Encyclopedia of Health and Medicine

anticoagulation therapy 13
ment arteries. The cardiovascular surgeon may also
use angioplasty to remedy occlusions in arteries
other than those supplying the HEART, such as to
treat PVD affecting the larger arteries in the legs.
Procedure
Angioplasty is almost always an AMBULATORY SUR-
GERY (same-day) procedure, or at most requires
one night in the hospital for recovery and observation
following the procedure. The cardiologist
uses local ANESTHETIA and general SEDATION to make
the person comfortable. After numbing the location
with local anesthetic the cardiologist inserts a
catheter into an ARTERY near the surface of the
body, typically the femoral artery in the groin, and
threads it into the occluded artery. Injected dye
helps the cardiologist to visualize the catheter’s
progress using FLUOROSCOPY (moving X-ray), which
displays the images on a closed circuit monitor.
Once the catheter is in position at the occlusion,
the cardiologist uses a syringe to inject a
small amount of sterile solution through the
catheter to inflate a tiny balloon at the catheter’s
tip. The balloon applies pressure against the walls
of the artery, expanding the channel through
which blood flows. The cardiologist may deflate
the balloon, advance the catheter, and reinflate
the balloon to widen a larger segment of the
artery. The procedure usually compresses accumulations
of ATHEROSCLEROTIC PLAQUE (atheromas) to
reduce their intrusion into the arterial passageway.
The cardiologist may also use the catheter to
place a STENT, a tiny springlike device that maintains
pressure against the arterial wall to help
maintain the widened channel in the artery at the
site of the compressed atheroma.
Risks and Complications
Risks during the angioplasty include HEART ATTACK
or STROKE from dislodged atherosclerotic plaque
(which is rare), excessive bleeding, trauma to the
artery, and irritation of the heart that causes
ARRHYTHMIA. The cardiac catheterization facility or
hospital where the cardiologist performs the
angioplasty is equipped and staffed for immediate
cardiac surgery if necessary. More common complications
are bleeding and PAIN at the catheter
insertion site, or INFECTION following the procedure.
The cardiologist may choose to administer
prophylactic ANTIBIOTIC MEDICATIONS, particularly in
people who are at risk for bacterial ENDOCARDITIS.
The most common complication of angioplasty
is restenosis (reclosure) of the artery, either from
the compressed atheroma reexpanding or from
continued atherosclerotic processes that create new
atheromas. About half of people who undergo
angioplasty experience restenosis within two years.
About a quarter have clinically significant restenosis
within six months and must have a repeat
angioplasty or CABG to restore blood flow to the
heart. Repeat angioplasty is generally less successful,
and carries a higher risk of damage to the
artery. As atherosclerosis progresses, which it tends
to do, other coronary arteries occlude as well.
Outlook and Lifestyle Modifications
Angioplasty is a temporary measure for most people,
providing relief of symptoms for six months to
two or three years. However, angioplasty does not
treat the underlying disease process, which is
likely to continue even with medical interventions
such as lipid-lowering medications to slow its
progress. Most arteries tend to reocclude. Some
people are able to undergo multiple angioplasty
procedures over time though others must look to
different treatment options such as CABG. The
most effective outcomes are those that follow the
angioplasty with lifestyle changes to improve cardiovascular
health such as WEIGHT LOSS AND WEIGHT
MANAGEMENT, daily physical activity, and SMOKING
CESSATION.
See also ATHERECTOMY; DIABETES AND CARDIOVAS-
CULAR DISEASE; MEDICATIONS TO TREAT CARDIOVASCULAR
DISEASE; PHYSICAL EXERCISE AND CARDIOVASCULAR
HEALTH; SURGERY BENEFIT AND RISK ASSESSMENT.
anticoagulation therapy Prophylactic (preventive)
treatment with medications to reduce the
risk of BLOOD clots, broadly including approaches
that inhibit various stages of COAGULATION. Anticoagulation
therapy is common treatment for a
number of cardiovascular conditions including
ATRIAL FIBRILLATION, INTERMITTENT CLAUDICATION, DEEP
VEIN THROMBOSIS (DVT), PULMONARY EMBOLISM, and
VALVULAR HEART DISEASE, and following MYOCARDIAL
INFARCTION (HEART ATTACK) and cerebral infarction
(ischemic or thromboembolic STROKE). Anticoagulant
medications prevent new clots from forming