Angioplasty is a keyhole surgery procedure for repairing
damaged or diseased blood vessels. It involves the use of a catheter
and a balloon to open up blocked arteries,
usually those in the heart. The catheter is
passed into a main artery, often in the groin, and pushed along until it
reaches the narrowed vessel. The balloon at the tip of the catheter is then
inflated so that it pushes opens up the artery – most commonly pushing
any build-up of plaque (fatty deposits) in the artery against the vessel's
wall – allowing a freer flow of blood. Angioplasty is less radical
alternative to open heart or bypass surgery.
Coronary angioplasty is used to restore blood
flow through a narrowed or blocked artery in the heart. It is also known
by a variety of other names: balloon angioplasty, coronary artery angioplasty,
percutaneous coronary intervention, and percutaneous transluminal angioplasty.
The arteries of the heart – the coronary
arteries – can become narrowed and blocked due to buildup of a
material called plaque on their inner walls. This narrowing reduces the
flow of blood through the artery and can lead, over time, to coronary
artery disease and heart attack.
In angioplasty, a thin tube called a catheter with a balloon or other device
on the end is first threaded through a blood vessel in the arm or groin
(upper thigh) up to the site of a narrowing or blockage in a coronary artery.
Once in place, the balloon is then inflated to push the plaque outward against
the wall of the artery, widening the artery and restoring the flow of blood
|Cross-section of a coronary artery with plaque buildup.
The coronary artery is located on the surface of the heart. Figure
A shows the deflated balloon catheter inserted into the narrowed coronary
artery. In figure B, the balloon is inflated, compressing the plaque
and restoring the size of the artery. Figure C shows normal blood
flow restored in the widened artery.
Angioplasty is used to:
Angioplasty was first used in 1977. A tiny balloon was used to open or widen
narrowed arteries. Since then, new devices and medicines have improved the
procedure and made it appropriate for more people. The improvements include:
- Relieve angina (chest
pain) caused by reduced blood flow to the heart.
- Minimize damage to the heart muscle during a heart attack. This damage
occurs when blood flow is totally cut off to an area of the heart.
- Stents. A stent is a tiny mesh tube
that looks like a small spring. The stent 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. Stents are
used in most angioplasties except when an artery is too small for a
stent to fit.
- When a stent is used, in 2 out of 10 people the artery will close
again within the first 6 months.
- When a stent is not used, in 4 out of 10 people the artery will
close again within the first 6 months.
- Plaque removers. Many kinds of plaque removers exist. They are used
to cut away plaque that narrows the inside of the arteries.
- Laser. A laser is used to dissolve or vaporize plaque. First approved
in 1992, laser devices are used in many major U.S. medical centers.
|Placement of a stent in a coronary artery with plaque
buildup. The coronary artery is located on the surface of the heart.
Figure A shows the deflated balloon catheter and closed stent inserted
into the narrowed coronary artery. In figure B, the balloon is inflated,
expanding the stent and compressing the plaque to restore the size
of the artery. Figure C shows normal blood flow restored in the stent-widened
Today, angioplasty is performed on more than 1 million people a year in
the United States. The procedure is best done:
Research on angioplasty continues to:
- By doctors who do at least 75 angioplasties a year
- In hospitals that do at least 400 angioplasties a year
- Increase its safety
- Prevent the artery from closing again
- Make it an option for more people
When is coronary angioplasty done?
Your doctor may consider angioplasty if lifestyle changes and medicines
do not improve your symptoms of coronary artery disease. Angioplasty is
an alternative to coronary bypass surgery, which is a major operation.
Your doctor will consider several factors when recommending angioplasty
or bypass surgery:
Angioplasty is often selected if:
- The number of blocked arteries you have
- Severity of the blockages
- Location of the blockages
- Other medical conditions you have
- Your surgical risk for bypass
- Your preference
The advantages of angioplasty are that it:
- 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 disadvantage of angioplasty is that the artery may close again. If this
happens, you will need a second angioplasty or bypass surgery. Bypass surgery
tends to do a more complete job of restoring the heart's blood supply.
