What is a Coronary Angioplasty procedure?
The heart receives blood via a set of arteries known as the coronary arteries. Healthy arteries are flexible, strong and elastic and have a smooth inner lining that allows blood to flow freely. These arteries can become stiff and narrow if cholesterol, cells and other substances build up inside the arteries. This build up can cause a partial or total blockage in the artery, restricting blood flow which in turn can restrict vital oxygen and nutrients.
A reduced flow of blood to the heart can cause various symptoms. Chest discomfort is the most common symptom. This is called angina. Both a partial and completely blocked artery can lead to a heart attack.
Treatment of angina may be by one of three means:
- Medications to improve blood supply through the narrowed arteries;
- Coronary artery bypass surgery;
- Percutaneous transluminal coronary angioplasty.
- Coronary Angioplasty is an invasive procedure performed to reduce or eliminate blockages in the coronary arteries, restoring blood flow to the heart tissue that has been deprived of oxygen and nutrients.
Coronary Angioplasty is not suitable for all blocked or narrow coronary arteries. Factors such as the number of blockages and where they are situated will determine if angioplasty is the most suitable treatment option for you. Your cardiologist will have determined the most suitable treatment based partly on the result of the Coronary Angiography.
How to prepare Coronary Angioplasty procedure
You will be asked to fast for 4 hours prior to the procedure, this includes food and water, although if you need to take medications you will be able to have a small amount of water.
Your cardiologist will advise if there is to be any changes to your usual medications prior to the procedure. If you are on Warfarin, you will usually be asked to cease taking this for 3-4 days prior, but you will need to check this with your Cardiologist. DO NOT stop taking Aspirin or Plavix / Iscover. Take other medication as usual on the day with a small amount of water. If you are unsure of any of the above, please check with your doctor.
Please advise the staff if you are aware of any allergies you may have. X-ray dye (contrast solution) used in in this procedure contains Iodine. If you have an allergy to Iodine, you must inform your doctor prior to this procedure.
A small plastic tube called an Intravenous Cannula will be inserted into a vein in your arm and an intravenous drip will be connected to it.
You may be given a mild sedative prior to the procedure to help you relax.
Your right groin area or right radial area on your arm will be clipped and you will be asked to shower using an antiseptic soap and dress in a hospital gown.
Your doctor may request you to have some tests done prior to the procedure when you arrive in hospital. These may include blood tests, 12 lead Electrocardiograph (ECG) and/or a chest X-ray. Bring with you any chest X-rays you may have had from the last 6 months.
What happens during a Coronary Angioplasty procedure?
Depending on how many blockages you have will depend on the length of the procedure, your procedure will most likely take between 40 minutes to 1 ½ hours.
The procedure is performed in a special theatre called the Cardiac Catheter Laboratory. This theatre has X-ray equipment and monitors to assist in acquiring pictures of the coronary arteries. Electrodes are attached to your arms, chest, legs and back to monitor your heart rhythm. Your Blood pressure and oxygen saturation will also be monitored throughout the procedure.
General anaesthetic in NOT required for this procedure, so you are awake for the duration. You may be given additional medications for sedation or pain relief during the procedure through the intravenous drip connected to the small tube in your arm.
Access to the blood circulation may be from the right or left leg, right elbow or right wrist artery. A small amount of a local anaesthetic agent (usually 1% Lignocaine) is injected into the skin. You may briefly experience a cool or a mild stinging sensation.
A hollow needle is inserted into the artery and a small tube (6cm to 9cm in length) called a “sheath” is inserted so as to gain access to the circulatory system. You may feel a bit of pressure while the sheath is being inserted. Thereafter you should not feel any discomfort.
A long, thin plastic tube called a “catheter” is inserted into the sheath and advanced through the arterial system into a coronary artery. You won’t feel the catheter in your body.
By watching on a special X-ray screen, the cardiologist can move the catheter into the artery. A small amount of contrast dye is injected through the catheter. Areas of blockage are shown up on the X-ray images, so your cardiologist knows precisely where to target treatment.
Next, a very thin wire is threaded into the narrowed artery across the blockage. Over this wire, a thin, expandable balloon is passed to the blockage. The balloon is inflated at the site, partially decreasing the amount of blockage. The balloon then deflates.
Because the balloon temporarily blocks blood flow to part of your heart, it is common to experience chest discomfort / pain while it is inflated. Your cardiologist might inflate and deflate the balloon several times before it is removed, stretching the artery a bit more each time to widen it. If you have several blockages, the procedure may be repeated at each site.
Your cardiologist and a team of cardiac nursing staff will be monitoring you during the procedure. If you are experiencing any discomfort or pain, it is important that you let them know. Your cardiologist will prescribe medication that the nursing staff will administer during the procedure to try and make you as comfortable as possible.
