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Coronary Angioplasty & Stenting

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 local anaesthesia.
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 working correctly.
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 blood flow. This is rarely used because balloon angioplasty and stenting have much better results.
  • 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.
    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:

  • Iodine
  • Shellfish
  • X-ray dye
  • Latex or rubber products (such as rubber gloves or balloons)
  • Penicillin-type medications
  • 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

  • During the procedure

  • Your heart rate, pulse, blood pressure and oxygen level will be monitored during the procedure.
  • 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.

  • Stent placement

    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 enough.
    You may be admitted to the hospital overnight for observation after the procedure.

    To keep your heart healthy after angioplasty, you should:

  • Quit smoking
  • 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

  • Complications

    Although angioplasty is a less invasive way to open clogged arteries than bypass surgery is, the procedure still carries some risks.
    The most common angioplasty risks include:

  • 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.