Why is thrombectomy/angioplasty just as effective as stent placement?
I understand that many (most) MIs are now thought to be the result of plaque rupture and subsequent thrombosis. I also understand that many locations of plaque rupture may not represent a significant occlusion due to plaque. Given that PCI hasn’t been shown to decrease morbidity or decrease the risk of an MI, why are stents used in such cases of revascularization? Is there some reason why thrombectomy/angioplasty wouldn’t be expected to be just as effective without the stent placement?
Submitted by Andrew from Iowa on 09/09/2016
Dear Andrew: When a plaque ruptures, the underlying layer of the artery is exposed which triggers clot formation. That is why we don’t bleed to death from cuts. However, when this ‘cut’ occurs in the inside the blood vessel, it triggers an occlusive clot. Most of the time all that is needed is to plaster the lining of the blood vessel over the exposed area. The existing clot is washed away and dissolved. When there is a lot of clot ‘burden’ present, it seems to make sense to physically remove the extra clot. Although the immediate cosmetic result is often good, the long term benefit remains to be proven. Covering the denuded area with a stent appears to be the best treatment at this time. Sincerely.