Angioplasty

Angioplasty is a medical procedure to open narrowed or blocked blood vessels of the heart called the coronary arteries and is not considered a surgery. It is also called percutaneous transluminal coronary angioplasty (PTCA) and percutaneous coronary intervention (PCI). Angioplasty is used in other parts of the body also to treat peripheral artery diseases.

Angioplasty is used to improve symptoms of coronary artery disease (CAD) such as angina and shortness of breath. Angina is a form of chest pain or discomfort that occurs when an area of the heart muscle is deprived of enough oxygen-rich blood. Angina may feel like pressure or squeezing in the chest. The pain also radiates to shoulders, arms, jaw, neck, or back. Angina can feel like indigestion.

Remarkably, angina itself is not a disease. Rather, it’s a symptom of an underlying heart problem and usually a symptom of coronary artery disease (CAD), the most common type of heart disease. In CAD, coronary arteries (the arteries that supply blood and oxygen to your heart) narrow down or get blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis.

Coronary angioplasty is also used to reduce damage to the heart muscle resulting from a heart attack. Atherosclerosis usually leads to heart attack. When plaque is formed, an area of plaque can rupture, resulting in a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.

Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women.

Procedure

Angioplasty is invariably performed under local anesthesia. It can be uncomfortable, but is not usually painful. Balloon angioplasty (percutaneous transluminal coronary angioplasty or PTCA) is widely used for treatment of the blockages of coronary artery disease.

The surgeon makes a small incision in the groin or arm and inserts a thin tube, called a catheter, into the artery. The catheter includes a small balloon and a small wire tube, called a stent. The stent is usually a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed coronary artery.

Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. This is to compress the plaque and enlarge the artery, and provide an adequate area for blood to flow through. The balloon is deflated and removed, and the stent stays in place permanently. The procedure may be repeated for one or more other narrowed sections within the coronary arteries.

Patients usually do not feel the catheter inside the blood vessels. Occasionally, the patient may feel a ‘missed’ or ‘extra’ heartbeat during the procedure. This is considered normal and of little concern. During the procedure patient heartbeat is monitored by electrodes placed on patient’s chest which provide a tracing on an ECG machine (electrocardiograph).

Duration

The duration of the procedure also depends on various factors. If just one section of artery is widened the procedure usually takes about 30 minutes. If several sections are to be widened then the procedure takes longer.

Hospital Stay and Recovery

Most people are admitted to hospital and monitored under specialized care overnight after angioplasty. They are usually sent home after 2-3 days stay in Hospital.

Over a several-week period, the artery heals around the stent.

Patients are advised to avoid any heavy activities such as lifting for about 15 days until the small wound where the catheter was inserted has healed. They’re also proscribed from driving a car for a week after having an angioplasty.

Success Rate

More than 9 in 10 coronary angioplasty procedures are successful at relieving angina. However, the use of coronary angioplasty is not possible with all people with angina. The reason for this is in some cases there are too many narrowed or it is not possible to stretch the artery for coronary angioplasty.

This occurs in about 1 in 20 cases where coronary angioplasty is tried. An alternative treatment coronary artery bypass grafting may then be an option to treat angina. Bypass grafting involves involve major surgery hence most patients feel that it was worth trying a coronary angioplasty first.

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