What Happens During Angioplasty?
First, a coronary angiography procedure would be done . Medication will be given to
relax , then the cardiologist will numb the area where the catheter will go with
Next, a thin plastic tube called a sheath is inserted into an artery -- sometimes in
your groin(femoral) sometimes in your arm (radial). A long, narrow, hollow tube
called a catheter is passed through the sheath and guided up a blood vessel to the
arteries surrounding the heart.
A small amount of contrast liquid is put into your blood vessel through the
catheter. It’s photographed with an X-ray as it moves through your heart's chambers,
valves, and major vessels. From those pictures, the cardiologist would tell if your
coronary arteries are narrowed and, in some cases, whether the heart valves are
If the cardiologist decides to perform angioplasty, he will move the catheter into
the artery that’s blocked. He’ll then do one of the procedures described below.
The whole thing lasts around 1 hour, but the preparation and recovery can add
much more time. You may stay in the hospital overnight for observation.
What Types of Procedures Are Used in Angioplasty?
Balloon Angioplasty: Uses a tiny balloon catheter that is inserted in a
blocked blood vessel to help widen it and improve blood flow to your heart. Once in
place, the balloon is inflated to push the plaque and stretch the artery open to
boost blood flow to the heart.
Stent: Angioplasty is often combined with the placement of a small wire mesh
tube called a stent. The stent helps to keep the artery open, decreasing its chance
of narrowing again. Most stents are coated with medication to help keep your artery
open (drug-eluting stents). Rarely, bare-metal stents may be used. A balloon
catheter, placed over a guide wire, puts the stent into your narrowed coronary
artery. Once in place, the balloon is inflated, and the stent expands to the size of
the artery and holds it open. The balloon is then deflated and removed while the
stent stays in place. Over several weeks, the artery heals around the stent.
Rotablation: A special catheter, with an acorn-shaped, diamond-coated tip, is
guided to the point of the narrowing in the r coronary artery. The tip spins at a
high speed and grinds away the plaque on the artery walls. The microscopic particles
are washed away in your bloodstream. This process is repeated as needed to improve
This is rarely used because balloon angioplasty and stenting have much better
Cutting balloon: This catheter has a special balloon tip with small blades.
When the balloon is inflated, the blades are activated. The small blades score the
plaque, then the balloon presses the plaque against the artery wall.
What Can you Expect Before an Angioplasty?
Most people will need a routine blood test and electrocardiogram.
Latex or rubber products (such as rubber gloves or balloons)
Some medications can be given to you before the procedure (bold thinners)
You’ll be awake during the procedure , but you’ll get medication to help you relax
You won’t be able to eat or drink for few hour before the procedure depending on the
advise of the cardiologist.
let them know if you are allergic to anything, especially:
During the procedure
Your heart rate, pulse, blood pressure and oxygen level will be monitored during the
The nurse will prepare the area in your leg, arm or wrist with an antiseptic
solution and will place a sterile sheet over your body.
The cardiologist will use a local anesthetic to numb the area where a very small
incision will be made. A small, thin guidewire is then inserted in the blood vessel.
With the help of live X-rays, the cardiologist will thread a thin tube (catheter)
through your artery.
Contrast dye is injected through the catheter once it is in place. This allows your
doctor to see the inside of your blood vessels and identify the blockage on X-ray
images called angiograms.
A small balloon with or without a stent at the tip of the catheter is inflated at
the site of the blockage, widening the blocked artery.
After the artery is stretched, the balloon is deflated and the catheter is removed.
If you have several blockages, the procedure may be repeated at each blockage.
Angioplasty can take up to several hours, depending on the difficulty and number of
blockages and whether any complications arise.
You might feel pressure in the area where the catheter is inserted. You may also
feel some mild discomfort when the balloon is inflated and your artery is stretched,
but typically you shouldn't feel any sharp pain during the procedure.
Most people who have an angioplasty also have a stent placed in their blocked artery
during the same procedure.
Here's what happens during a stent placement:
The stent, which is collapsed around a balloon at the tip of the catheter, is guided
through the artery to the blockage.
At the blockage, the balloon is inflated and the spring-like stent expands and locks
into place inside the artery.
The stent stays in the artery permanently to hold it open and improve blood flow to
your heart. In some cases, more than one stent may be needed to open a blockage.
Once the stent is in place, the balloon catheter is deflated and removed.
More X-ray images (angiograms) are taken to see how well blood flows through your
newly widened artery.
Most stents implanted during an angioplasty are drug coated. The medication in the
stent is slowly released to help prevent future plaque buildup and the re-narrowing
of the blood vessel.
After your stent placement, the cardiologist will prescribe medications, such as
aspirin, clopidogrel , ticagrelor or prasugrel , to reduce the chance of blood clots
forming on the stent.
What Happens After an Angioplasty?
If the catheter was put into the artery at your groin, you’ll have to lie flat
(without bending your legs) while the groin sheath is in place. A sheet may be
placed across your leg with the sheath to remind you to keep it straight.
After the sheath is removed, you’ll have to lie flat for about 6 hours to prevent
bleeding, but your nurse can raise your head about two pillows high after 2 hours.
Your nurse will tell you when you can get out of bed.
You shouldn’t eat or drink anything except clear liquids until the groin sheath is
removed. That’s because you can get nauseated while it’s on.
If your catheter was put into the artery at your wrist or arm, your doctor will put
a special bandage on to make sure it heals properly. You’ll wear this for a couple
of hours. The nurse will remove it and check to see if your artery has healed
You may be admitted to the hospital overnight for observation after the procedure.
To keep your heart healthy after angioplasty, you should:
Lower your cholesterol levels
Eat a healthy diet that is low in saturated fat
Maintain a healthy weight
Control other conditions, such as diabetes and high blood pressure
Get regular exercise
Take medications as prescribed by your doctor
Although angioplasty is a less invasive way to open clogged arteries than bypass
surgery is, the procedure still carries some risks.
Re-narrowing of your artery: When angioplasty is combined with drug-eluting
stent placement, there's a small risk the treated artery may become clogged again
(less than 5%). The risk of re-narrowing of the artery is about 10% to 20% when
bare-metal stents are used.
Blood clots: Blood clots can form within stents even after the procedure.
These clots can close the artery, causing a heart attack. It's important to take
aspirin in combination with clopidogrel ,prasugrel , ticagrelor or another
medication that helps reduce the risk of blood clots exactly as prescribed to
decrease the chance of clots forming in your stent.
Bleeding: You may have bleeding in your leg or arm where a catheter was
inserted. Usually this simply results in a bruise, but sometimes serious bleeding
occurs and may require a blood transfusion or surgical procedures.
The most common angioplasty risks include: