Coronary Angioplasty and Stenting - General Information
Opening clogged arteries to reduce chest pain and other symptoms

Plaques that accumulate in your coronary arteries can cause chest pain, heart attacks and strokes. Angioplasty can reopen clogged arteries and improve your health. When your arteries are healthy, their flexibility and smooth, inner lining allow your blood to flow freely to your heart, supplying it with nutrients and oxygen. But your arteries can become stiff and narrow if fats, cholesterol and other material accumulate inside them, forming plaques. This narrowing and stiffness is called atherosclerosis.

Coronary angioplasty is a medical procedure used to open arteries that have narrowed to the point that they impede blood flow to the heart. This procedure can improve some of the symptoms associated with blocked arteries, such as chest pain, heart attack and stroke.

Who is angioplasty for?

When medications or lifestyle changes aren't enough to reduce the effects of these blockages in your arteries, or if you have worsening chest pain or heart problems, your doctor might suggest coronary angioplasty (AN-je-o-plas-te). This procedure widens (dilates) blocked arteries, which can help prevent the complications of atherosclerosis. Angioplasty is usually combined with implantation of a stent in the clogged artery to help prop it open and decrease the chance of reblockage. Angioplasty is also known as coronary artery balloon dilation, balloon angioplasty and percutaneous coronary intervention (PCI).

How do you prepare for angioplasty?

In general, your doctor will examine you before an angioplasty and review your medical history with you. You'll receive instructions on what you can or can't eat or drink before the procedure. Typically you have to stop eating or drinking by midnight the night before. Your preparation may vary slightly if you're already hospitalized. Whether the angioplasty is prescheduled or done as an emergency, you'll likely have some routine tests first, including:

• Chest X-ray
• Electrocardiogram
• Blood tests

You'll also get instructions about making any adjustments to your current medications. You may need to stop taking certain medications, particularly if you have diabetes and take insulin or oral medications for the condition. Take all of your medications to the hospital with you, including nitroglycerin. Take approved medications with only small sips of water. Tell your doctor or nurse if you're allergic to any medications.  Angioplasty usually requires an overnight hospital stay. Make sure you arrange for transportation home.

How is angioplasty performed?

Angioplasty is performed by a heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians, usually in a cardiac catheterization laboratory. It should be done only at a medical institution with backup cardiac surgical facilities because of a small risk of complications that could require emergency heart surgery.  Coronary angioplasty isn't considered surgery because it's less invasive — your body isn't cut open. Rather, angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to widen the blocked area. In most cases, a mesh tube (stent) is also placed inside the artery to hold it open more widely and prevent re-narrowing in the future.

Angioplasty is commonly performed through an artery in your groin (femoral artery). Less commonly, it may be done using an artery in your arm or wrist area. Before the procedure, the area is prepared with antiseptic solution and a sterile drape is placed over your body. A local anesthetic is injected into your groin to numb the area. Small electrode pads are placed on your chest to monitor your heart rate and rhythm during the procedure.  General anesthesia isn't needed, so you're awake during the procedure. You'll receive fluids and medications for relaxation and mild sedation through an intravenous catheter. You'll get blood-thinning medications (anticoagulants) to reduce blood clotting and other medications to relax your coronary arteries.

Honing in on the target blockages

A short tube called a sheath is inserted into your femoral artery. A guide catheter — a hollow, flexible and longer tube — is then inserted into the sheath. Aided by X-ray images on a monitor, your doctor threads the guide catheter through that artery all the way up until it reaches your blocked coronary artery. You might feel pressure in your groin while this is being done, but you shouldn't feel sharp pain. You also won't feel the catheter in your body. If you do have pain, tell your health care team.

Next, a small amount of contrast agent, or dye, is injected through the catheter. Areas of blockage in the coronary artery show up on the X-ray images, so your doctor knows precisely where to target treatment.  A small catheter with a tiny deflated balloon at the tip is inserted through the guide catheter and threaded into the narrowed artery. The balloon is inflated for up to several minutes at the site of the blockage, stretching out the artery wall and decreasing the amount of blockage. The balloon then deflates.

Because the balloon temporarily blocks blood flow to part of your heart, it's common to experience chest pain while it's inflated. Your doctor might inflate and deflate the balloon several times before it's removed, stretching the artery a bit more each time to widen it. If you have several blockages, the procedure may be repeated at each site.

Stents provide added support

Once the artery is widened, a device called a stent is usually placed in the artery to act as scaffolding to help prevent it from renarrowing after the angioplasty. The stent looks like a very tiny lattice-work coil of wire mesh.

To insert the stent, it's collapsed to make it smaller, placed on a balloon catheter and guided to the blockage during the angioplasty procedure. When the balloon inflates, the spring-like stent expands and locks into place inside the artery. The stent remains in the artery permanently to hold it open and improve blood flow to your heart. Stents can be coated with medication that is slowly released to help prevent arteries from reclogging. These coated stents are called drug-eluting stents.

Once stents are in place, the balloon catheter is removed and more images (angiograms) are taken to see how well blood flows through your newly widened artery. Finally, the guide catheter is removed and the procedure completed. The entire procedure usually takes about 30 minutes to several hours.

The recovery period: Watching for problems

Because of the risk of bleeding from the anticoagulants, your doctor may leave the sheath in your artery for several hours after the procedure so the blood vessel isn't disturbed. To help prevent additional bleeding, you must keep your leg still until the sheath has been out for about six hours, or until your doctor gives his approval.  After the sheath is removed, pressure is temporarily applied to the site to prevent bleeding and aid healing. Alternatively, your doctor may choose to remove the sheath immediately and use a patch or stitches to close the artery. In any case, you may have bruising and tenderness at the point where the catheter was inserted.

Your heart is monitored for 12 to 24 hours after the procedure, and your vital signs are checked frequently. Your doctor will likely prescribe medications to prevent blood clots, relax your arteries and protect against coronary spasms. You'll probably remain hospitalized a day — in rare cases two or more days.  When you return home, drink plenty of fluids to help rid your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for several days afterward. Ask your doctor or nurse about other restrictions in activity.

Call your doctor's office if:

• The catheter insertion site starts bleeding or swelling
• You develop increasing pain or discomfort at the insertion site
• You have signs of infection, such as redness, drainage or fever
• There's a change in temperature or color of the leg or arm that was used for the procedure
• You feel faint or weak
• You develop chest pain or shortness of breath

You should be able to return to work or your normal routine the week after angioplasty.

Results

For most people, coronary angioplasty greatly increases blood flow through the previously blocked artery. Your chest pain should subside and you may have a better ability to exercise.

Lifestyle modifications will help you maintain your good results, including:

• Avoiding tobacco products
• Lowering your cholesterol levels
• Maintaining a healthy weight
• Controlling other conditions, such as diabetes and high blood pressure
• Getting regular exercise.