Coronary angioplasty and stents can open clogged arteries and improve blood flow to the heart.
Coronary angioplasty (AN-jee-o-plas-tee), also called percutaneous coronary intervention, is a procedure used to open clogged heart arteries. Angioplasty uses a tiny balloon catheter that is inserted in a blocked blood vessel to help widen it and improve blood flow to the heart.
Angioplasty is often combined with the placement of a small wire mesh tube called a stent. The stent helps prop the artery open, decreasing its chance of narrowing again. Most stents are coated with medication to help keep the artery open (drug-eluting stents). Rarely, bare-metal stents are used.
Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty is also often used during a heart attack to quickly open a blocked artery and reduce the amount of damage to the heart.
Angioplasty is used to treat the buildup of fatty plaques in the heart's blood vessels. This buildup is a type of heart disease known as atherosclerosis.
Angioplasty may be a treatment option for you if:
Angioplasty isn't for everyone. Depending on the extent of your heart disease and your overall health, your doctor may determine that coronary artery bypass surgery is a better option than angioplasty for you.
You may need coronary artery bypass surgery if:
In coronary artery bypass surgery, the blocked part of your artery is bypassed using a healthy blood vessel from another part of your body.
If there's too much cholesterol in the blood, the cholesterol and other substances may form deposits (plaques) that collect on artery walls. Plaques can cause an artery to become narrowed or blocked. If a plaque ruptures, a blood clot can form. Plaques and blood clots can reduce blood flow through an artery.
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:
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 (Plavix), prasugrel (Effient) or another medication that helps reduce the risk of blood clots exactly as prescribed to decrease the chance of clots forming in your stent.
Talk to your doctor about how long you'll need to take these medications. Never stop taking these medications without discussing it with your doctor.
Other rare risks of angioplasty include:
Before a scheduled angioplasty, your doctor will review your medical history and do a physical exam. You may need to have some tests, including a chest X-ray, electrocardiogram and blood tests, before your procedure. Your doctor will also perform an imaging test called a coronary angiogram to see if the arteries to your heart are blocked and if they can be treated with angioplasty.
If your doctor finds a blockage during your coronary angiogram, he or she may decide to perform angioplasty and stenting immediately after the angiogram while your heart is still catheterized.
Your doctor will give you instructions to help you prepare.
Angioplasty is performed by a heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians in a special operating room called a cardiac catheterization laboratory.
Angioplasty is performed through an artery in your groin, arm or wrist area. General anesthesia isn't needed. You'll receive a sedative to help you relax, but you may be awake during the procedure depending on how deeply you are sedated.
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 angioplasty also have a stent placed in their blocked artery during the same procedure. A stent, which looks like a tiny coil of wire mesh, supports the walls of your artery and helps prevent it from re-narrowing after angioplasty.
Here's what happens during a stent placement:
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, your doctor will prescribe medications, such as aspirin, clopidogrel (Plavix), ticagrelor (Brilinta) or prasugrel (Effient), to reduce the chance of blood clots forming on the stent.
If you had a nonemergency procedure, you'll probably remain at the hospital overnight while your heart is monitored and your medications are adjusted. You generally should be able to return to work or your normal routine the week after angioplasty.
When you return home, drink plenty of fluids to help flush your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for at least a day afterward. Ask your doctor or nurse about other restrictions in activity.
Call your doctor's office or hospital staff immediately if:
It's important that you closely follow your doctor's recommendations about your treatment with blood-thinning medications — aspirin and clopidogrel (Plavix), prasugrel (Effient) or similar medications.
Most people who have undergone angioplasty with or without stent placement will need to take aspirin indefinitely. Those who have had stent placement will need a blood-thinning medication, such as clopidogrel, for six months to a year. If you have any questions or if you need any other type of surgery, talk to your cardiologist before stopping any of these medications.
When placing a coronary artery stent, a health care provider will find the blocked heart artery (A). A balloon on the tip of a flexible tube (catheter) is inflated. It widens the blocked artery. Then a metal mesh stent is placed (B). The stent holds the artery open so blood moves through (C).
Coronary angioplasty greatly increases blood flow through the previously narrowed or blocked coronary artery. Chest pain generally should decrease. You may be better able to exercise.
Having angioplasty and stenting doesn't mean your heart disease goes away. You'll need to continue healthy lifestyle habits and take medications as prescribed by your doctor.
If you have symptoms similar to those you had before coronary angioplasty, such as chest pain or shortness of breath, contact your doctor. If you have chest pain at rest or pain that doesn't respond to nitroglycerin, call 911 or emergency medical help.
To keep your heart healthy after angioplasty, you should:
Successful angioplasty also means you might not have to undergo coronary artery bypass surgery, a more invasive procedure that requires a longer recovery time.