Coronary Angioplasty

As you age, a waxy substance called plaque (plak) can build up inside your arteries. This condition is called atherosclerosis (ath-er-o-skler-O-sis). Atherosclerosis can affect any artery in the body. When atherosclerosis affects the coronary arteries, the condition is called Coronary Heart Disease (CHD) or Coronary Artery Disease (CAD).

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.

Angioplasty can restore blood flow to the heart. During the procedure, a thin, flexible catheter (tube) with a balloon at its tip is threaded through a blood vessel to the affected artery. Once in place, the balloon is inflated to compress the plaque against the artery wall. This restores blood flow through the artery.

Doctors may use the procedure to improve symptoms of CHD, such as angina. The procedure also can reduce heart muscle damage caused by a heart attack.

Serious complications from angioplasty don’t occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure. The most common complications are discomfort and bleeding at the catheter insertion site.

Research on angioplasty is ongoing to make it safer and more effective and to prevent treated arteries from narrowing again.

Other Names for Coronary Angioplasty

• Balloon Angioplasty
• Coronary Artery Angioplasty
• Percutaneous Coronary Intervention
• Percutaneous Intervention
• Percutaneous Transluminal Angioplasty
• Percutaneous Transluminal Coronary Angioplasty

Your doctor may recommend coronary angioplasty if you have narrow or blocked coronary arteries as a result of Coronary Heart Disease (CHD).

Angioplasty is one treatment for CHD. Other treatments include medicines and Coronary Artery Bypass Grafting (CABG). CABG is a type of surgery in which a healthy artery or vein from the body is connected, or grafted, to a blocked coronary artery.

The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This improves blood flow to the heart.

Compared with CABG, some advantages of angioplasty are that it:

• Does not require open-heart surgery
• Does not require general anesthesia (that is, you wont be given medicine to make you sleep during the procedure)
• Has a shorter recovery time

However, angioplasty is not for everyone. For some people, CABG might be a better option. For example, CABG might be used to treat people who have severe CHD, narrowing of the left main coronary artery, or disease in the entire three vessels with long areas of blockage. Your doctor will consider many factors while recommending the treatment plan.

Angioplasty also is used as an emergency treatment for heart attack. As plaque builds up in the coronary arteries, it can rupture. This can cause a blood clot to form on the surface of the plaque and block blood flow to the heart muscle. Quickly opening the blockage restores blood flow and reduces heart muscle damage during a heart attack.

• Before you have coronary angioplasty, your doctor will need to know the location and extent of the blockages in your coronary (heart) arteries. To find this information, your doctor will use coronary angiography (an-jee-OG-rah-fee). This test uses dye and special X-rays to show the insides of your arteries.
• During angiography, a small tube (or tubes) called a catheter is inserted into an artery, usually in the groin (upper thigh). The catheter is threaded to the coronary arteries.
• Special dye, which is visible on X-ray pictures, is injected through the catheter. The X-ray pictures are taken as the dye flows through your coronary arteries. The dye shows whether blockages are present and their location and severity.
• For the angioplasty procedure, another catheter with a balloon at its tip (a balloon catheter) is inserted in the coronary artery and placed in the blockage. Then, the balloon is expanded. This pushes the plaque against the artery wall, relieving the blockage and improving blood flow.
• A small mesh tube called a stent usually is placed in the artery during angioplasty. The stent is wrapped around the deflated balloon catheter before the catheter is inserted into the artery.
• When the balloon is inflated to compress the plaque, the stent expands and attaches to the artery wall. The stent supports the inner artery wall and reduces the chance of the artery becoming narrow or blocked again.
• Some stents are coated with medicine that is slowly and continuously released into the artery. They are called drug-eluting stents. The medicine helps prevent scar tissue from blocking the artery following angioplasty.

Coronary angioplasty is done in a hospital. A cardiologist will perform the procedure. A cardiologist is a doctor who specialises in diagnosing and treating heart diseases and conditions.

If angioplasty isn’t done as an emergency treatment, you’ll meet with your cardiologist beforehand. He or she will go over your medical history (including the medicines you take), do a physical exam, and talk to you about the procedure.

