Thrombolytics and angioplasty
A class of drugs called thrombolytics and a procedure called angioplasty with or without stenting are both types of reperfusion therapy—ways to open up your blocked coronary artery
during a heart attack and restore blood flow to your heart. Your doctor may also use the term "percutaneous coronary intervention" to describe angioplasty with or without stenting.
Thrombolytics
A thrombus is a blood clot that blocks your coronary artery during a heart attack. Thrombolytics are medicines that can dissolve the clot in your arteries by helping your body's own clot-dissolving mechanism. Thrombolytics are given intravenously (by IV).
Angioplasty with or without stenting (percutaneous coronary intervention)
During angioplasty, the doctor threads a thin flexible tube called a catheter into your blocked coronary artery. At the end of the catheter is a tiny balloon. The doctor inflates the balloon inside the artery to open the blocked area. The doctor may also put in a stent that will expand the artery to keep it open.
The goal of these treatments is to limit the amount of damage to the heart. People who are treated with thrombolytics or angioplasty soon after their heart attack often have much less damage to the heart than those who do not receive these treatments. They are also much less likely to die from the heart attack or to develop complications such as heart failure.
Differences between angioplasty with or without stenting and thrombolytics Factor
Angioplasty with/without stenting
Thrombolytic drug therapy
Advantages
- Effective for opening up the blocked coronary artery for people having a heart attack
- Allows doctor to evaluate all of the major coronary arteries for other blockages and possibly treat them
- More successful than thrombolytics in restoring blood flow
- Lower risk of serious bleeding compared with thrombolytics
- A good option for people in cardiogenic shock
- Widely available
- Not an invasive procedure
- Can be administered in any hospital at any time of day
- Requires only close monitoring
Disadvantages
- May not be available because many hospitals (especially those in rural areas) do not have the staff and other resources needed to perform urgent angioplasty
- Not always available for emergencies
- Some people with other serious medical problems may not be able to have this procedure.
- More demanding to perform on someone having a heart attack
- Less effective in people with cardiogenic shock
- Less likely to restore normal blood flow to the heart than angioplasty
Risks
- Small risk of damaging the artery in which the catheter is placed
- Small risk of kidney failure related to use of dye
- Small chance of severe bleeding in the brain
- Other serious bleeding can occur
The scientific research conducted to date has not shown conclusively which reperfusion treatment is better in all cases. The American College of Cardiology/American Heart Association guidelines for treating a heart attack recommend percutaneous coronary intervention (angioplasty) for initial treatment of a heart attack as long as the following conditions are met:1
Conditions for an angioplasty Condition
What it means
Angioplasty with or without stenting is performed by physicians skilled in the procedure.
Physician performs more than 75 procedures per year Angioplasty with or without stenting is performed in a high-volume medical center supported by experienced nurses and technicians.
Medical center performs more than 200 procedures per year The guidelines also recommend angioplasty with or without stenting for people who cannot take thrombolytic medicines because they have a high risk of bleeding and for people who are having a heart attack and are also in cardiogenic shock.
| Author: | Robin Parks, MS | Last Updated: May 14, 2007 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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