Angioplasty and Stents: When They Help and When They Don't

Diagram of a balloon and stent opening a narrowed coronary artery

Angioplasty with a stent can save lives during a heart attack, when a blocked artery needs to be reopened fast. For stable coronary artery disease, where narrowing causes chest pain on exertion but no attack is underway, large trials found that adding a stent to good medical treatment did not lower the risk of heart attack or death.

That gap surprises many patients. If you or someone you care for has been offered a planned (non-emergency) stent, this guide explains what the procedure does, where the evidence is strong, where it's weaker, and what to ask.

Key takeaways

  • Emergency use is well supported: the NHS says angioplasty after a heart attack can improve survival compared with clot-busting drugs and lower the chance of another heart attack.
  • Stable disease is different: the COURAGE and ISCHEMIA trials found no reduction in death or heart attack from routine stenting on top of optimal medicines.
  • Symptom relief is the main reason for planned stenting, usually when angina isn't controlled by medicines.
  • Medicines matter after a stent: most people take two blood thinners for up to a year and must not stop them early.
  • Asking questions is normal: a second opinion before a planned procedure is reasonable.

What does angioplasty actually do?

Coronary angioplasty widens narrowed or blocked coronary arteries, the vessels that supply the heart muscle. When a stent is placed, it's often called percutaneous coronary intervention, or PCI.

According to the NHS, you're usually awake with local anesthetic. A thin tube (catheter) goes in through a small cut in the wrist, arm or groin and is guided to the heart using X-ray video. A small balloon is inflated at the narrowed section to push the artery open, and a stent, a small wire mesh tube, is usually left in place to keep it open. The procedure usually takes between 30 minutes and 2 hours.

After a planned procedure for angina, many people go home the same day or the next day. After a heart attack, the hospital stay is often several days.

When does angioplasty clearly help?

During a heart attack

In a heart attack, a coronary artery is suddenly blocked and heart muscle starts to die. Reopening it quickly limits the damage. The NHS states that emergency angioplasty after a heart attack can improve survival compared with clot-busting medicines and reduce the chance of another attack. This is the setting where stents have their strongest record.

If you think someone is having a heart attack, call emergency services right away. The NHS lists warning signs such as tight or squeezing chest pain that may spread to the arms, neck or jaw, shortness of breath, feeling sick, sweating, and pale or gray skin. Don't drive yourself to hospital.

Angina that medicines don't control

The NHS also lists angioplasty for angina (chest pain from reduced blood flow) that isn't controlled well enough by medicines. Here, the main aim is to ease symptoms and improve day-to-day life.

What do the big trials show for stable heart disease?

Most planned stents are placed in people with stable coronary artery disease. Three trials shaped how cardiologists think about this group.

TrialWho took partWhat it found
COURAGE (published 2007)2,287 people with stable coronary disease in the US and CanadaOver a median 4.6 years, adding PCI to optimal medical therapy did not reduce death, heart attack or hospital admission for acute coronary syndrome. A longer follow-up found no survival benefit.
ORBITA (published 2017)200 people with stable angina at UK sitesCompared PCI with a placebo (sham) procedure. At six weeks, PCI did not increase exercise time more than placebo, and angina scores were similar in both groups.
ISCHEMIA5,179 people with moderate or severe ischemia on testingOver a median 3.2 years, an initial invasive strategy did not reduce cardiovascular events or deaths compared with an initial conservative strategy.

ORBITA was small and short, and it has been debated. But taken together, the message is consistent: for many people with stable disease, a stent doesn't extend life or prevent heart attacks beyond what good medical care achieves. It may still help symptoms in people whose angina persists despite treatment, and some patterns of disease are often treated differently, which is why individual advice matters.

What is "optimal medical therapy"?

