Clinton procedure considered relatively routine

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Former President Bill Clinton underwent a balloon angioplasty to clear a clogged coronary artery Thursday at a New York City hospital, and two stents were inserted into the artery to keep it open.

Clinton had been suffering from chest pain, and his cardiologist suspected the blockage and admitted him to New York Presbyterian Hospital for the procedure, which is considered relatively routine.

Clinton was reported to be in good spirits following the procedure, which is performed through a catheter inserted into a blood vessel in the groin, under minimal sedation. Clinton’s immediate and long-term prospects are considered to be good.

At least 1.25 million Americans undergo the procedure each year, and the outcomes are generally good. A balloon on the end of the catheter is inflated at the site of the blockage to compact the plaque against the artery walls. Then, using the same catheter, surgeons leave behind a stent — a small, spring-shaped piece of wire that keeps the plaque from expanding again.

When the procedures were first used, the wires were bare and the rate of reclosure of the artery was relatively high. More recently, surgeons have favored so-called drug-eluting stents, which slowly release drugs that help to prevent reclogging.

In 2004, Clinton underwent quadruple bypass surgery to correct four blockages in his arteries. Surgeons used mammary arteries taken from under the breast and veins from the leg to bypass the blocked areas. Bypass was probably chosen then because four sites had to be corrected and because bypasses were then considered more effective than angioplasty.

Apparently, one of the bypasses has itself become clogged, not a highly surprising development considering Clinton’s well-known proclivity for cheeseburgers and other fast foods.

Several questions remain that could affect Clinton’s overall prognosis. The hospital has not yet said whether the angioplasty was performed in one of the bypasses or in his original arteries. If it was in one of the bypasses, it is useful to know whether it was an artery or a vein, said Dr. Michael Lee, an assistant clinical professor of medicine at UCLA’s Ronald Reagan Medical Center.

If the stent was placed in the original artery or in the artery that was used for a bypass, statistics suggest there is about a 98% chance that it will remain open a year later, he said. If it was placed in a vein used for a bypass, the odds would be somewhat lower — about 80% to 85%. Also, little data is available about the long-term outcomes for stents placed in veins.

-- Thomas H. Maugh II