Angioplasty, also called percutaneous coronary intervention (PCI), is a procedure used to open blocked coronary arteries (caused by coronary artery disease). It restores blood flow to the heart muscle without open-heart surgery. Angioplasty can be done in an emergency setting such as an acute heart attack or in an elective setting when heart disease is strongly suspected from non-invasive testing.
For angioplasty, a special catheter (a long, thin, hollow tube) is inserted into a blood vessel and guided to the blocked coronary artery. The catheter has a tiny balloon at its tip. Once the catheter is in place, the balloon is inflated at the narrowed area of the coronary artery. This presses the plaque or blood clot blocking the artery against the sides of the artery making more room for blood flow.
The use of fluoroscopy (a special type of X-ray that’s like an X-ray "movie") helps the doctor find the blockages in the coronary arteries as a contrast dye moves through the arteries. This is called coronary angiography.
The doctor may determine that another type of procedure is necessary. This may include the use of atherectomy (removal of plaque) at the site of the narrowing of the artery. In atherectomy, there may be tiny blades on a balloon or a rotating tip at the end of the catheter. When the catheter reaches the narrowed spot in the artery, the plaque is broken up or cut away to open the artery.
Coronary stents are now used in nearly all angioplasty procedures. A stent is a tiny, expandable, metal mesh coil that is put into the newly-opened area of the artery to help keep the artery from narrowing or closing again.
Once the stent has been placed, tissue will start to form over it within a few days after the procedure. The stent will be completely covered by scar tissue within a month or so. Medicines called antiplatelets must be taken to decrease the "stickiness" of platelets (special blood cells that clump together to stop bleeding), and to prevent blood clots from forming inside the stent. Your doctor will give specific instructions on which medicines need to be taken and for how long.
Most stents are coated with medicine to prevent the formation of too much scar tissue inside the stent. These stents, called drug-eluting stents, or DES, release medicine within the blood vessel that inhibits the overgrowth of tissue within the stent. This helps deter re- narrowing of the blood vessel.Some stents do not have this medicine coating and are called bare metal stents or BMS. They may have higher rates of stenosis but do not require long-term use of antiplatelet medicines. This may be the preferred stent in people who are at high risk of bleeding.
Because stents can become blocked, it is important for you to talk with your doctor about what you need to do if you have chest pain after a stent placement.
If scar tissue does form inside the stent, a repeat procedure may be needed. This may be using either balloon angioplasty or with a second stent. In some cases, radiation therapy may be given through a catheter placed near the scar tissue to stop the growth of scar tissue and open up the vessel. This is called brachytherapy.
Angioplasty is done to restore coronary artery blood flow when the narrowed artery is in a location that can be reached in this manner. Not all coronary artery disease (CAD) can be treated with angioplasty. Your doctor will decide the best way to treat your CAD based on your circumstances.
Possible risks associated with angioplasty, stenting, atherectomy, and related procedures include, but are not limited to:
You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-rays or treatments over a long period.
For some people, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
Angioplasty may be done as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices. Most people who undergo angioplasty and stent placement are monitored overnight in the hospital.
Generally, angioplasty follows this process:
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will stay flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation and sensation in the affected leg or arm.
Tell your nurse right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.
Bed rest may vary from 2 to 6 hours depending on your specific condition. If your doctor placed a closure device, your bed rest may be shorter.
In some cases, the sheath or introducer may be left in the insertion site. If so, the bedrest will be last until the sheath is removed. After the sheath is removed, you may be given a light meal.
You may feel the urge to urinate often because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bed rest so that your affected leg or arm will not be bent.
After the specified period of bed rest has been completed, you may get out of bed. The nurse will help you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up to avoid any dizziness from the long period of bed rest.
You may be given pain medicine for pain or discomfort at the insertion site or from having to lie flat and still for a long time.
You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.
You may go back your usual diet after the procedure, unless your doctor decides otherwise.
You will most likely spend the night in the hospital after your procedure. Depending on your condition and the results of your procedure, your stay may be longer. You will get detailed instructions for your discharge and recovery period.
Once at home, monitor the insertion site for bleeding, unusual pain, swelling, abnormal discoloration, or temperature change. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, tell your doctor.
If your doctor used a closure device at your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the site. There will be a small knot, or lump, under the skin at the site. This is normal. The knot should slowly disappear over a few weeks.
It will be important to keep the insertion site clean and dry. Your doctor will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities. Your doctor will instruct you about when you can return to work and resume normal activities.
Tell your doctor if you have any of the following:
Your doctor may give you other instructions after the procedure, depending on your particular situation.
Before you agree to the test or the procedure make sure you know: