Angioplasty

Angioplasty is a specialised treatment to unblock narrowed or blocked coronary arteries and increase the blood flow to the heart muscle.

It involves threading a tiny balloon up to the area which is narrowed and temporarily inflating the balloon to widen the artery. Angioplasty is also known as percutaneous coronary intervention (PCI), Percutaneous Transluminal Coronary Angioplasty (PTCA).

Angioplasty is often combined with the placement of a stent or stents. A stent is a small wire tube which is expanded in the coronary artery and permanently helps to prop the artery open. Some stents are coated with medication to help keep your artery open (drug-eluting stents), while others are not (bare-metal stents).

 

Related topics: Atherosclerosis, angina, heart attack, angiogram, your heart health.

 

Angioplasty – Why is it Performed?

 

Angioplasty is a treatment option for coronary artery disease from atherosclerosis 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.

You may have had an angiogram to investigate heart problems which has shown that there are fatty build-ups narrowing your coronary arteries. Occasionally the angioplasty and stenting can proceed immediately at this time to prevent serious complications such as a heart attack. Angioplasty is also used as an emergency treatment for people who’ve had a heart attack.

 

Angioplasty – What are the Risks?

 

As with most invasive procedures there are some risks but angioplasty and stenting is considered a safe procedure and serious complications are rare.

While the balloon is inflated in the artery, you may feel chest discomfort (like your angina) as blood cannot flow along the vessel. The pain only lasts while the balloon is inflated which is usually for about 1 minute. There can be some bleeding in your leg or arm where a tube was inserted. Usually this simply results in a bruise, but sometimes more serious bleeding can occur needing a blood transfusion.

At the time of the treatment a sudden narrowing due to clotting or a tear in the inner wall of the blood vessel may occur, but these are less problematic complications due to the availability of new drugs to prevent clotting and stents to seal any tears in the arteries. Rarely more serious complications can happen such as heart attack and stroke.

 

Angioplasty – How is it Performed?

 

The angioplasty procedure is very similar to an angiogram and is carried out in the same room, the cath lab or angio suite. Angioplasty takes about 45 minutes to 1½ hours and you will be awake during the procedure.

You will be asked not to eat or drink anything for 4 hours before your angioplasty. You may have some blood taken before the angioplasty. Remind your doctor of any allergies that you might have. You may be given some blood-thinning medicine before your angioplasty. But if you are taking warfarin, it is likely to be stopped a day or two before the procedure.

A small needle will be inserted into a vein in your arm. This IV will allow staff to give you any medication that you might need directly into your blood stream. You will be given some medicine to help you to relax. It will make you sleepy, but it will not put you to sleep.

Just like for an angiogram your groin or wrist will be numbed with local anaesthetic. A small tube (catheter) is threaded through your blood vessel (artery) up to your heart. Instead of just injecting dye into your arteries, your doctor will pass a tiny wire into the narrowed or blocked artery. Over this, he or she will thread the angioplasty catheter, which has a tiny balloon on the end of it. When the doctor has the catheter in the narrowed area the balloon is inflated.

If a stent (a small wire tube) is being placed it will ride on the balloon and will be expanded into place when the balloon is inflated. The balloon is then deflated and taken out and the stent stays in place. The catheters and wires are then removed and pressure applied to the entry site.

When the balloon is inflated you may feel your original symptoms, such as chest, jaw or arm discomfort. This happens because the balloon stops blood flowing through your artery for a short time. These symptoms are fairly common, but tell your doctor so that he or she can deflate the balloon or give you some medicine to ease the pain.

Your doctor may inflate and deflate the balloon several times to flatten the plaque against the walls of your artery and make your artery wider.

 

Angioplasty – Afterwards

 

After your angioplasty you will be confined to bed for up to 6 – 8 hours, depending on whether your wrist or groin is used. You will need to restrict your movement and not sit up if your groin is used. This is to help reduce the risk of bleeding. You will usually be attached to a heart monitor, have frequent blood pressure checks and your wrist or groin checked for bleeding.

Depending on the reason for your angioplasty you’ll probably remain in hospital for one day while your heart is monitored and your medications are adjusted. You can expect to have some bruising and tenderness where the catheters were placed (wrist or groin) but if you notice any redness, swelling or bleeding, you should contact your doctor.

Most people will need to take blood thinners (antiplatelet drugs) after angioplasty with or without stenting. It is really important to follow your doctor’s instructions about these medications so as to reduce the risk of blood clots forming in the artery or around the stent.

At home, you should be able to get up and about but any heavy lifting should be avoided as this puts pressure on the wound in the artery in your groin or wrist. You shouldn’t drive for at least a week after having angioplasty and longer if you also had a heart attack.

It is normal to feel a little tired afterwards but you should be able to return to work or your normal routine the week after angioplasty, unless you have also had a recent heart attack. If you have had a heart attack it will take longer to recover. Please view our article explaining a Heart Attack and our booklet Step By Step Through Heart Attack for more information on recovering from one.

 

Angioplasty – Results and Staying Healthy

 

Angioplasty with or without stenting can greatly improve the blood flow through previously narrowed coronary arteries and most people get relief from their symptoms. In the long term, about 1 in 10 patients redevelop their anginal symptoms and have to undergo the procedure again or have other therapy for their angina.

It is important to realise that this procedure does not cure your heart disease. You will still need to continue with a healthy lifestyle and take the medications your doctor prescribes in order to reduce your risk factors and prevent further problems.

 

Resources

 

Angioplasty and Angiogram – our guides from symptoms to treatment

Step by Step through Heart Attack – our patient information booklet

Step by Step through Stroke – our patient information booklet

Step by Step through Heart Medicines – our patient information booklet

Step by Step through Inherited Heart Disease – our patient information booklet

Step by Step through Heart Failure – our patient information booklet

Angina – our guide from symptoms to treatment

AF and You – our information booklet for people living with Atrial Fibrillation

Heart & Stroke Conditions A-Z – see our range of guides.

Your Heart Health – view our articles on ways to manage and reduce your risk factors, from being active to stress, cholesterol, losing weight, blood pressure and more.

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