Heart Surgery - Coronary Angioplasty Procedure
Heart Surgery - Coronary Angioplasty Procedure
Coronary angioplasty (AN-jee-oh-plas-tee) is a medical procedure used to open narrowed or clogged blood vessels of the heart. A thin balloon or other device is threaded through a blood vessel in the groin or arm into a heart (coronary) artery. The balloon is inflated to compress the blockage and stretch the artery open.
It is used in patients with coronary artery disease (CAD) to:
- Relieve chest pain caused by reduced blood flow to the heart
- Minimize damage to the heart muscle during a heart attack, which occurs when blood flow is totally cut off to an area of the heart
CAD develops over time as fatty deposits, called plaque (plak), build up on the inside walls of the coronary arteries. The buildup of plaque narrows the arteries, reducing the flow of blood to the heart. This is called atherosclerosis.
Angioplasty was first used in 1977. A tiny balloon was used to open or widen narrowed arteries. Since then, new devices and medications have improved the procedure and made it appropriate for more people. The improvements include:
- Stents: A stent is a tiny mesh tube that looks like a small spring. It is inserted in the area where the artery is narrowed to keep it open. Some stents are "coated" with medication to help prevent the artery from closing again. Most people will have a stent placed unless the artery is too small.
- When a stent is placed, only 2 out of every 10 people have the artery close again in the first 6 months.
When a stent is not used, 4 out of 10 people have the artery close again in the first 6 months.
Plaque removers: These devices are used to cut away plaque that narrows the inside of the arteries. There are many kinds.
- Laser: A laser is used to dissolve or vaporize plaque. The first laser device was approved in 1992. It is used in many major U.S. medical centers.
Today, over 1 million people in the U.S. receive angioplasty each year. They are best done:
- By doctors who do at least 75 angioplasties a year
- In hospitals that do at least 400 angioplasties a year.
Research on angioplasty continues to:
- Make it even safer
- Prevent the artery from closing again
- Make it an option for more people.
Other Names for Coronary Angioplasty
- Percutaneous coronary intervention (or PCI)
- Percutaneous transluminal angioplasty (or PCTA)
- Balloon angioplasty
- Coronary artery angioplasty
When Is Coronary Angioplasty Done?
Your doctor may consider angioplasty if lifestyle changes and medications do not improve your symptoms of coronary artery disease (CAD). It is an alternative to coronary bypass surgery, which is a major operation.
Your doctor will recommend angioplasty or bypass surgery based on:
- The number of blocked arteries you have
- Severity of the blockages
- Location of the blockages
- Whether you have other medical conditions
- Your surgical risk for bypass
- Your preference.
Angioplasty is often selected if:
- The blockage is small
- The blockage can be reached by angioplasty
- The artery affected is not the main artery that supplies blood to the left side of the heart
- You do not have heart failure.
The advantages of angioplasty are that it:
- Is not surgery
- Is done with local anesthesia (an-es-THEE-Z-ah) and mild sedation
- Has a shorter recovery period than bypass surgery
- Provides similar survival outcomes as bypass surgery in some patients.
The disadvantage of angioplasty is that the artery may close again. If this happens, you will need a second angioplasty or bypass surgery. Also, bypass surgery tends to do a more complete job of restoring the heart's blood supply.
Your doctor will discuss treatment options with you and recommend the best procedure for you.
Coronary angioplasty is also used as an emergency procedure during a heart attack to quickly open a blocked coronary artery. This minimizes the damage during a heart attack and restores blood flow to the heart muscle. There are also drugs that can be used to dissolve clots in a coronary artery. These drugs are most effective when given soon after the heart attack begins (within 3 hours). Early angioplasty, without drugs that dissolve clots, also minimizes damage to the heart muscle.
What Are the Risks of Coronary Angioplasty?
Angioplasty is a common medical procedure and major complications are rare. However, there are risks with any medical procedure. The risks of angioplasty include:
- Bleeding from the blood vessel where the catheter (small flexible tube) was inserted
- Damage to the blood vessel from the catheter
- Allergic reaction to dye given during the angioplasty.
Other less-common complications include:
- Heart attack
- Need for emergency open-heart surgery during the procedure
The risk of complications is higher in:
- Older persons (ages 75 and older)
- Persons with diabetes.
What Happens Before Coronary Angioplasty?
Meeting with Your Doctor
A heart specialist (cardiologist) performs the angioplasty. If your angioplasty is not done as an emergency, you will meet with your cardiologist before the procedure to have a physical exam and discuss the procedure. Your doctor will order:
- Blood tests
- An electrocardiogram (EKG)
- A chest x-ray
Your angioplasty will be scheduled at a hospital. You will also be told:
- When to begin fasting (not eating or drinking) before coming to the hospital
- What medications you should and should not take on the day of the angioplasty
- The time to come to the hospital and where to go.
