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A coronary angioplasty is a procedure to open an artery in the heart that has become narrowed. This allows better blood flow through the artery and to the heart muscle. It is often done with a balloon that is passed through a special catheter (tube).
Atherosclerosis is a disease of the arteries. Cholesterol and fatty deposits build up on the walls of the arteries. This restricts blood flow. When this build up happens in the heart, it may lead to a heart attack . Lifestyle changes and medicines can be used to treat atherosclerosis. If they are not enough, an angioplasty may be done.
If you are planning to have an angioplasty, your doctor will review a list of possible complications which may include:
Some factors that may increase the risk of complications include:
Your doctor will likely do the following:
In the days leading up to your procedure:
Local anesthetic will be given. It will numb the area of the groin or arm where the catheter will be inserted. You will also be given sedation and pain medicine through an IV. This will help to keep you comfortable during the procedure.
The area of the groin or arm where the catheter will be inserted will be shaved, cleaned, and numbed. A needle will be inserted into the artery. You will receive blood thinning medicines during the procedure. A wire will be passed through the needle and into the artery. The wire will be guided through until it reaches the blocked artery in the heart. A soft, flexible catheter tube will then be slipped over the wire and threaded up to the blockage.
The doctor will be taking x-ray pictures during the procedure to know where the wire and catheter are. Dye will be injected into the arteries of the heart. This will make a better view of the arteries and blockages
Once the blockage is reached, a small balloon at the tip of the catheter will be rapidly inflated and deflated. This will stretch the artery open. The deflated balloon, catheter, and wire will be removed.
Your doctor may also insert a small mesh tube called a stent into the artery where there was a narrowing. A stent acts to keep the artery open by providing support inside the artery.
After the procedure is done and the blood thinning medicines have worn off, the catheter will be removed. Pressure will be applied for 20-30 minutes to control bleeding.
A bandage will be placed over the groin or arm area.
30 minutes to three hours
The anesthetic should numb the area where the catheter is inserted. You may feel a burning sensation when the anesthesia is given. You may also feel pressure when the catheters are moved. Some people have a flushed feeling or nausea when the dye is injected. You may feel some chest pain during inflation of the balloon.
The usual length of stay is overnight. Speak to your doctor to see if this is an option in your case.
You will likely need to lie still and flat on your back for a period of time. A pressure dressing may be placed over the area where the catheter was inserted to help prevent bleeding. It is important to follow the nurses' directions.
Sometimes the procedure is not successful or the artery narrows again. You may require repeat angioplasty or coronary artery bypass grafting (CABG).
After you leave the hospital, contact your doctor if any of the following occurs:
RESOURCES:
American Heart Association
http://www.americanheart.org/
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/
CANADIAN RESOURCES:
Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/
Heart Healthy Kit: Public Health Agency of Canada
http://www.phac-aspc.gc.ca/
References:
American College of Cardiology Task Force. American College of Cardiology/Society for Cardiac Angiography and Interventions clinical expert consensus document on cardiac catheterization laboratory standards: a report of the American College of Cardiology Task Force on clinical expert consensus documents. J Am Coll Cardiol. 2001 Jun 15;37(8):2170-2214.
Angioplasty. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Angioplasty/Angioplasty_WhatIs.html . Accessed January 12, 2009.
Baim D, Grossman W. Coronary Angioplasty, in Cardiac Catheterization, Angiography, and Intervention . 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2000.
Bain S, Moheet AM, Rasmussen P. Which patients benefit from carotid stenting? What recent trials show. Cleve Clin J Med . 2008 Oct;75(10):714-20. Review.
Bravata DM, Gienger AL, McDonald KM, Sundaram V, Perez MV, Varghese R, Kapoor JR, Ardehali R, Owens DK, Hlatky MA.Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med . 2007 Nov 20;147(10):703-16. Epub 2007 Oct 15. Review.
Cardiac Procedures and Surgeries At-A-Glance. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3054086 . Accessed January 12, 2009.
Chaer RA, Makaroun MS.Current indications for carotid angioplasty and stenting. Perspect Vasc Surg Endovasc Ther . 2008 Sep;20(3):239-44. Review.
Hochman J, Lamas GA, Buller CE, et al. Coronary intervention for persistent occlusion after myocardial infarction. N J Eng Med. 2006;355:2395-2407. Available at: http://content.nejm.org/cgi/content/abstract/NEJMoa066139 . Accessed January 12, 2009.
Kasper DL, et al. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill Professional;2004.
Smith SC, Dove JT, Jacobs AK, et al. ACC/AHA guidelines of percutaneous coronary interventions. J Am Coll Cardiol. 2001;37:2215.
Weaver WD. Heart Disease: A Textbook of Cardiovascular Medicine . 5th ed. Philadelphia, PA:WB Saunders; 1997.
Last reviewed November 2009 by Craig Clark, DO, FACC, FAHA, FASE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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