Outcome of Patients Undergoing Balloon Angioplasty in the Two Months Prior to Noncardiac Surgery

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…Arterial recoil or acute thrombosis at the site of balloon angioplasty is most likely to occur within hours to days after balloon coronary angioplasty. Delaying surgery for at least 2 to 4 weeks after balloon angioplasty to allow for healing of the vessel injury at the balloon treatment site is supported by the study by Brilakis et al 309 Daily aspirin antiplatelet therapy should be continued perioperatively. The risk of stopping the aspirin should be weighed against the benefit of reduction in bleeding complications from the planned surgery.…”

Management of Antiplatelet Therapy in Patients With Coronary Artery Disease Requiring Cardiac and Noncardiac Surgery

“…28 After an ACS, a strategy of plain old balloon angioplasty only without stent implantation may be safer than stent placement if a good angiography result is achieved. [80][81][82] However, in patients revascularized by balloon angioplasty, surgery should not be postponed beyond 6 to 8 weeks to prevent restenosis. On the other side, delaying surgery for at least a week after balloon angioplasty allows for healing of the vessel injury and decreases the risk of acute or subacute closure.…”

Optimal Timing of Noncardiac Surgery After Stents

“…When surgery is required within 30 days of revascularization and when dual antiplatelet therapy is not feasible periooperatively, balloon angioplasty alone may be a reasonable strategy if a good acute result is expected because aspirin rather than dual antiplatelet may be sufficient. 22 In-stent restenosis, leading to recurrent coronary ischemia, is pathophysiologically distinct from stent thrombosis, and usually develops gradually. The hazard for BMS restenosis peaks at 4 to 9 months after stent placement, with a few additional events presenting later in the first year, and an overall risk of about 14% over the first year.…”