What to Expect
- Angioplasty usually takes 1 to 2 hours, depending on the treatment options your doctor uses.
- During the procedure, you will be awake, but sleepy.
- You will be given medications to help you relax. These medications may make you feel sleepy. You may feel like you are floating or numb.
- A catheter or tube may be left in the blood vessel in the leg after the procedure. It is removed 4 to 6 hours later. Some doctors use a special device to seal the opening in the blood vessel.
- You will need to lie still for several hours until the blood vessel in your leg seals.
- Most people usually return home within a day or two.
What Happens During Coronary Angioplasty?
Angioplasty is performed in a special part of the hospital called the cardiac catheterization (kath-eh-ter-ih-ZA-shun) lab. This lab is equipped with special video screens and x-ray machines. Your doctor will use this equipment to see enlarged pictures of the blocked areas in your coronary arteries.
Preparation or Prep
You will be taken into the cardiac catheterization lab, where you will lie on a table. The doctor will use an intravenous (IV) line to give you fluids and medications. The medications are given to relax you and prevent blood clots. The rest of your prep includes:
- Shaving the area where the catheter or tube will be inserted (usually the groin or arm)
- Cleaning the shaved area to make it germ free
- Numbing the area (the numbing medicine may sting as it is going in).
Steps in Angioplasty
Once you are comfortable, the doctor will begin the procedure:
- A small cut in your groin or arm is made. The doctor threads a very thin catheter or tube through a blood vessel to the area of the coronary artery that is blocked.
- A small amount of dye is injected into the tube. An x-ray is taken so that your doctor will be able to see the coronary arteries, valves, and chambers of your heart. This is called an angiogram.
- Once the blockage is reached, your doctor expands or inflates the balloon attached to the tube. The balloon will widen the artery to increase the flow of blood to the heart muscle.
- A special device may be used to remove some of the plaque from the wall of the artery.
- A stent is usually placed at the site to keep the artery open. The stent remains in place forever.
- When the doctor finishes, the inner catheter and other tools are removed from the blood vessels. A special outer catheter may remain in place, or if a closure device is used, all tubes will be removed.
During the procedure, potent antiplatelet (an-tee-PLATE-let) medicines are given through the IV to prevent clots from forming in the artery or on the stent. These medicines are usually started just before the angioplasty to help thin your blood. You may receive them for 12 to 24 hours after your angioplasty.
After the procedure, you will be moved to a special care unit where:
- You will lie flat without bending your legs. You will need to lie flat longer if no closure device is used. If the angioplasty was performed in your arm, you will not need to lie flat.
- If the catheter is removed later, pressure will be applied to the site.
- You will lie still for several hours to allow the blood vessels in your leg to seal completely.
- Afterward, you may walk with assistance.
As you recover, the nurses will check:
- Your heart rate and blood pressure
- Your groin or arm for bleeding.
The place where the tube was inserted may feel sore or tender. This may last for about 1 week.In most cases, you should be able to go home in a day or two after the procedure.
What Happens After Coronary Angioplasty?
Angioplasty is not a cure for CAD. You need to discuss with your doctor what led to CAD and the need for angioplasty. Select the links below for more information on how to slow the development of CAD and how to lower your chance of having a heart attack.
- Preventing coronary artery disease
- Living with angina
- Life after a heart attack.
When you are ready to leave the hospital, you will be given instructions to follow at home. These instructions may include:
- How much activity or exercise you will be allowed
- When you should follow up with your doctor
- What medications you should be taking
- Checking the area where the tube was inserted every day for signs of infection
- Calling your doctor if you have a fever or signs of infection
- Calling your doctor for pain or bleeding where the tube was inserted
- For any chest pain call 9-1-1.
Your doctor will prescribe medication to prevent blood clots from forming. It is very important that you take them as directed. They can prevent the stent from becoming blocked. The medications may include:
- Anticoagulants (an-tee-ko-AG-u-lants)
- Antiplatelet drugs such as aspirin and clopidogrel (Plavix)Most people return to work and other normal activities in about 1 week.
Your doctor may recommend that you participate in a cardiac rehabilitation (rehab) program. Cardiac rehab offers medical guidance and support to help you return to work or daily activities. "Recovering from Heart Problems Through Cardiac Rehabilitation: Patient Guide," from the U.S. Agency for Healthcare Quality and Research, provides more information on cardiac rehab.
Source: National Institutes of Health
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