What is it?
Angioplasty, also called a balloon angioplasty or percutaneous coronary intervention (PCI), is a procedure that is used to open narrowed or obstructed arteries or veins. During an angioplasty, a special tube, called a catheter, with an inflatable balloon is inserted into your coronary artery until it reaches the blockage. The balloon is then inflated, which presses the obstruction outward to the sides of the artery, restoring blood flow. More often than not, a stent is placed to hold the artery open after the artery is widened.
A stent is a small, expandable mesh-like tube helps increase blood flow. Over time, the artery will begin to heal, building tissue around it which holds the stent in place. After 3-12 months the stent will be fully covered, although the duration depends on the stent has antiplatelet medication which prevents clotting within he stent. The stent can also be coated with medicine that prevents scar tissue from forming. The specifics of your stent and associated medications should be discussed with your doctor.
Once the artery has been widened and the stent has been placed (if needed), the balloon is then deflated and removed from your artery.
Though less invasive than surgery, an angioplasty and stents may still require an overnight hospital stay. It can be done emergently, for a heart attack, for example, or as an elective surgery if your healthcare provider believes it to be necessary. An angioplasty can be done in an inpatient (hospital) or outpatient setting in a cardiac catheterization lab.
Why you might need it:
Angioplasty is performed to treat people who have narrowed or blocked arteries due to build up of plaque, which refers to fatty deposits made of cholesterol, calcium or other substances found in your blood. This blockage in your arteries is called atherosclerosis. Conditions such as coronary artery disease or peripheral artery disease can be treated with angioplasty, although not all coronary artery disease is treatable in this way – sometimes open heart surgery called coronary artery bypass grafting is necessary, which creates a new path for blood flow as opposed to widening the blocked or narrowed artery.
You may need a stent for the same reasons you need an angioplasty.
Symptoms that may precede an angioplasty could include chest pain, shortness of breath, fatigue, leg pain, weakness or numbness, high blood pressure, dizziness, etc. Because these symptoms are common for a number of heart conditions, it’s important to work with your healthcare provider to determine what is causing your symptoms.
Risks:
The risks of an angioplasty can range from minor to more severe. Bleeding or bruising at the insertion site, allergic reactions to the contrast dye, infection at the insertion site or, more rarely, within the blood stream can occur. Greater, although more uncommon risks, include blood clots, which can form within the artery causing a heart attack, a re-narrowing (called restenosis) of the treated artery, stroke, kidney damage or arrhythmia can occur. It’s important that you talk with your healthcare provider about any questions or concerns you may have prior to the procedure as they are in the best position to educate you on the risks and benefits of the procedure.
Stents are generally considered safe, but do carry the same risks as an angioplasty because of the stent placement being done with an angioplasty.
It is important to watch for any concerning symptoms following your procedure. Any chest pain, shortness of breath, weakness or dizziness, etc. should immediately be reported to your healthcare provider or presented to your local emergency room. If you feel it is an extreme medical emergency you shouldn’t hesitate to call 9-1-1.
How to prepare:
Depending on how emergent the need for an angioplasty is, you may or may not have time to prepare. There are times that an angioplasty is needed to save a patient from a heart attack. In the event that the procedure is planned and scheduled, you’ll review your health history with your cardiologist. Some tests may be required prior to your procedure, such as an electrocardiogram (ECG) or other imaging tests to evaluate your blood vessels before the procedure. You should always discuss your current medications and/or supplements to ensure you don’t need to stop taking any of them prior to the procedure – medications such as blood thinners, ibuprofen or aspirin should be adjusted or stopped based on the guidance of your provider. Any medicines that are provided should be taken as instructed. You may be instructed not to eat or drink for a period of time prior to your procedure. Because you will be under anesthesia or sedation, you will not be allowed to drive, so you should plan for someone to accompany you to and from the procedure location. Wear comfortable clothing and leave your jewelry and any important items at home or with your chaperone. You may be asked to wear a gown for your procedure.
What to expect/results:
When you arrive, you will be evaluated by your healthcare team and prepared for your procedure. Electrodes will be placed on your chest to monitor your heart and they will take your blood pressure, as well as other vitals. You will receive medications and local anesthesia administered through an IV in your arm or hand. Depending on your circumstances, you may receive local or general anesthesia. A small cut will be placed, typically in your groin or wrist area, and then the catheter will be inserted into your blood vessel and guided toward your heart. Your healthcare provider will insert dye through the tubing, which allows them to see your blood vessels more clearly using imaging. Once the catheter reaches the blockage, they will inflate the balloon on the tip of the catheter to expand the artery if possible, and possibly place a stent to keep the artery open. Then the balloon will be deflated and the catheter will be removed. If there is more than one blockage, the procedure will be repeated as necessary.
From start to finish, the procedure usually takes a couple hours but can depend based on your condition. Afterwards, you’ll likely remain in recovery for observation. Your medical care team will instruct you on discharge instructions when you arrive home. Typically you can expect to be put on blood thinning mediations to prevent blood clots or aspirin with other medications – always check with your healthcare provider before taking medications that were not prescribed to you. You should avoid physical exercise or lifting for at least 24 hours after your procedure. Depending on the outcome of your procedure, your cardiologist may recommend specific activities such as exercise, healthy eating and/or therapy to help you recovery from the procedure. You should discontinue any tobacco use and follow a heart-healthy program to help you recovery. You should take any concerning symptoms following your procedure very seriously (see risks above).
Your cardiologist will ask that you follow up with them regularly to ensure you are maintaining good habits and keeping your heart as healthy as possible post-procedure.