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Angioplasty & Stents - Angioplasty After Clot Busters

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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

If clot busters fail, should you undergo angioplasty?

If clot busters fail to work, angioplasty is sometimes performed—this is called “ rescue angioplasty.” There are no large studies testing whether rescue angioplasty works. Rescue angioplasty restores blood flow to the heart in a high number of patients but it is not clear whether this translates into a reduced risk of dying. Rescue angioplasty is much riskier than regular angioplasty because of the high risk of bleeding problems and complications.73 Women and the elderly are particularly prone to bleeding problems with rescue angioplasty.74 In addition, the chances of the artery renarrowing are higher after rescue angioplasty than after traditional angioplasty and patients who fail rescue angioplasty have a high risk of dying.75, 76

If clot busters worked, is there an additional benefit for angioplasty?

Historically, studies have found that routine angioplasty after successful clot buster treatment results in more bleeding problems, emergency bypass surgery, and a possible increased risk of dying.28 It has been argued that these studies are out of date because they were conducted before the wide use of stents and reduced doses of blood thinning medications. More recent studies are generally small, but several have found that angioplasty (with stents) after clot buster treatment reduces the risk of dying or having a heart attack and preserves heart function better than clotting medication alone, without an increase in bleeding problems.77, 78

Heart attack patients who continue to show signs of restricted blood flow to the heart after clot buster treatment are known to benefit from additional procedures. In this situation, angioplasty or bypass surgery reduces the risk of having chest pain or another heart attack, but does not prolong life.79

What is "facilitated angioplasty"?

Angioplasty may be combined with lower doses of clot busters or with blood thinning drugs called glycoprotein IIb/IIIa inhibitors (the so-called “super aspirins”), or a combination of the two. This is known as facilitated angioplasty (the drugs facilitate unblocking the clogged artery). Research suggests that combining angioplasty and low-dose clot busters is no better than angioplasty alone for reducing the risk of dying or having a heart attack or stroke.80 There is a suggestion that it restores stronger blood flow to the heart than angioplasty alone.81 The facilitated angioplasty strategy may offer some advantages over clot busters alone, however, this treatment has a higher risk of bleeding problems. Current guidelines state that this facilitated strategy may be considered for high-risk patients when there is likely to be a long delay before angioplasty and there is a low risk of bleeding.54

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