Coronary Angioplasty

Also known as percutaneous coronary intervention, coronary angioplasty is a procedure used to open clogged heart arteries.

Angioplasty involves temporarily inserting and inflating a tiny balloon in the place where the artery is clogged to help widen it. Angioplasty can be combined with the permanent placement of a small wire mesh tube called a stent to help prop the artery open and decrease its chance chance of narrowing once more.

Some stents are coated with medication to help your artery open (drug-eluting stents) while others are not (bare-metal stents). Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath.

Angioplasty can also be used during a heart attack to rapidly open a clogged artery and decrease the amount of damage to your heart.

Here are the most common reasons to receive coronary angioplasty and stents.

Angioplasty is used in the treatment of a type of disease known as atherosclerosis.

Atherosclerosis is the gradual buildup of fatty plaques in the blood vessels of your heart. Your doctor may suggest angioplasty as an option for treatment when medications or lifestyle changes are not effective enough to improve your heart's health or if you have a heart attack, worsening chest pain or other symptoms.

Angioplasty is not for everyone. If the main artery that bings blood to you heart is narrow, if your heart muscle is weak or if you have multiple diseased blood vessels, then coronary artery bypass surgery may be a better option for you compared to angioplasty.

In coronary artery bypass surgery, the blocked part of your artery is bypassed using a blood vessel from a different part of your body. If you have diabetes and several blockages, your doctor may suggest coronary artery bypass surgery.

The decision of angioplasty versus coronary artery bypass surgery will depend on upon the extent of your heart disease and overall medical condition.

The most common coronary angioplasty and stents risks include:

Re-narrowing of your artery (restenosis)

With angioplasty alone, without placement of stents, restenosis happens in about 30% of cases.

Blood clots

Blood clots can form within stents even after the procedure. These clots can close the artery, causing a heart attack. It is important to take blood anticoagulant medication, such as aspirin, clopidogrel (Palvix) and many others.

Bleeding

You may have to bleed in your leg or arm where the catheter was inserted.

Other risks of angioplasty may include:

Heart attack

Although rare, you may have a heart attack during the procedure.

Coronary artery damage

Your coronary artery may be torn or ruptured (dissected) during the procedure. These complications may require emergency bypass surgery.

Kidney problems

The dye used during angioplasty and stent placement can cause kidney damage, especially in people who already have kidney problems. If you're at increased risk, your doctor may take steps to try to protect your kidneys, such as limiting the amount of contrast dye and making sure that you're well hydrated during the procedure.

Stroke

During angioplasty, a stroke can occur if plaques break loose when the catheters are being threaded through the aorta. Blood clots also can form in catheters and travel to the brain if they break loose. Stroke is an extremely rare complication of coronary angioplasty, and blood thinners are used during the procedure to reduce the risk.

Abnormal heart rhythms

During the procedure, the heart may beat too quickly or too slowly. These heart rhythm problems are usually short-lived, but sometimes medications or a temporary pacemaker is needed.

To prepare for a coronary angioplasty and stents, your doctor reviews your medical history and performs a physical exam.

You may also have one or more of the following examinations before an angioplasty and stenting procedure:

Ultrasound

A scanner is passed over the carotid artery to produce images (using sound waves) of the narrowed artery and of the blood flow to the brain.

Magnetic resonance angiography (MRA) or computerized tomography angiography (CTA)

These exams provide highly detailed images of blood vessels by using either radiofrequency waves in a magnetic field or by using X-rays with contrast material.

Carotid angiography

During this exam, contrast material (visible on X-rays) is injected into an artery so that vessels can be seen and examined. You'll receive instructions on what you can or can't eat or drink before angioplasty. Your preparation may be different if you're already staying at the hospital before your procedure.

The night before your procedure

Follow your doctor's instructions about adjusting your current medications. Your doctor may instruct you to stop taking certain medications before angioplasty, particularly if you take certain diabetes medications or blood thinners. Take approved medications with only small sips of water.

Arrange for transportation home. Angioplasty usually requires an overnight hospital stay, and you won't be able to drive yourself home the next day because of lingering effects of the sedative.

Here’s what you can expect before, during, and after your coronary angioplasty and stents.

During the procedure

Your body is not cut open except for a very small incision in the skin over a blood vessel in the leg, arm or wrist through which a small, thin tube (catheter) is threaded and the procedure performed.

Angioplasty can range from a period of 30 minutes to several hours, depending on the difficulty and number of blockages and whether any complications arise.

Angioplasty is performed by a heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians in a special operating room called a cardiac catheterization laboratory. This room is often called the cath lab.

