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Angioplasty & Stents - Other Devices

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Angioplasty & Stents
Risks
Effectiveness
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 devices besides balloons and stents can be used?

In addition to balloons and stents, other devices are sometimes used during angioplasty. These include diamond-tipped atherectomy devices that break up hardened plaque, rotating blades that cut through the blockage, and laser-tipped catheters to zap the plaque or blood clot into tiny pieces that are washed away into the bloodstream. These devices are rarely used instead of balloons or stents but they may be used to pre-treat problematic blockages—for example, one that is very hard or calcified. Because these techniques are more traumatic to the blood vessel than balloons or stents they have a higher rate of complications, including tears of the artery. Women are more susceptible to these complications, probably because their blood vessels are smaller.

What are distal protection (clot-catching) devices?

During angioplasty, the blood clot and fatty plaque blocking the artery is broken up into smaller pieces and washed into the bloodstream, but it is not removed. There is some concern that these smaller pieces may cause problems further downstream, perhaps blocking or restricting blood flow in some of the tiny blood vessels. Distal protection devices, so-called because they protect areas distal to (far away from) the actual blockage, capture and retrieve blood clots and fatty plaque.

Distal protection devices have mostly been studied in bypass surgery patients who develop blocks in their bypass grafts (the healthy artery sewn around the blockage to allow blood flow to bypass it). However, some small studies have found that they also have benefits when used for angioplasty in patients with unstable angina or a heart attack, including increased blood flow to the heart and a lower risk of additional cardiac events during the first month after a procedure.82-85

What are thrombectomy devices?

Thrombectomy devices remove blood clots or thrombus before angioplasty for a heart attack (“-ectomy” means “to cut out” as in tonsillectomy). As of yet, there are no large studies comparing these devices with regular angioplasty.

A pooled analysis of all the available studies on these devices suggests that they should be used selectively. Overall, they do not help reduce the chances of the artery renarrowing and they may in fact increase the risk of future problems including heart attack.86



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