplasty, the sheath that was placed when the catheter was inserted is removed. The more traditional method is to wait 4 to 6 hours until the effects of the blood thinning drugs have worn off and then to apply pressure while removing the sheath. Studies suggest that removing the sheath earlier reduces the risk of bleeding complications.22, 23

What other complications can occur?

A clogged artery that has been widened with balloon angioplasty can snap shut after the procedure. While rare, this complication has a high risk of death.24-26 It is far less likely to happen if a stent is left in place to prop open the artery compared with balloon-only angioplasty.27, 28

Angioplasty procedures may cause tears in the arteries of the heart. Women and the elderly are more prone to this rare but serious complication, probably because of their smaller blood vessels. These artery tears occur more often with devices other than balloons or stents, such as atherectomy devices that cut through hardened, fatty plaque.29 Atherectomy devices are generally larger than balloons or stents, and the procedure is more aggressive and thus more likely to injure the artery.

In rare cases, stent implantation damages the wall of the artery, triggering the formation of a life-threatening blood clot (thrombosis). Improvements in stent techniques and anti-clotting medications have greatly reduced the chances of this occurring. See the section on drug-coated stents for information about blood clot complications that may be related to this kind of stent.

Filed in Treatment & Recovery > Angioplasty


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