PTCA: pros and cons

Advantages and disadvantages of the PTCA method

The primary success rate of PTCA is very high at over 90%. The patient has no puncture except for the puncture site, which has to heal and is almost immediately symptom-free and more efficient. This can be demonstrated the day after the examination in the exercise ECG.

The downside of the comparatively simple procedure is the high rate of relapse: in about one third of the patients, the dilation, despite medical support, only lasted a few months and the PTCA had to be repeated.

Tears in the vessel wall

To test the long-term outcome of the PTCA, a heart catheter examination will be performed again after about half a year. One possible complication of the procedure is the tearing of the vessel inner wall as a result of dilation. Smaller tears are often unavoidable and insignificant, while larger ones can affect the bloodstream. The doctor tries to glue them with the help of a new dilatation or with a stent. If this fails, usually a bypass operation is indicated.

Danger of a blood clot

It can also lead to the formation of a blood clot and the detachment of deposits, which then move with the bloodstream, completely close the vessel at a narrower point and so can lead to a heart attack. This may also be prevented by a new widening and a stent, drugs can dissolve the clot.

In case of failure, immediate emergency bypass surgery is essential, but less than 2 out of every 1, 000 patients are affected. In addition, the abducted material can also cause a closure of the pulmonary vessels (pulmonary embolism) or cerebral vessels (stroke).

Allergic reaction

Other rare but potentially life-threatening complications are cardiac arrhythmias, allergic reactions, or thyroid dysfunction due to the contrast agent, as in cardiac catheterization.

High risk of injury

Skin, soft tissue or nerve injuries at the puncture site, bleeding, inflammation, circulatory disorders and injuries to the punctured vessel are a little more common.

A fatal course occurs with an average frequency of about 0.05% of cases - the risk also depends on the pre-existing conditions and the age.

PTCA with stent or bypass op?

In a study of 3, 000 patients in Europe and the US (Syntax Study, 2008), dilation with stent care was compared with bypass surgery. Result: The PTCA is gentler, those affected seem to suffer less strokes thereafter. It usually has to be repeated in comparison to bypass surgery because of the high rate of relapse. Interestingly, neither method was superior in terms of mortality and heart attack rate.

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