Recuperation. Angioplasty is less invasive than bypass surgery, requiring only one night in the hospital. Recuperation takes about a week. It should be pointed out the chest pain after the procedure is very common and usually due to problems other than ischemia. Chest pain is even more common when a stent is used, possibly because the artery is stretched.

Short-Term Complications:
Reclosure During or Shortly after Angioplasty. Reclosure of the artery during or shortly after angioplasty is often but not always due to blood clots. Aspirin, heparin, coumarin, or combinations of anti-clotting drugs are generally used during and after the operation. Aspirin is more effective than heparin. New anti-clotting agents (tirofiban, abciximab, argatroban, clopidogrel, or bivalirudin) may be more effective for preventing reclosure, often when administered in combination with heparin or aspirin. Anti-clotting drugs are not wholly protective, in any case, because reclosure in some cases is due to other, unknown causes.

Long-Term Complications:
Reclosure (Restenosis) Within a Year of Angioplasty. Narrowing or reclosing of the artery (restenosis) occurs within a year of angioplasty in nearly half of angioplasty patients, often requiring a repeat operation. Reclosure, in this case is not due to blood clots and so anti-clotting agents are not useful. Theories for the cause of restenosis include the following:

• The release of large amounts of oxidants (damaging unstable particles) at the surgical site may activate damage in certain white blood cells that causes overgrowth in smooth muscles in the blood vessels. With this theory in mind, researchers have tested an antioxidant drug, probucol (Lorelco), with some success. Other drugs that are being investigated for their ability to limit smooth muscle growth include verapamil, a calcium channel blocker, and a protein called angiopeptin.
• Some experts argue that other activities, such as scarring, may remodel and narrow the blood vessels.

A number of approaches, including coronary stents, have been developed to prevent restenosis.

• Radiation treatment of the site is used to prevent reclosure, although some experts are concerned about its long-term safety. Studies suggest, however, a high rate of late blockage occurring after angioplasty within two to 15 months in patients who receive radiation treatments.
• Directional atherectomy has been another attempt to solve the problem of reocclusion of the blood vessels. A balloon catheter is inserted for determining position; then, a tiny cutter spinning at 2,500 rpm removes plaque fragments from the arterial walls. The use of angioplasty with the coronary artery stent, however, is proving to be safer and more effective.