- Is not surgery
- Is done with local anesthesia and
- Has a shorter recovery period than bypass surgery
- Provides similar survival outcomes as bypass surgery in some patients
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. Quickly opening a blocked coronary artery 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 within 3 hours after the heart attack begins.
Angioplasty performed early, 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. Major complications are rare,
but any medical procedure has risks. The risks of angioplasty include:
Other less-common complications 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
The risk of complications is higher in:
- Heart attack
- Need for emergency open-heart surgery during the procedure
- People ages 75 and older
- People 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
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
- What medicines you should and should not take on the day of the angioplasty
- When to come to the hospital and where to go
What to expect
- Angioplasty usually takes 1–2 hours, depending on the treatment options
your doctor uses.
- During the procedure, you will be awake but sleepy.
- You will be given medicines to help you relax. These medicines may
make you feel sleepy or as though you are floating or numb.
- A catheter or tube may be left in the blood vessel after the procedure.
It is removed 4–6 hours later. Some doctors use a special device to
seal the opening in the blood vessel.
- You must lie still for several hours until the blood vessel seals.
- Usually you can return home in 1–2 days.
What happens during coronary angioplasty?
Angioplasty is performed in a special part of the hospital called the cardiac
catheterization lab. This lab has special video screens and X-ray machines.
Your doctor uses this equipment to see enlarged pictures of the blocked
areas in your coronary arteries.
At the cardiac catheterization lab, you will lie on a table. The doctor
will use an intravenous (IV) line to give you fluids and medicines. The
medicines 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 arm or groin.
- 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
When you are comfortable, the doctor will begin the procedure.
- A small cut is made in your arm or groin to find an artery. The doctor
then threads a very thin wire through the artery up to the area of the
coronary artery that is blocked.
- When the wire reaches the area of the blockage, a tube (catheter)
with a deflated balloon on the end is passed over the wire to the site
of the blockage.
- A small amount of dye may be injected through the tube into the blood
stream to help show the blockage on X-ray. This X-ray picture of the
heart is called an angiogram.
- When the tube reaches the blockage, the balloon is inflated. The balloon
widens the artery to increase the flow of blood to the heart muscle.
Plaque removers may be used to take away 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 permanently.
When the doctor finishes, the wire and catheter are removed. A special
outer catheter may remain in place. If a closure device is used, all tubes
will be removed.
During the procedure, strong antiplatelet medicines are given through the
IV to prevent clots from forming in the artery or on the stent. These medicines
help thin your blood. They usually are started just before the angioplasty
and may continue for 12–24 hours afterward.
After the angioplasty procedure, you will be moved to a special care unit.
While you recover, nurses will check:
The place where the tube was inserted may feel sore or tender for about
- If angioplasty is performed through the artery in your groin, you
will have to lie flat without bending your legs. You must lie flat longer
if no closure device is used. If the angioplasty is performed through
your arm, you will not have to lie flat.
- If the catheter is removed later, pressure will be applied to the
You must lie still for several hours to allow the blood vessels in your
groin (or arm) to seal completely.
- Afterward, you may walk with assistance.
In most cases, you may go home 1–2 days after the procedure.
What happens after coronary angioplasty?
Angioplasty is not a cure for coronary artery disease (CAD). You should
discuss with your doctor what led to CAD and the need for angioplasty.
When you are ready to leave the hospital, you will receive instructions
to follow at home, including:
Your doctor will prescribe medicine to prevent blood clots from forming.
It is very important that you take the medicine as directed. The medicine
can prevent the stent from becoming blocked. Types of medicine may include:
Most people can return to work and other normal activities about 1 week
- How much activity or exercise you can do.
- When you should follow up with your doctor.
- What medicines you should take.
- What you should look for daily when checking for signs of infection
around the area where the tube was inserted, such as:
- When you should call your doctor, for example:
- If you have a fever or signs of infection
- If you have pain or bleeding where the tube was inserted
- When you should call emergency service. For example, if you have any
Your doctor may recommend that you participate in a cardiac rehabilitation
(rehab) program. Cardiac rehab provides medical guidance and support to
help you return to work or daily activities.
• HEART TOPICS
• HEALTH AND DISEASE
Source: U.S. National Heart, Lung and Blood Institute