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Coronary Angioplasty

Coronary Angioplasty
By Medicover Hospitals / 08 Mar 2021
Home | Procedure | Coronary Angioplasty

Overview

  • In the 1960s and early 1970s, bypass surgery was the only procedure to boost blood flow to a heart with blocked arteries. Bypass surgery patients used to spend a lot of days in the hospital and a month in rehab. In 1977, coronary angioplasty was introduced to open blocked heart arteries as an alternative route. Angioplasty is used to clear the significant artery blockages that may cause heart disease symptoms like chest pain (Angina) and/or shortness of breath.
  • Why Coronary-Angioplasty is done?

  • Coronary angioplasty also called percutaneous coronary intervention (PCI) is a procedure that is used to open clogged arteries supplying the heart. These arteries are known as coronary arteries. Angioplasty involves temporarily inserting and inflating a tiny balloon in the artery region, where it is clogged and helps to widen the artery.
  • The stable insertion of a thin wired, mesh-like tube called stent is normally paired with angioplasty to help the artery open and reduce its risk of narrowing again. Some stents are covered with drugs (drug-eluting stents, DES) to help hold the artery intact, while others are not (bare-metal stents, BMS).
  • Angioplasty may relieve the symptoms of chest pain and shortness of breath caused by blocked heart arteries. During a heart attack, angioplasty can also be used to rapidly open a blocked artery and decrease the amount of damage to the heart.
  • Why is Coronary Angioplasty Done?

  • Angioplasty is used to treat fatty plaque accumulation in the blood vessels of the heart. This buildup is a form of atherosclerosis known as heart disease. For you, angioplasty can be a treatment choice if:
    • 1.You have tried any medications or lifestyle changes but still have more blockages, then it may improve heart health
    • 2.You have chest pain, which is worsening
    • 3.You have had a heart attack (Angioplasty helps to quickly open the blocked artery and reduce the damage of the heart)
    • 4.Angioplasty isn’t for everyone; it depends on the extent of the heart disease and on the overall health of the patient. The doctor will determine whether coronary artery bypass surgery is a better option than angioplasty for you.

    Risks

    Re-narrowing of the Artery

  • When bare-metal stents are used, the chance of re-narrowing the artery is around 10% to 20%. However, there is a reduced/minimal risk when the clogged artery is treated with drug-eluting stent (less than 5%).
  • Blood Clots

  • Even after the operation, blood clots may form inside the stents. The artery may be closed by such clots, triggering a heart attack. It is very important to continue antiplatelets and anticoagulants (if prescribed by the doctor) to reduce the risk of blood clots.
  • Bleeding

  • Bleeding can occur in the leg or arm, where a catheter has been inserted. This simply results in a bruise but extreme bleeding often occurs and may require a blood transfusion or surgery.
  • How is Coronary Angioplasty Done?

  • The doctor may need to know if your coronary arteries are blocked before coronary angioplasty is performed. If there is more than one blocked artery, then the doctor will need to know where and how severe are the blockages.
  • The doctor will do an angiogram and take an x-ray image of the arteries. A tiny tube called a catheter with a balloon at the end is inserted into a large blood vessel in the groin (upper thigh) or arm during an angiogram. A catheter is then threaded in the coronary arteries. A small amount of dye is injected into the coronary arteries and an x-ray picture is taken. This image will display any blockages, how many are there, and where they are located. Once the doctor has the total information then the angioplasty can proceed.
  • During the Procedure

