Success clearing clogged arteries

Angioplasties—procedures to open blocked arteries—have been successful about 10 percent more often in recent years than they were in the mid-1980s, and patients treated a few years ago were about 40 percent less likely to need later angioplasty or surgery than were patients a dozen years earlier.

Using national registries, David O. Williams of Brown University in Providence, R.I., and his colleagues compared records for 1,559 people who underwent angioplasty in 1997 or 1998 with the outcomes of 2,431 people getting similar treatment in 1985 or 1986. Angioplasty, in which a surgeon threads a small balloon through a person’s arteries and then inflates it, was the only procedure used on the 1985-1986 patients. It successfully opened the blocked arteries 82 percent of the time.

By 1997, cardiologists were regularly inserting mesh tubes called stents into patients’ arteries to hold them open after angioplasty (SN: 1/27/01, p. 54). They less frequently used other techniques, such as atherectomy, a procedure to scrape away excess fat. In 92 percent of the 1997-1998 cases, the procedures successfully opened blocked arteries.

Within a year after their initial angioplasty, almost 13 percent of the people treated in 1985 or 1986 developed further artery blockage and underwent heart-bypass surgery, compared with about 7 percent of those in the 1997-1998 group, the researchers report in the Dec. 12, 2000 Circulation.

Doctors added stents to angioplasty in about 64 percent of the 1997-1998 treatment group. They used atherectomy along with angioplasty and stents in 6 percent of patients and atherectomy with angioplasty but no stents in another 3 percent.

“Patients were older and sicker [in the 1990s group] . . . and in spite of that, they had better results,” says Williams. Stents, he says, can probably take most of the credit.