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angioplasty

Coronary angioplasty

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.

• 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 artery.

• 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?

• 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 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.

• Is not surgery
• Is done with local anesthesia and mild sedation
• Has a shorter recovery period than bypass surgery
• Provides similar survival outcomes as bypass surgery in some patients

What are the risks of coronary angioplasty?

• Bleeding from the blood vessel where the catheter (small flexible tube) was inserted
• Damage to the blood vessel from the catheter
• Infection
• Allergic reaction to dye given during the angioplasty

• Heart attack
• Need for emergency open-heart surgery during the procedure
• Stroke
• Death

• Women
• People ages 75 and older
• People with diabetes

What happens before coronary angioplasty?

Meeting with your doctor

• Blood tests
• An electrocardiogram (EKG)
• A chest X-ray

• When to begin fasting (not eating or drinking) before coming to the hospital
• 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?

Preparation (Prep)

• 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

• 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.

Recovering

• 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 site.
  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.

• Your heart rate and blood pressure
• Your arm or groin for bleeding

What happens after coronary angioplasty?

Going home

• 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:
• Redness
• Swelling
• Drainage
• 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 chest pain.

• Anticoagulants
• Antiplatelet drugs, such as aspirin and clopidogrel (Plavix)

Cardiac rehabilitation

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