Treatment Options

Balloon Angioplasty with Stent Placement for Coronary Artery Disease

Significant Value

The coronary arteries are blood vessels that carry blood and oxygen to the heart muscle. Coronary artery disease occurs when these arteries become clogged with fatty deposits (plaque). Plaque forms in the arteries over many years in a process called atherosclerosis. As plaque builds up, the artery opening gradually narrows and becomes clogged. Coronary artery disease is the single leading cause of death in the U.S. It accounts for over 950,000 deaths a year, which is about 1 death every 33 seconds.

One method of reopening or enlarging the pathway within a blood vessel is a balloon angioplasty procedure. Balloon angioplasty involves inserting a catheter that has a deflated balloon at its tip into the narrowed part of a blood vessel within the heart. Once in place, the balloon is inflated, compressing the arterial plaque and enlarging the space within the blood vessel. This restores normal blood blow to the heart muscle. The balloon is then deflated and the catheter and balloon are removed.

Approximately 40 individuals in every 100 experience a re-narrowing (restenosis) of the treated blood vessel within 6 months after a balloon angioplasty procedure alone. In certain individuals, the placement of a stent within the treated blood vessel can reduce the chance that re-narrowing will occur after balloon angioplasty. Stents are wire mesh tubes used to prop open arteries after a balloon angioplasty.

Since the placement of a stent can cause significant scarring within smaller blood vessels, approximately 20 individuals in every 100 will experience a re-narrowing of the treated vessel within 6 months after stent placement. Physical characteristics of the treated vessel, as well as other conditions may place individuals at a higher risk for re-narrowing, or blockage, than others. In order to prevent the scarring associated with stent placement, researchers have developed a drug-coated stent. The drug-coated stent releases a drug for a brief period of time after the stent is initially placed within the blood vessel. The drug reduces the risk of scarring and subsequent re-narrowing.

Things to Consider

  • Coronary artery disease (CAD) occurs when coronary arteries become clogged with fatty deposits (plaque).
  • Balloon angioplasty compresses the arterial plaque and enlarges the space within the blood vessel, thus restoring normal blood flow to the heart muscle.
  • In certain individuals, the placement of a stent within the treated blood vessel can reduce the chance that narrowing will reoccur after balloon angioplasty.
  • The best choice of treatment depends largely on the severity of the individual's CAD.

See also:

Results

Significant Value

Will I live longer if I have this procedure?

Balloon angioplasty with stent placement is typically associated with prolonged life in appropriate individuals when compared to noninvasive alternatives or no treatment. An untreated narrowed or blocked blood vessel within the heart can cause a heart attack and sudden death.

Will a balloon angioplasty improve my quality of life?

Treatment with balloon angioplasty and stent placement can improve your quality of life. The pain and physical limitations associated with a narrowed or clogged blood vessel within the heart are improved when these procedures are done.

Will the treatment of coronary artery disease with balloon angioplasty and stenting improve my cardiac symptoms?

This procedure is typically very successful in reducing most or all of an individuals cardiac symptoms caused by coronary artery disease. 

Safety

Moderate Value

Though rare, significant complications can be associated with a balloon angioplasty procedure and/or stent placement. A small percentage of individuals need emergency coronary artery bypass graft surgery or CABG when the procedure fails to open the blood vessel or the treated vessel ruptures as the balloon is inflated.

At present, there is no evidence of long-term complications associated with having a permanent stent.  However, because of scar tissue build up at the stent site, some stented arteries may re-narrow over time and need a repeat balloon angioplasty procedure.

Comparison

Significant Value

The options of non-surgical treatment (changes in lifestyle, medication), balloon angioplasty and stenting, or CABG depend largely on the severity of the individual's coronary artery disease. Individuals who have narrowed blood vessels of the heart with no significant decrease in blood flow can alter their lifestyle and take medications to reduce the chance of further narrowing of the affected vessel(s).

If blood flow to the heart is diminished, balloon angioplasty and stenting can restore normal blood flow and reduce the risk of re-narrowing. In individuals with multiple areas of blood vessel narrowing or blockage, CABG is generally recommended.

Cost

Significant Value

The cost for balloon angioplasty with stent placement generally ranges from $30,000 to over $48,000.

The cost may or may not be covered by your health benefits plan.

Sources

The following are off-site links off-site link :

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CardioSmart. American College of Cardiology. (2012, February). Angioplasty for heart attack and unstable angina. Retrieved January 8, 2014 from https://www.cardiosmart.org/Healthwise/tx43/03/tx4303.   

 

MayoClinic.com. (2010, December ). Coronary angioplasty and stents. Retrieved January 8, 2014 from http://www.mayoclinic.com/health/angioplasty/MY00352.  

Next Review Date

1/23/2015

This document has been classified as public information.

Table of Findings

results:  significant value

safety:  moderate value

comparison:  significant value

cost: significant value


total: significant value

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Page modified:January 31, 2014