Angioplasty is a safe procedure when done by experts. When the patient is above 75 years, the procedure becomes technically difficult because of age-related changes that occur in the body.The arteries in the body become hard due to deposits of calcium. In those who develop heart attack due to fresh blood clot formation, dilating the artery with balloons and implanting stent/s is relatively easier due to the soft nature of block.

In those who dont develop a heart attack but suffer chest pain (angina) not amounting to a heart attack, the blocks are relatively difficult to negotiate because these are formed due to a hard matrix containing calcium and other natural salts in addition to fat.

Many people may have 100 per cent blocks, which might necessarily not cause any symptoms. This is because they develop blocks over a period of time and the blocked vessel develops smaller channels called collaterals, which tend to grow in size and number as time passes.

The mathematics of blocks is not simple. Some people may have multiple blocked vessels but doctors may advise only lifestyle modifications and medical managements in the form of oral pills that keep blood thin (aspirin) and keep cholesterol low (statins).

Some individuals who have only a single block may require an angioplasty or even bypass surgery.

If the block is in the left main parent vessel then bypass surgery is advised. If there are focal blocks (one or more) they can be addressed by angioplasty.

The process of recovery involves recovery at the heart level and at the site where the blood vessel was punctured (groin/hand) to gain access to the heart.

Those who are elderly they have unusual risk involved due to age related changes occurring in the body.

Risks in the elderly

Stroke/paralysis: Due to deposits of cholesterol in the internal linings of blood vessels, these cholesterol particles may get dislodged due to catheter manipulations. If they get into the blood vessels of the brain or elsewhere it might lead to a stroke/paralysis. Often, if it is a small area, recovery is complete without permanent residual damage. But if its large, the patient might not recover completely.

Bleeding: During angioplasty the doctor administers blood thinning medication through the saline drip and also orally. These are required so that the angioplasty site does not develop a fresh blood clot. Often the puncture site may continue to bleed sometimes requiring blood transfusions and prolonged hospitalisation. This may occasionally leave a painful swelling at the puncture site but it resolves gradually over a period of time.

Kidney Failure: Relative compromise of kidney functioning as a background plus use of radio-contrast for angiography/angioplasty may sometime cause kidney damage in the elderly. Often recovery is complete but in those whom functioning of kidneys is already marginal and those who have diabetes mellitus might require dialysis subsequently.

Procedure related: In elderly people due to calcification of blood vessels, negotiating blocks with balloons and placing stents is not easy. It involves the use of costly appliances to burr the calcium laden solid area with special machine/ modality called Rota-ablator. Considering all this it may take an unusually long time.

But in expert hands, angioplasty is safer than bypass surgery in the elderly (especially those above 80 years). In angioplasty all the blocks need not be addressed. Doctors can decide based on the physiological importance of the blocked vessel and focus on the culprit vessel alone and leave the rest to medicines and nature.

The writer is a Consultant Interventional Cardiologist based in Mumbai.

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