Typically, angioplasty and stents are for patients with more than 80% blockage in arteries supplying blood to the heart. “Broadly, the two conditions that are a must to perform an angioplasty would be worsening chest pain or a positive stress test.” The need for an immediate angioplasty after a routine or elective angiogram (an x-ray to examine blood vessels) is almost never needed.
A coronary angioplasty is a minimally invasive procedure to open clogged arteries of the heart. It is often followed by the placement of a small wire mesh tube called a stent, which is coated with medicine and helps keep the artery open. Around 500,000 to 700,000 angioplasties are performed in India every year, according to estimates by cardiology associations. However, there’s no survey to determine whether all of these are necessary procedures.
Unnecessary angioplasty carries its own long-term risks. “After the procedure, patients are placed on blood thinners, which can lead to complications like in-stent restenosis (re-narrowing of stented part of artery), especially if there is uncontrolled diabetes. Once that occurs, the blockage becomes even more severe, exceeding 90%. Why convert a healthy individual into a cardiac patient unnecessarily?”
For younger patients, suggests drug-coated balloon and laser-assisted angioplasty as better alternatives. “A stent placed at an early age will remain in the body for the patient’s entire life and can have its own effects. Drug-coated balloons make for stentless angioplasty, where the arteries remain natural, with less need for blood thinners. This keeps arteries ready for a future bypass, if needed. Laser-assisted angioplasty is also stentless and prevents re-blockages.” These alternatives are for patients with long (more than 25mm) and diffuse blockages, thin arteries (common in Indian diabetic patients), and stent failure.
“If a patient has chronic but stable chest pain, then emergency angioplasty is not required. There are advanced drug therapies for the condition.”
LAB PRESSURE:
The cost of an angioplasty ranges between Rs 1.5 lakh and Rs 3.5 lakh in private hospitals. “The scheme gets approved based on heart blockage diagrams submitted by doctors. If the angiography CD is not reviewed by a qualified cardiologist, false blockages can go unnoticed.” “Rising competition has turned cardiology into a business. In just five years, the number of cath labs in the Kandivali to Mira road are has increased to fivefold.”
“We rely on advanced tests like the thallium stress test, which assess blood flow to the heart muscle. Even in cases of 50-60% blockage, a decision should be guided by comprehensive medical evaluation rather than haste or financial motives.”
KNOW WHEN YOU NEED ONE:
However, stray instances of medical fraud should not diminish the importance of angioplasty, whether elective or emergency, cautions. “In most cases, these are life-saving procedures ones that are planned rather than emergency ones. However, if the cardiologist suggests an angioplasty during the angiogram session and the patient has doubts, another cardiologist in the same hospital can be consulted with permission. It’s very unlikely that two doctors will give incorrect advice.”
“Refusing angioplasty in an emergency and taking the patient home due to lack of trust can be extremely risky.”
FIVE THINGS TO DO BEFORE THE ANGIOPLASTY:
- PROPER KNOWLEDGE – Have complete information about the type and location of blockage, and the number of arteries involved. If blockage is partial and large arteries are not affected, medication can be considered.
- TIME TO THINK – Don’t be in a hurry to get the procedure done, except for heart attack cases and when there is excruciating chest pain. Anybody can walk 500 m to 1 km distance without chest pain or exertion can take some time.
- SECOND OPINION – If you are not satisfied with the doctor’s suggestion, you should get a second opinion. Carrying t he angiography film is important because reports may not give a clear picture.
- DON’T BE TOO CYNICAL – In cases of acute heart attack or excruciating or increasing chest pian, angioplasty or surgery is needed. Delay can prove to be life-threatening.
- ASK FOR DETAILS – You must ask the doctor or hospital to mention full details of the stent – company name, manufacturing date, code and size — used on the discharge summary. This will prevent a cheaper stent being used at inflated cost.