Angioplasty is the commonly used term for coronary angioplasty. The more technical terms used for the same procedure are percutaneous coronary intervention (PCI) and percutaneous transluminal coronary angioplasty (PTCA). Angioplasty is a procedure to open blocked arteries in your heart by inserting and inflating a tiny balloon. Most patients who undergo angioplasty also get a ?stenting? done at the same time. Stents are coiled metal meshes that hold the arteries open and reduce the chances of re-narrowing (restenosis). Stents coated with drugs to decrease clotting or narrowing at the site are called drug eluting stents (DES). Uncoated stents are called bare metal stents.

 

What is angioplasty?

Angioplasty is the commonly used term for coronary angioplasty. The more technical terms used for the same procedure are percutaneous coronary intervention (PCI) and percutaneous transluminal coronary angioplasty (PTCA). Angioplasty is a procedure to open blocked arteries in your heart by inserting and inflating a tiny balloon. Most patients who undergo angioplasty also get a “stenting” done at the same time. Stents are coiled metal meshes that hold the arteries open and reduce the chances of re-narrowing (restenosis). Stents coated with drugs to decrease clotting or narrowing at the site are called drug eluting stents (DES). Uncoated stents are called bare metal stents.

Who needs an angioplasty?

Patients diagnosed with coronary atherosclerosis (plaques in the coronary arteries) are advised angioplasty if their disease is unlikely to respond to medicines. Patients who have had a heart attack and those who have angina are potential candidates for angioplasty. Angioplasty may also be done during a heart attack to instantly open a blocked artery and reduce the extent of damage to your heart.

 

Do I need an angioplasty or a by-pass?

This decision can only be made by your cardiologist after evaluating your angiogram, which is an image of the arteries of your heart. Patients in whom the main artery supplying the left side of the heart is blocked, those who have very weak heart muscle, or those with small diseased blood vessels are better suited for a coronary artery bypass grafting (CABG). Patients with diabetes or three or more blockages are also often advised CABG. CABG, generally called bypass surgery involves bypassing the blockage in your artery by creating a new conduit with a blood vessel from another part of your body (graft).

What happens during an angioplasty and stent placement?

Your angioplasty will be done in a special room called a cardiac catheterization laboratory, often called a cath lab. It will be performed by a cardiologist (heart specialist) assisted by a team of specially trained nurses and technicians. You will be conscious throughout angioplasty as general anesthesia is not required for the procedure.

 

A very small incision will be made in your groin through which a thin tube (catheter) will be inserted in the groin artery called the femoral artery. Before making this incision your doctor will inject a local numbing agent in your groin. Occasionally the catheter maybe inserted through an artery in the arm or wrist instead of the groin artery.

 

You may also be started on a drip to give you fluids and a medication to reduce your anxiety. Your heart will be monitored continuously through an electrocardiogram (ECG) during the procedure, so you can expect ECG electrodes to be placed on your chest when you are undergoing angioplasty.

 

Your doctor will insert a guide wire followed by a catheter into your femoral artery and move the catheter from the incision area up to the arteries in your heart. However, you will not feel anything moving within your body except for some mild pressure at the insertion site.

 

In order to visualize the blockage in your heart arteries, your doctor will inject a dye in the catheter and observe X-ray images of your artery called angiograms. Once the blockage site is visualized, a small balloon at the end of the catheter will be inflated to widen the blocked artery. It will be kept inflated for a while to let your artery stretch and then deflated and removed. 

 

Nowadays, a coiled wire mesh called a stent is placed in the arteries of most undergoing angioplasty to prevent re-narrowing. Stents are of two broad types; drug eluting stents (DES) and bare metal stents. Drug eluting stents are coated with a medication that is slowly releases and helps prevent re-clogging of the artery.

 

In order to put the stent in your artery, your doctor will first place it around the balloon at the tip of catheter and guide it up to the site of blockage. At the blockage, the balloon will be inflated to expand the stent which will now lock in place to hold the artery open. Angiogram images taken after placing the stent will show improved blood flow through the widened artery.

 

The entire procedure usually takes about 30 minutes though it can take longer if multiple stents have to be placed or any complications arise.

How long will I be hospitalized after angioplasty?

Uncomplicated angioplasty does not require prolonged hospitalization. Most patients are hospitalized for one day during which they are put on continuous ECG monitoring. Some medications to prevent blood clotting will also be administered after the procedure. You will be able to resume normal activities within a week of your angioplasty. However, you should avoid excessive exertion for several days after the procedure.

What medications will I need to take after angioplasty?

People who undergo angioplasty are put on blood thinning medications. Aspirin and clopidogrel (Plavix) are the most commonly prescribed medicines. Aspirin will have to taken for life whether or not you had a stent placement. Clopidogrel is prescribed for a year or more, mostly in patients who have a stent inserted.

What are the complications during/ after an angioplasty?

Angioplasty is a very safe procedure but complications do arise in some cases. The common complications associated with angioplasty are:

 

• Restenosis: There is a chance of re-narrowing of your arteries after angioplasty. Drug eluting stents reduce the chances of restenosis to a large extent.
• Clotting within stents: Blood clotting within a stent can occur within days to months of stent placement
• Bleeding at the site of catheter insertion: Occasionally the bleeding maybe severe enough to require blood transfusion or surgery

 

All other complications of angioplasty are relatively rare. They include:

 

• Heart attack during the procedure
• Coronary artery rupture requiring emergency bypass surgery
• Kidney damage caused by dye injected for the angiogram
• Stroke caused by blood clots dislodged during angioplasty
• Arrhythmias or heart rhythm disturbances 

What is life like after an angioplasty?

Angioplasty is extremely effective at improving blood flow through a blocked artery for a long-term. You will note a reduction in chest pain on exertion and your ability to exercise will improve. Your doctor will prescribe some medications that you will need to adhere to very strictly. Most patients will need to continue aspirin throughout their lives.

 

In addition, you will be advised some lifestyle changes to keep you arteries and heart healthy. Some things that you will need to work on after undergoing angioplasty would be:

 

• Having a low cholesterol diet
• Losing weight if you are overweight
• Engaging in regular physical activity
• Ensuring good control of your diabetes, blood pressure and cholesterol level
• Smokers must quit smoking

 

Most patients will be able to resume their routine activities after an angioplasty. However, you should always remain watchful of symptoms of chest pain and shortness of breath. If you develop chest pain that does not respond to nitroglycerine (sorbitrate), get emergency medical help as it could be a heart attack.