Once the artery is widened, a device called a stent may be placed in the artery as scaffolding to help prevent it from re-narrowing after the angioplasty. The stent looks like a very tiny lattice-work coil of wire and mesh. A stent is not deployed in all instances. Your cardiologist will discuss this with you.
To insert a stent, it is compressed onto a balloon catheter and guided to the blockage. When the balloon inflates, the spring-like stent expands and locks into place inside the artery.
The stent remains in the artery permanently to hold it open and improve blood flow to your heart.
Some stents can be coated with medication (called Drug Eluting Stents) that is slow is slowly released to help prevent arteries from reclogging. If you have a Drug Eluting Stent you will have to remain on your anti-coagulation medications for a minimum of 6 to 12 months. If you need to stop this mediation for other procedures, you will need to check with your Cardiologist before doing so.
What happens after a Coronary Angioplasty procedure?
Your Cardiologist may leave the tube in your groin/arm for several hours after the procedure. If your puncture site is in your groin you will have to lie flat until the sheath is removed this may be 3 to 6 hours.
Alternatively, your doctor may choose to remove the sheath and use other measures to close the artery such as plugging them with collagen. In any case, you may have bruising and tenderness at the point where the sheath was removed.
You will remain in hospital overnight for monitoring of your vital signs and also your puncture site. Your cardiologist will see you the next day before you are discharged and will answer any questions you or your family may have. They will also discuss any changes to your medications.
Your cardiologist will also schedule a follow-up appointment with you one to three months after your procedure. Before leaving hospital, you will receive information about long-term therapy that may assist in preventing further coronary artery disease and instructions regarding when to return to work.
Heavy lifting and vigorous exercise should be avoided for several days to ensure that the arteries are properly healed. Most patients return to work or their normal routine the week after their coronary angioplasty.
It is normal to have some bruising, a small lump (about the size of a pea) and/or a small amount of pain where the sheath was inserted for the first week after the procedure.
Your artery can re-narrow within months, requiring further procedures including surgery. Therefore, it is important that you report any recurrence of unusual symptoms you may experience to your doctor.
Coronary Angioplasty Frequently Asked Questions
“It is important to note that the risks and complications associated with coronary angioplasty are generally low, and most patients recover well from the procedure with no complications. However, it is important to discuss any concerns or questions with your doctor before undergoing any medical procedure.
Bleeding: There is a risk of bleeding at the site where the catheter was inserted, particularly if the catheter was inserted through the groin. In rare cases, bleeding may require blood transfusions or additional medical procedures to control.
Allergic reactions: Some patients may be allergic to the contrast dye used in the procedure, which can cause a range of symptoms from mild itching or hives to more severe reactions such as anaphylaxis.
Kidney damage: The contrast dye used in coronary angioplasty can cause kidney damage in some patients, particularly those with pre-existing kidney disease. Your doctor may recommend additional fluids or medications to reduce the risk of kidney damage.
Restenosis: In some cases, the treated artery may become narrowed again (restenosis) after a period of time following angioplasty. This may require additional procedures or surgeries to reopen the artery.
Blood clots: Blood clots may form at the site of the stent placement, which can cause a heart attack or stroke. Your doctor may prescribe blood-thinning medications to reduce the risk of blood clots.
Infection: There is a small risk of infection at the site where the catheter was inserted, particularly if the catheter was inserted through the groin.
Coronary artery dissection: Rarely, angioplasty can cause a tear in the coronary artery (dissection), which can lead to chest pain and other complications.”
“Angioplasty and stenting are combined procedures performed to open up narrowed or blocked arteries in the body, particularly those supplying blood to the heart.
Angioplasty involves using a small balloon catheter to open up a narrowed or blocked artery. During angioplasty, the small deflated balloon catheter is introduced along a guidewire through the obstructed artery. The balloon is inflated to open the artery and compress the plaque or blockage against the arterial wall, thereby widening the artery and restoring blood flow.
Stenting involves placing a small metal mesh tube, called a stent, into the artery to help keep it open. A stent is inserted during an angioplasty procedure. Once the balloon is inflated and the artery is widened, the stent is then inserted and expanded to hold the artery open. The stent remains in place permanently, providing structural support to the artery and reducing the risk of re-narrowing.
In summary, angioplasty is the process of inflating a balloon to open up a blocked artery, and stenting involves placing a permanent metal mesh tube inside the artery to keep it open. “
“The lifespan of a stent after angioplasty can vary depending on several factors, including the type of stent used, the patient’s overall health, and their lifestyle choices.
Drug-eluting stents (DES) are designed to release medication to help prevent restenosis (re-narrowing) of the artery, and they have been shown to be effective in reducing the need for repeat procedures. These stents can last for many years, with studies suggesting that they remain effective for at least 10 years after implantation.”