    • In a separate operating room called a cardiac catheterization laboratory, angioplasty is done by the heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians.
    • Angioplasty is carried out in your groin, arm or wrist area through an artery. The procedure does not involve general anaesthesia. To help you relax, you may receive a sedative but depending on how deeply you are sedated, you might be awake during the operation.
      • 1.You will receive fluids, soothing medications, and blood-thinning medications (anticoagulants) in the hand or arm through an IV catheter.
      • 2.During the operation, the heart rate, pulse, blood pressure and level of oxygen will be controlled.
      • 3.The doctor will use an antiseptic solution to prepare the region of your leg, arm or wrist and will put a sterile sheet over the body
      • 4.A local anaesthetic will be used by your doctor to numb the region, where a very small incision will be made. A small, thin guidewire is inserted in the blood vessel.
      • 5.The doctor will thread a thin tube (catheter) into your artery with the help of live X-rays
      • 6.After it is in place, a contrast dye is inserted through the catheter. This helps the inside of the blood vessels to be seen by your doctor and to locate the blockage on X-ray pictures called angiograms.
      • 7.At the location of a blockage, a thin balloon with or without a stent at the tip of the catheter is inflated, widening the blocked artery. The balloon is deflated and the catheter is removed after the artery is stretched.
      • 8.If a stent has to be placed, then the stent is located in the balloon inflated area, and the stent is placed.
      • 9.Stents prevent re-blockages, and medicated stents (DES) release medicine immediately after their placement
      • 10.If you have several blockages, the doctor can repeat the process for each blockage.
      • The coronary angioplasty can take up to several hours, and this can also depend on the difficulty and the number of blockages.

    After the procedure

  • If you have a non-emergency operation, you will possibly stay overnight in the hospital while your heart is being checked and your medications are being changed. The week after angioplasty, you can return to work or your daily routine.
  • Drink plenty of water when you get home, to help your body flush out the contrast dye. Avoid strenuous exercise and lifting any heavy objects for at least a day or two after the coronary angioplasty is done.
    • the location where your catheter was implanted begins to bleed or swell
    • the place where your catheter was implanted, you develop pain or discomfort
    • you have symptoms of infection, such as swelling, redness, fluid/pus draining, or fe
    • you observe change in the colour of the leg or arm that was used for the procedure
    • you develop discomfort, shortness of breath, or pain in the chest

    Change in Daily routine

  • While coronary artery disease (CAD) symptoms can be minimized by angioplasty, it is not a cure for CAD or the risk factors that have contributed to it. It can help treat CAD and preserve the positive outcomes of angioplasty by making healthy lifestyle changes. The patients may focus on some important lifestyle changes:
  • Follow a healthy diet for controlling high blood pressure and cholesterol levels
  • Quit smoking, if you have the habit
  • Be physically active
  • Lose weight if you’re overweight
  • Reduce stress
  • Frequently Asked Questions:

    Coronary angioplasty is a technique used to enlarge the coronary arteries (the main blood vessels supplying the heart) that are blocked or narrowed. The word "angioplasty" means to open a narrowed or blocked artery by using a balloon to stretch.
    Angioplasty is a procedure to open narrowed or blocked heart blood vessels (coronary arteries) that supply blood to the heart. This is done with the help of thin balloons within the blocked artery. A short, mesh-like tube called stent is expanded inside the coronary artery to retain the structure of the opened artery. The stent is immediately placed after angioplasty, in most people.
    Angioplasty is a minimally invasive technique used to open small or blocked arteries accompanied with stent placement. Depending on the location of the artery affected, this technique is used in various parts of the body.
    Coronary angioplasty presents a risk of complications, as in all forms of surgery. The risk of serious issues, however, is minimal. During or after angioplasty, complications may occur. Bleeding or bruising under the skin, where the catheter has been inserted is common.
    Normally, it will take a couple of weeks to get back to regular activities after angioplasty. Before leaving the hospital patient would be given detailed instructions on exercise, medications and follow-up appointments.
    In India, the average cost of angioplasty is approximately from Rs 1.5 lakh to 2.5 lakh. However, the prices may change based on the hospitals in each city.
    Angioplasty costs in Hyderabad may vary depending on different factors and range from Rs 1,00,000 lakh to 2,00,000 lakh

    Citations:

  • Coronary Angioplasty, https://www.nejm.org/doi/full/10.1056/NEJM199610243351707
  • Outcomes of Coronary Angioplasty ,https://www.nejm.org/doi/full/10.1056/NEJM199912233412601