Introduction
Continuous accumulation of cholesterol deposits or plaques in the heart's arterial walls can result in clogging or blocking of the arteries supplying the heart, which can lead to symptoms like severe chest discomfort. Coronary angioplasty procedures are performed by heart surgeons (cardiologists) to unblock or unclog the blocked coronary arteries to widen the arterial diameter for improving blood circulation to the heart. Coronary angioplasty procedures help to improve symptoms like chest pain and shortness of breath. Coronary angioplasty is usually performed in patients with conservative and pharmacological management fails to resolve the conditions. Coronary angioplasty procedures are performed to decrease the risk of heart failure due to reduced blood flow to the heart.
What Is Coronary Angioplasty?
Coronary angioplasty is a surgical procedure performed by the cardiologist to unclog or widen the blocked coronary arteries (main arterial supply of the heart) to improve the blood circulation to the heart and reduce the associated symptoms like shortness of breath and chest pain (angina). It is performed using a balloon catheter (pipe-like apparatus) to widen the arterial walls. A coronary angioplasty procedure usually performed with simultaneous placement of a stent (a metallic tube placed to maintain the patency of the arterial opening) is called PCI (Percutaneous coronary intervention). The coronary angioplasty procedure is mostly performed under local anesthesia, and it takes an average of two to three hours to complete the procedure.
What Are the Complications That Can Trigger in Elder People After Coronary Angioplasty?
Although coronary angioplasty is a less invasive procedure, the cardiologist uses a balloon catheter (thin pipe-like apparatus) to widen the arteries and improve blood circulation to the heart. However, a few complications can trigger after coronary angioplasty in older people, such as:
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Formation of Blood Clots: There is a risk of the formation of blood clots within the stents after the procedure. The formation of clots can increase the risk of heart attack or cardiac failure in patients. Therefore, patients are usually kept on blood thinners to avoid clogging arteries like Clopidogrel and Aspirin after the coronary angioplasty procedure.
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Bleeding: Sometimes, there is an increased risk of bleeding or severe bleeding during the surgery, which may require blood transfusion procedures.
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Re-Narrowing of the artery or Restenosis: After the coronary angioplasty and stent placement, there is an increased risk of re-narrowing or restenosis of the arteries due to clogging again. It is mostly observed in cases where bare-metal stents are used.
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Risk of Cardiac Stroke: There is an increase in the risk of cardiac stroke if there is the migration of loose blood clots to the brain if it forms loose clots in the catheter. It is one of the most serious complications after coronary angioplasty procedures.
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Risk of Coronary Artery Damage: In the case of older people, the artery has more tortuous and rigid lesions with more advanced-stage coronary artery diseases. The calcification of the artery is more pronounced in older people, making it difficult to operate. Rupturing and damage to the coronary arteries become severe complications in such patients resulting in emergency bypass surgery. Coronary artery bypass surgery in older adults carries an increased risk of morbidity and mortality during the procedure but also improves the long-term survival rates.
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Abnormal Heart Rhythms: There is a high risk of increased heart rhythms in older patients during the procedure. It can be resolved by medications or a pacemaker (a tiny device placed in the heart to control heart rhythms).
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Increased Risk of Kidney Problems: In patients with kidney problems, kidney damage is increased due to the dye used in coronary angioplasty or stent placement procedures. It can also affect people with no history of kidney disease. So, it is recommended to control the usage of contrast agents during the procedure and advise the patient to keep themselves well hydrated.
There are various risks associated with coronary angioplasty procedures in elderly patients than in younger patients. However, complex coronary artery anatomy, multi vessels disease, bifurcation lesions, complete occluded arteries due to calcifications, and underlying cardiac disorders are a few other factors that increase the risk of complications associated with coronary angioplasty surgeries.
Who Is Under Risk of Complications From Coronary Angioplasty Procedures?
People who are at risk of having complications from coronary angioplasty surgeries are:
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In people above the age of 70 years old.
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A person with a previous history of kidney disease has decreased kidney functioning. Contrast agents used in the coronary angioplasty procedure can cause further damage to the kidney.
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People with underlying systemic diseases like diabetes, hypertension, or other medical conditions.
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People with severe heart disease or poor blood flow through the heart have weak heart functioning.
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Elderly women are at greater risk of complications from coronary angioplasty procedures because of hormonal imbalances and differences in blood vessels.
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Patients with multiple blockages are at greater risk.
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Patients with a history of heart surgery are at greater risk of complications from coronary angioplasty procedures.
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Elderly people consuming multiple medications are at higher risk of complications because of multiple drug interactions or adverse reactions to the drug before and after coronary angioplasty.
Conclusion
Percutaneous coronary Intervention (PCI) is the preferred surgical procedure in older age due to the reduced risk of complications and is less invasive. However, older people above sixty years have more tortuous and rigid artery lesions with increased calcifications, making it difficult to determine the prognosis of the condition after the surgery. However, the risk of complications completely relies on the severity of the disease condition, overall health, and other underlying disease conditions of the patient undergoing a coronary angioplasty procedure.