Your doctor also may recommend tests, such as blood tests, an EKG (electrocardiogram), and a chest X-ray.

Once the angioplasty is scheduled, your doctor will advise you:

• When to begin fasting (not eating or drinking) before the procedure. Often, you have to stop eating and drinking 6–8 hours before the procedure.
• What medicines you should and should not take on the day of the procedure.
• When to arrive at the hospital and where to go.

Even though angioplasty takes only 1–2 hours, you’ll likely need to stay in the hospital overnight. Your doctor may advise you to not drive for a certain amount of time after the procedure. Thus, you’ll probably need to arrange a ride home.

Coronary angioplasty is done in a special part of the hospital called the cardiac catheterisation (KATH-eh-ter-ih-ZA-shun) laboratory. The Cath Lab has special video screens and X-ray machines. Your doctor will use this equipment to see enlarged pictures of the blockages in your coronary arteries.

Preparation

• In the cath lab, you’ll lie down. An Intravenous (IV) line will be placed in your arm to give you fluids and medicines. The medicines will relax you and help prevent blood clots from forming.
• The area where your doctor will insert the catheter will be shaved. The catheter usually is inserted in your groin (upper thigh). The shaved area will be cleaned and then numbed. The numbing medicine may sting as its going in.

The Procedure

• During angioplasty, you’ll be awake and sometimes sleepy.
• Your doctor will use a needle to make a small hole in an artery in your arm or groin. A thin, flexible guide wire will be inserted into the artery through the small hole. Then, your doctor will remove the needle and place a tapered tube called a sheath over the guide wire and into the artery.
• Next, your doctor will put a long, thin, flexible tube called a guiding catheter through the sheath and slide it over the guide wire. The catheter is moved to the opening of a coronary artery, and the guide wire is removed.
• Your doctor will inject special dye through the catheter. The dye will help show the inside of the coronary artery and any blockages on an X-ray picture called an angiogram.
• Another guide wire is then put through the catheter into the coronary artery and threaded past the blockage. A thin catheter with a balloon at its tip (a balloon catheter) is threaded over the wire and through the guiding catheter.
• The balloon catheter is positioned in the blockage. Then, the balloon is inflated. This pushes the plaque against the artery wall, relieving the blockage and improving blood flow through the artery. Sometimes the balloon is inflated and deflated more than once to widen the artery.
• Your doctor may put a stent (small mesh tube) in your artery to help keep it open. If so, the stent will be wrapped around the balloon catheter.
• When your doctor inflates the balloon, the stent will expand against the wall of the artery. When the balloon is deflated and pulled out of the artery with the catheter, the stent remains in place in the artery.
• Doctor inserts a tube called a balloon catheter into a coronary artery narrowed by plaque. A small mesh tube called a stent is wrapped around the balloon catheter. When the balloon is inflated, it compresses the plaque, widens the artery, and anchors the stent to the artery wall. The stent helps maintain blood flow through the artery.
• After angioplasty is done, the sheath, guide wires, and catheters are removed from your artery. Pressure is applied to stop bleeding at the catheter insertion site. Sometimes a special device is used to seal the hole in the artery.
• During angioplasty, you’ll receive strong antiplatelet medicines through your IV line. These medicines help prevent blood clots from forming in the artery or on the stent. Your doctor may start you on antiplatelet medicines before the angioplasty.

After coronary angioplasty, youll be moved to a special care unit. Youll stay there for a few hours or overnight. You must lie still for a few hours to allow the blood vessel in your arm or groin (upper thigh) to seal completely.

While you recover, someone on your healthcare team will check your blood pressure, heart rate, oxygen level, and temperature. The site where the catheters were inserted also will be checked for bleeding. That area may feel sore or tender for a while.

