An Interview with Dr. Shirish Hiremath on Angioplasty
Angioplasty is a procedure that is used to dilate any blockage in the artery using a catheter tipped with a small balloon. PTCA or Percutaneous Transluminous Coronary Angioplasty is widely used across the world to treat some critical conditions of the heart.
Question : Can I be off medicines after PTCA?
Successful angioplasty is not a passport to trouble-free future. The cholesterol deposits can take place elsewhere a few months or a few years later. It is like 'aging' for the heart and we all know we can only get older!! It is nature’s law. Hence the care to prevent blockages must go on forever. Never forget to take your tablets. Blood thinners are always given and are a must to keep the stent open. Commonly used blood thinners: Aspirin for all; plus one of the three - clopidogrel (Brand names: Clopitab, Plavix), prasugrel (Brand names: Eftient, Prasudoc, Prasita), and ticagrelor (Brand name: Brilinta).
Question : Why are medicines required after PTCA?
Answer : Medicines are very strongly required in initial months (especially first 3 to 12 months). They generally are later reduced to some extent. The medication requirement is also dependent on the kind of stent that is used; the older generation stents would require medicines for a long, long time while the recommendations for newer generation is about 3 months. Aspirin, however, is to be continued for life. Warning: Never stop these blood thinners on your own. It could lead to catastrophic events due to clot formation in stents, including sudden death. Occasionally, a non-heart related procedure, (e.g., tooth extraction or a prostate surgery) may necessitate stoppage of these medicines. If these other surgeries are not urgent, they are best delayed beyond 3 months. Stoppage of medicines has to be guided by your doctors. (Alternatively you could write to us on drmshiremath@gmail.com for advise/suggestion). Remember, temporary stoppage like these should be very brief and the drugs should be reinitiated as early as possible.
Question : Can these blood thinners cause bleeding by themselves?
Answer : Potentially, yes. However, they have been used for years and clearly under standard dosages. There are small red-black spots under the skin, which disappear on their own and are not unusual. But one must report these to the doctor. A dose-adjustment is possible, maintaining the benefit to the stents at the same time. Smart doctors will use minimum dose required, as occasionally major bleeding episodes have happened, (e.g., brain hemorrhage). Simply, daily issues like cuts during shaving can lead to prolonged ooze. One must, therefore avoid getting hurt or injured while on these blood thinners, especially in early months.
Question : Your advice on "post-angioplasty care."
Answer : Yes, angioplasty will certainly bring joy to your life, but one must remember a little extra care can give a lifetime of happiness!!
Question : Is angioplasty here to stay?
Answer : The reality is "angioplasty is here to stay!!" It is meant for a lifetime relief from heart trouble, and truly, the stents, once implanted can be good for life. Any problem that can possibly occur with the stent could be in its first 6 months only, and beyond 6 months, the stents will never ever trouble a person. The stents develop a thin layer of coating (just like a plaster finish on a brick-wall) in about 3 weeks. This makes the surface very smooth and permanently healthy. Occasionally, this layering process can become uncontrolled leading to narrowing from inside the stent. This happens in first 3 months only, and hence, it is said that after its initial 6 months the stent will never ever narrow. It happens in very few cases and certainly a negligible percentage with the newer generation of stents. The suggested remedy is that we take care of controlling the risk factors in the remaining vessels and segments, for obvious reasons, which are normal at the time of angioplasty. Remember, the same vascular tree goes from head-to-toe and lack of control on risk factor could lead to (apart from the heart arteries) narrowing of the arteries of brain (presenting as cerebrovascular attack and paralysis), leg (leading to pain while walking which can ultimately lead to leg gangrene and amputation). The clot formation inside stent is altogether a different issue and is almost 100% preventable with regularly taking the blood thinner tablets. This too happens in initial weeks and hence one should never forget to take tablets in these important initial months.
