When a cardiologist is not able to insert a heart stent, this is usually due to:
- Either the artery being blocked for a long time (called a CTO or chronic total occlusion, usually with severe calcification) or
- Because the artery is very tortuous and the narrowing is in an area which is difficult to reach
In the first instance, ie CTO, where the procedure has been unsuccessful - one could reattempt the procedure with further specialised equipment, and with experts who have specialised exclusively in opening up such arteries.
In the case of tortuous arteries, it maybe worthwhile reattempting the procedure with specialised kit, and a combination of two operators might also help.
During the initial attempt more often than not the operator is able to partially cross the narrowing even in severely occluded blood vessels and this may help in the subsequent attempt as a channel might open up.
However there is also the possibility that the artery might be damaged during the initial attempt and this can vary from a small tear to something more substantial even necessitating emergency surgery or other bail-out procedures. As with all invasive procedures a severe complication could be life threatening as well.
However in the case of blood vessels which have been blocked for a long time strange to say even in the event of unsuccessful procedure there maynot be a significant change in patients symptoms or outcome as the heart has coped with the previously occluded vessel for quite some time.