Coronary angioplasty and stents
Coronary angioplasty and stents
Coronary angioplasty (AN-jee-o-plas-tee), also called percutaneous coronary intervention (PCI), is a procedure used to open clogged heart arteries. Angioplasty involves temporarily inserting and blowing up a tiny balloon where your artery is clogged to help widen the artery.
Angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent to help prop the artery open and decrease the chance of it narrowing again. Some stents are coated with medication to help keep your artery open (drug-eluting stents), while others are not (bare-metal stents).
Angioplasty can improve some of the symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart.
Why it's done
Angioplasty is used to treat a type of heart disease known as atherosclerosis. Atherosclerosis is the slow buildup of fatty plaques in your heart's blood vessels. When medications or lifestyle changes aren't enough to improve your heart health, or if you have a heart attack, worsening chest pain (angina) or other symptoms, your doctor might suggest angioplasty as a treatment option.
Angioplasty isn't for everyone, though. If the main artery supplying the left side of your heart is narrowed, if your heart muscle is weak or if you have small diseased blood vessels , then coronary artery bypass surgery may be a better option. In coronary artery bypass surgery, the blocked portion of your artery is bypassed using a vein from another part of your body.
In addition, if you have diabetes and multiple blockages, your doctor may suggest coronary artery bypass surgery. The decision of angioplasty versus bypass surgery will depend on the extent of your heart disease and overall medical condition.
Coronary artery plaques
Atherosclerosis (ath-ur-o-skluh-RO-sis) is hardening and narrowing of the arteries caused by the accumulation of fatty deposits (plaques) and other substances. A blood clot also may form at the ...
Although angioplasty is a less invasive way to open clogged arteries, the procedure still carries some risks.
The most common angioplasty risks include:
Other rare risks of angioplasty include:
How you prepare
Before a scheduled angioplasty, your doctor will review your medical history and do a physical exam. You'll also have an imaging test called a coronary angiogram to determine if your blockages can be treated with angioplasty. A coronary angiogram helps doctors determine if the main arteries to your heart are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a catheter — a long, thin tube that's fed through an artery, usually in your groin, to arteries in your heart. As the dye fills your arteries, they become visible on X-ray and video, so your doctor can see where your arteries are blocked. If your doctor finds a blockage during your coronary angiogram, it's possible he or she may decide to perform angioplasty and stenting immediately after the angiogram while your heart is still catheterized.
You'll receive instructions about eating or drinking before angioplasty. Typically, you have to stop eating or drinking by midnight the night before. Your preparation may be different if you're already staying at the hospital before your procedure.
Whether the angioplasty is pre-scheduled or done as an emergency, you'll likely have some routine tests first, including a chest X-ray, electrocardiogram (ECG) and blood tests.
The night before your procedure, you should:
What you can expect
During the procedure
Angioplasty is performed by a heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians, usually in a special operating room called a cardiac catheterization laboratory.
Angioplasty is commonly performed through an artery in your groin (femoral artery). Less commonly, it may be done using an artery in your arm or wrist area. Before the procedure, the area is prepared with antiseptic solution and a sterile drape is placed over your body. A local anesthetic is injected into your groin to numb the area. Small electrode pads are placed on your chest to monitor your heart rate and rhythm during the procedure.
General anesthesia isn't needed, so you're awake during the procedure. You'll receive fluids and medications to relax you through an intravenous (IV) catheter. You'll get blood-thinning medications (anticoagulants) to reduce blood clotting, and then the procedure begins:
Because the balloon temporarily blocks blood flow to part of your heart, it's common to experience chest pain while it's inflated. If you have several blockages, the procedure may be repeated at each blockage.
Here's what happens:
After your stent placement, you may need prolonged treatment with medications to reduce the chance of blood clots forming on the stent material.
After the procedure
When you return home, drink plenty of fluids to help rid your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for several days afterward. Ask your doctor or nurse about other restrictions in activity.
Call your doctor's office or hospital staff immediately if:
Most people who have undergone angioplasty with or without stent placement will need to take aspirin for life. Those who have had stent placement will need a blood-thinning medication such as clopidogrel for a year or longer in some cases. If you have any questions or if you need noncardiac surgery, talk to your cardiologist before stopping any of these medications.
For most people, coronary angioplasty greatly increases blood flow through the previously narrowed or blocked coronary artery . Your chest pain should decrease, and you may have a better ability to exercise.
Having angioplasty and stenting doesn't mean your heart disease goes away. You'll need to continue healthy lifestyle habits and possibly take medications to ensure your artery doesn't re-narrow. If your symptoms return, such as chest pain or shortness of breath, or other symptoms similar to those you had before your procedure, contact your doctor. If you have chest pain at rest or pain that doesn't respond to nitroglycerin, call 911 or emergency medical help.
To keep your heart healthy after angioplasty, you should:
Successful angioplasty also means you might not have to undergo an invasive surgical procedure called coronary artery bypass surgery. In a bypass, an artery or a vein is removed from a different part of your body and sewn to the surface of your heart to take over for the blocked coronary artery. This surgery requires an incision in the chest. Recovery from bypass surgery is usually longer and more uncomfortable.
If you have many blockages or narrowing of the main artery leading to the heart, reduced heart function, or diabetes, your doctor may recommend bypass surgery instead of angioplasty and stent placement. In addition, for technical reasons some blockages may be better treated with bypass surgery.
Last Updated: 2010-12-17
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