The comparison in these trials wasn't "do nothing." It was a full program of medicines and lifestyle change. The NHS lists the main medicines used for coronary heart disease:

  • Blood thinners such as low-dose aspirin or clopidogrel, to reduce clot risk
  • Statins, to lower LDL cholesterol
  • Beta blockers, which slow the heart and are used for angina and high blood pressure
  • Nitrates, which widen blood vessels and relieve chest pain
  • ACE inhibitors, which relax blood vessels and ease the heart's workload

Alongside these, stopping smoking, eating well and regular exercise all lower the risk of further problems. Diet is one piece you control day to day; see our guides on fruits that help reduce cholesterol and farmed vs wild salmon for heart health. For a broader look at whether procedures fix the underlying disease, read does heart attack care treat the cause or just symptoms?

What are the risks and what is recovery like?

The NHS describes the risk of serious problems as small, but it depends on your age, general health and whether the procedure is planned or an emergency. Possible complications include:

  • Bleeding or bruising where the catheter went in (common)
  • Damage to the artery used for access, or to an artery in the heart
  • Allergic reaction to the contrast dye
  • Heavy bleeding needing a transfusion
  • Less commonly, heart attack, stroke or death

After a stent, the NHS says most people take low-dose aspirin plus a second blood thinner such as clopidogrel, prasugrel or ticagrelor for up to a year. Stopping early greatly raises the risk of a heart attack, so follow the schedule exactly. For a planned procedure, expect to avoid heavy lifting, strenuous activity and driving for about a week. Cardiac rehabilitation is usually offered to help you recover. Since aspirin also comes up in cancer research, our look at what the research really shows on aspirin and cancer explains why that is a separate question from heart care.

Questions to ask before a planned stent

Use this checklist with your cardiologist:

  1. Is this to relieve my symptoms, or to lower my risk of heart attack or death?
  2. Have my medicines been adjusted fully, and what happens if I try that first?
  3. What did my tests show about how much heart muscle is affected?
  4. Is there anything about my arteries that makes a procedure more likely to help me?
  5. What are my personal risks, and how long will I need blood thinners?
  6. Would a second opinion be helpful?

When to get medical help

Call emergency services for chest pain that feels tight or squeezing, pain spreading to the arm, neck or jaw, severe breathlessness, or if someone collapses. After angioplasty, the NHS advises calling for urgent help if bleeding from the wound won't stop after 10 minutes of pressure, if severe chest pain doesn't ease, or if the arm or leg used becomes discolored, cold or numb. Contact your care team for increasing pain or swelling at the wound or a high temperature. Not all chest pain is cardiac, but it should always be checked; this article on chest pain during strong emotions covers some of the other causes.

FAQ

Does a stent prevent future heart attacks?

During a heart attack, reopening the artery improves survival and lowers the chance of another attack, according to the NHS. In stable coronary disease, trials such as COURAGE and ISCHEMIA found that routine stenting on top of good medical treatment did not reduce heart attacks or deaths. Medicines and lifestyle changes remain the backbone of prevention.

How long do you take blood thinners after a stent?

The NHS says most people take two blood thinners, low-dose aspirin plus another such as clopidogrel, prasugrel or ticagrelor, for up to a year. The second one is usually stopped after about a year, while aspirin often continues long term. Never stop either early without talking to your cardiologist, because that raises the risk of a heart attack.

Is it OK to get a second opinion before angioplasty?

Yes, for a planned procedure it's a reasonable step. Ask whether the aim is symptom relief or prevention, and whether medicines have been tried fully. In an emergency such as a heart attack, though, there's no time to wait. Treatment should go ahead quickly because delays allow more heart muscle to be damaged.

What to do next

  1. If you've been offered a planned stent, write down the questions above and take them to your next appointment.
  2. Ask for a copy of your test results and a plain explanation of what they show.
  3. Review your current medicines with your doctor or pharmacist to make sure each one is at the right dose.
  4. Learn the heart attack warning signs and share them with your family.

This article is for general information and is not medical advice.

Last reviewed: October 2026.

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