Going Home

Most people go home the next or 3rd day after the procedure. When your doctor thinks youre ready to leave the hospital, youll get instructions to follow at home, such as:

• How much activity or exercise you can do? (Most people are able to walk the day after the angioplasty.)
• When you should follow up with your doctor?
• What medicines you should take?
• What you should look for daily when checking for signs of infection around the catheter insertion site? (Signs of infection include redness, swelling, and drainage.)
• When you should call your doctor? For example, you may need to call if you have shortness of breath, a fever or signs of infection, pain or bleeding.
• When you should call Emergency Department? (For example, if you have any chest pain).

Your doctor will prescribe medicine to help prevent blood clots from forming. Take all of your medicine as your doctor prescribes.

If you got a stent during angioplasty, the medicine reduces the risk that blood clots will form in the stent. Blood clots in the stent can block blood flow and cause a heart attack.

Recovery and Recuperation

Most people recover from angioplasty and return to work within a week of leaving the hospital.

Your doctor will want to check your progress after you leave the hospital. During the follow up visit, your doctor will examine you, make changes to your medicines (if needed), do any necessary tests, and check your overall recovery.

Use this time to ask questions you may have about activities, medicines, or lifestyle changes, or to talk about any other issues that concern you

Lifestyle Changes

Although angioplasty can reduce the symptoms of Coronary Heart Disease (CHD), it isnt a cure for CHD or the risk factors that led to it. Making healthy lifestyle changes can help treat CHD and maintain the good results from angioplasty.

Talk with your doctor about your risk factors for CHD and the lifestyle changes you should make. Lifestyle changes might include changing your diet, quitting smoking, being physically active, losing weight or maintaining a healthy weight, and reducing stress.

Your doctor may recommend cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Cardiac rehab includes exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. Your doctor can tell you where to find a cardiac rehab program near your home.

Coronary angioplasty is a common medical procedure. Serious complications do not occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure.
Angioplasty complications can include:

• Discomfort and bleeding at the catheter insertion site
• Blood vessel damage from the catheters
• An allergic reaction to the dye used during the angioplasty
• An arrhythmia (irregular heartbeat)
• The need for emergency Coronary Artery Bypass Grafting during the procedure (less than 1 percent of people). This may occur if an artery closes down instead of opening up
• Kidney damage caused by the dye used during the angioplasty
• Heart attack (1 percent of people)
• Stroke (0.1 percent of people)

Sometimes chest pain can occur during angioplasty because the balloon briefly blocks blood supply to the heart. As with any procedure involving the heart, complications can sometimes be fatal. However, this is rare with coronary angioplasty. Less than 2 percent of people die during the procedure.

• People aged 65 and older
• People who have chronic kidney disease
• People who are in shock
• People who have extensive heart disease and blockages in their coronary (heart) arteries
• Research on angioplasty is ongoing to make it safer and more effective and to prevent treated arteries from narrowing again

Restenosis

Another problem that can occur after angioplasty is too much tissue growth within the treated portion of the artery. This can cause the artery to become narrow or blocked again, often within 6 months. This complication is called restenosis (RE-sten-o-sis).
When a stent (small mesh tube) is not used during angioplasty, 30 percent of people have restenosis. When a stent is used, 15 percent of people have restenosis.

Stent Restenosis

The tissue growth through and around the stent over time causes a partial blockage of the artery and abnormal blood flow. Stents coated with medicine (drug-eluting stents) reduce the growth of scar tissue around the stent. These stents further reduce the risk of restenosis. When these stents are used, about 10 percent of people have restenosis.
Other treatments, such as radiation, can help prevent tissue growth within a stent. For this procedure, a wire is put through a catheter to where the stent is placed. The wire releases radiation to stop any tissue growth that may block the artery.

Blood Clots

Studies suggest that there’s a higher risk of blood clots forming in medicine-coated stents compared with bare metal stents. However, no firm evidence shows that these stents increase the chance of having a heart attack or dying if used as recommended. Researchers continue to study medicine-coated stents.
Taking medicine as prescribed by your doctor can lower your risk of blood clots. People who have medicine-coated stents usually are advised to take antiplatelet medicines, such as clopidogrel and aspirin, for up to a year or longer.
As with all procedures, you should talk with your doctor about your treatment options, including the risks and benefits.