Angioplasty is commonly performed through an artery in your groin (femoral artery). Less commonly, it may be done using an artery in your arm or wrist area.

Before the procedure, the area is prepared with antiseptic solution and a sterile sheet is placed over your body. A local anesthetic is injected to numb the area where the catheter will be inserted. Small electrode pads are placed on your chest to monitor your heart during the procedure.

General anesthesia isn't needed. You'll be sedated but awake during the procedure. You'll receive fluids, medications to relax you and blood-thinning medications (anticoagulants) through an IV catheter.

Then, the procedure begins

After numbing the incision area, a small needle is used to access an artery in your leg or arm. A small cut is made in the skin. Your doctor will insert a thin guidewire followed by a catheter into the artery and thread from the incision area up to the blockage in your heart.

You might feel pressure in the area where the catheter is inserted, but you shouldn't feel a sharp pain. Tell your doctor if you do. You also won't feel the catheter in your body.

A small amount of dye is injected through the catheter. This helps your doctor look at the blockage on X-ray images called angiograms. A small balloon at the end of the catheter is inflated, widening the blocked artery.

After the artery is stretched, the balloon is deflated and removed. Your doctor might inflate and deflate the balloon several times before it's removed, stretching the artery a bit more each time.

If you have several blockages, the procedure may be repeated at each blockage. Because the balloon temporarily blocks blood flow to part of your heart, it's common to experience chest pain while it's inflated.

Stent placement

Most people who have angioplasty also have a stent placed in their blocked artery. The stent is usually inserted in the artery once it is widened by the inflated balloon. The stent supports the walls of your artery to help prevent it from re-narrowing after the angioplasty. The stent looks like a tiny coil of wire mesh. Here's what happens:

The stent, which is collapsed around a balloon at the tip of the catheter, is guided through the artery to the blockage. At the blockage, the balloon is inflated and the spring-like stent expands and locks into place inside the artery.

The stent stays in the artery permanently to hold it open and improve blood flow to your heart. Once the stent is in place, the balloon catheter is removed and more images (angiograms) are taken to see how well blood flows through your newly widened artery. Finally, the guide catheter is removed and the procedure completed.

After your stent placement, you may need prolonged treatment with medications, such as aspirin or clopidogrel (Plavix) to reduce the chance of blood clots forming on the stent.

After the procedure

You'll probably remain hospitalized one day while your heart is monitored and your medications are adjusted. You should be able to return to work or your normal routine the week after angioplasty. When you return home, drink plenty of fluids to help flush your body of the contrast dye.

Avoid strenuous exercise and lifting heavy objects for several days afterward. Ask your doctor or nurse about other restrictions in activity.

Call your doctor's office or hospital staff immediately if:

• The site where your catheter was inserted starts bleeding or swelling
• You develop pain or discomfort at the site where your catheter was inserted
• You have signs of infection, such as redness, swelling, drainage or fever
• There's a change in temperature or color of the leg or arm that was used for the procedure
• You feel faint or weak
• You develop chest pain or shortness of breath

Blood thinners

It's important that you closely follow your doctor's recommendations about your treatment with blood-thinning medications — aspirin and clopidogrel or similar medications. Most people who have undergone angioplasty with or without stent placement will need to take aspirin for life.

Those who have had stent placement will need a blood-thinning medication such as clopidogrel for a year or longer in some cases. If you have any questions or if you need noncardiac surgery, talk to your cardiologist before stopping any of these medications.

Understanding the results of your coronary angioplasty and stents will be made possible by your doctor.

Coronary angioplasty increases blood flow to the previously narrowed or blocked coronary artery and your chest pain should decrease.

However, having angioplasty and stenting does not signify the eradication of your heart disease. You will have to continue a healthy lifestyle and take medications prescribed by the doctor.

To keep your heart healthy after angioplasty, you should:

• Quit smoking.
• Lower your cholesterol levels.
• Control other conditions, such as diabetes and blood pressure.
• Get regular exercise.
• Maintain a healthy weight.

Successful angioplasty also means that you might not have to undergo a surgical procedure called coronary artery bypass surgery. In a bypass, an artery or a vein is removed from a different part of your body and sewn to the surface of your heart to take over for the blocked coronary artery. This surgery requires an incision in the chest.

Recovery from bypass surgery is usually longer and more uncomfortable. If you have many blockages or narrowing of the main artery leading to the heart, reduced heart function, or diabetes, your doctor may recommend bypass surgery instead of angioplasty and stent placement. In addition, some blockages may be better treated with bypass surgery.