What is Coronary angioplasty?
Coronary angioplasty is a procedure in which a balloon is used to open a blockage in a coronary artery of the heart narrowed by atherosclerosis. This procedure improves blood flow to the heart. Atherosclerosis is a condition in which plaque accumulates on the inner walls of the arteries. This can occur in any artery, including the coronary arteries, which transports oxygen-rich blood to the heart. Coronary artery disease (CAD) occurs when atherosclerosis affects the coronary arteries.
Stents : Stents are small expandable mesh or tubes placed in narrowed or weakened arteries in the body.
Types of Coronary Stents
There are three types of stents available. These are:
Coated with medication, it is eluted (released) during the procedure to prevent the formation of scar tissue in the artery lining.
Bioresorbable vascular scaffold
It is a popular drug-eluting type of stent. It is a widely popular scaffold which disappears after the job is done as the body absorbs it over time.
Bare metal stent
It is made of stainless steel and doesn't have any special coating.
When is a coronary angioplasty used?
Patients with a blockage in one or two coronary arteries are most commonly recommended for angioplasty with stenting. It may also be used to
- Improve CAD symptoms like angina and shortness of breath.
- Reduce the damage to the heart muscle caused by a heart attack. When blood flow through a coronary artery is completely blocked, a heart attack occurs. During a heart attack, angioplasty is used to open the blockage and restore blood flow through the artery.
- Reduce the risk of heart attack in some patients.
Risks of coronary angioplasty
Although serious complications from an angioplasty are rare, any invasive procedure carries some risk.
Risks of angioplasty include:
- A reaction to the contrast dye
- Heart attack
- Blood vessel or kidney damage
- Abnormal heart rhythm
- Chest pain
- Blood clots
- If a stent is not properly placed in your artery, you may experience a repeat blockage.
Benefits of a coronary angioplasty
Benefits of angioplasty include:
- It is minimally invasive so reduces the risk and lowers the cost than a surgical procedure.
- You’ll only have one wound where the catheters were placed and a smaller wound at your arm where an IV line is placed.
- If necessary, your doctor can insert a stent during your angioplasty.
Coronary angioplasty and Stent Insertion Procedure
Before the Procedure
- If your angioplasty is not being performed as an emergency treatment, you will meet with your doctor prior to the procedure.
- Your doctor will review your medical history including any medications that you are taking and perform a physical examination.
- Investigations such as blood tests, an electrocardiogram and a chest x-ray are performed.
- You will be advised to begin fasting 6-8 hours prior to the procedure.
During the Procedure
- Coronary angioplasty is performed in a specialised area of the hospital known as the cardiac catheterization laboratory (cath lab). The equipment in the cath lab allows your doctor to view enlarged images of the blocked areas in your coronary arteries.
- You will lie on a table in the cath lab. An intravenous (IV) line will be inserted into your arm to deliver fluids and medications. The medications will help you relax and prevent the formation of blood clots. These medications may cause you to feel sleepy, floating, or numb.
- TA catheter is usually inserted in the arm or groin after shaving. The shaved area will be cleaned to eliminate germs before being numbed. The numbing medication may sting as it is injected.
- A small incision is made in your arm or groin to insert a tube known as a sheath. The doctor then inserts a very thin guide wire through the artery in your arm or groin toward the blocked portion of the coronary artery.
- Your doctor will then insert a catheter, which is a long, thin, flexible tube, through the sheath up to the heart. Next, your doctor will insert the catheter into the blocked coronary artery. Once the catheter is in the proper position, the guided wire is removed.
- A small amount of dye will be injected through the catheter into the bloodstream to show the blockage on an x-ray. This procedure of taking x-ray images of the heart is called an Angiogram.
- Then, your doctor will insert a tube containing a small deflated balloon through the catheter and into the coronary artery where the blockage is located.
- The balloon is inflated when the tube reaches the blockage. The balloon pushes the plaque against the artery wall, widening it. This aids in increasing blood flow to the heart.
- After that, the balloon is deflated. To widen the artery, the balloon is sometimes inflated and deflated multiple times. The balloon and tube are then removed.
- Plaque is sometimes removed during angioplasty. To remove hard plaque, a catheter with a rotating shaver on its tip is inserted into the artery. Lasers can also be used to dissolve or break up the plaque.
- If your doctor needs to place a stent (small mesh tube) in your artery, another tube with a balloon will be inserted. The balloon is wrapped in a stent. Your doctor will inflate the balloon, causing the stent to expand against the artery wall.
- The balloon is then deflated and the tube is used to remove it from the artery. The stent remains in place in the artery.
- After the angioplasty, your doctor will pull back the catheter and remove it along with the sheath. The artery hole is either sealed with a special device or pressure is applied until the blood vessel seals.
- Strong antiplatelet medications are administered through IV during angioplasty to prevent blood clots forming in the artery or on the stent. These medications will thin your blood. They are typically initiated just prior to the angioplasty and may last for 12 to 24 hours afterward.
- Drug-eluting stents contain a medication that is actively released at the stent implantation site. Drug-eluting stents have a thin medication surface to reduce the risk of restenosis.
- If you have a drug-eluting stent, your doctor will prescribe certain medications for several months after the procedure to prevent clotting in the stent. It is critical that you continue to take your medications as directed until your doctor tells you otherwise.
- During the same procedure, most people who have angioplasty also have a stent placed in their blocked artery. A stent, which resembles a tiny coil of wire mesh, supports the walls of your artery and prevents it from narrowing again after angioplasty.
- During a stent placement, the stent is guided through the artery to the blockage after collapsing around the balloon at the catheter's tip.
- The balloon at the tip of the catheter is inflated at the blocked area, and the spring-like stent expands and locks into place inside the artery.
- The stent is permanently implanted in the artery to keep it open and improve blood flow to your heart. More than one stent may be required in some cases to open a blockage.
- The balloon catheter is deflated and removed once the stent is in place.
- More X-ray images (angiograms) are taken to assess the flow of blood through your newly widened artery.
- The majority of angioplasty stents are drug-coated. The medication in the stent is gradually released to help prevent plaque buildup and blood vessel re-narrowing in the future.
- Following the placement of your stent, your doctor will prescribe medications such as aspirin, clopidogrel, ticagrelor, or prasugrel to reduce the likelihood of blood clots forming on the stent.
After the procedure
- If you have a non-emergency procedure, you will most likely spend the night in the hospital while your heart is monitored.
- The week following angioplasty, you should be able to return to work or your normal routine.
- When you get home, drink plenty of fluids to help your body flush out the contrast dye. For at least a day after surgery, avoid strenuous exercise and lifting heavy objects.
Recovery time after coronary angioplasty
- You'll need to stay in the hospital for several hours, if not overnight, to recover from angioplasty. Your doctor will tell you what medications you need and how active you can be after your angioplasty. Because you were sedated, you will need to be driven home by someone from the hospital.
- Rest at home and drink plenty of fluids. Don't do anything strenuous for the next 24 hours.
- Following your angioplasty procedure, you may need to take aspirin or other blood thinners. If your doctor has prescribed blood thinners, it is critical that you take them exactly as prescribed. Don't skip any doses. If you believe you should stop taking blood thinners, you should consult with your doctor first.
Coronary angioplasty at Medicover hospitals
Medicover Hospital is known for having the best teams of heart surgeons and cardiologists on board, all of whom are experts in various heart diseases and their treatments. We provide comprehensive care with the best and most well-known cardiologists. Our interventional cardiologists at Medicover believe in treating their patients with the utmost care and ensure that all patients are satisfied with their treatment. We assure you that you are in excellent hands at Medicover Hospital.