Cardiothoracic Surgery

Angioplasty

Illustration of angioplasty

What Is an Angioplasty?

Coronary angioplasty is also called a percutaneous coronary intervention, a medical procedure that is used to open clogged heart arteries. This procedure involves temporarily inserting and inflating a small balloon in a clogged artery. This will help widen the artery.

The procedure is often accompanied by the permanent installation of a small wire mesh tube called a stent. The stent helps keep the artery open and reduces the chance of it narrowing again. Some stents are covered with medication, and others are not.

Angioplasty can help symptoms of blocked arteries. These can include chest pain and shortness of breath. The procedure can also be done at the time of a heart attack to open a blocked artery and decrease the damage done to your heart.

Atherosclerosis

Angioplasty is used to treat atherosclerosis. This condition is the slow buildup of plaque in your heart's blood vessels. Your doctor may advise you to get an angioplasty if medication and lifestyle changes do not help alone.

Are You a Candidate?

Angioplasty is not recommended in all cases. If the main artery that carries, blood to the left side of your heart is narrow, or if your heart muscle is weak, or if you have many affected blood vessels, then coronary artery bypass surgery might be the way to go. Coronary artery bypass surgery works by bypassing the blocked part of your artery with a blood vessel that is taken from another part of your body.

If you have diabetes and many blockages, then your doctor may recommend this kind of surgery.

Risks

Even though angioplasty is less invasive than bypass surgery, there are still some risks involved:

  • Re-narrowing of the artery - If you don't get stents placed, then your artery may get blocked again.
  • Blood clots - Blood clots can occur within the stents. These clots can close off the artery, leading to a heart attack. Medications such as aspirin can help alleviate the problem.
  • Bleeding - Bleeding can occur in the location where the catheter is inserted. This bleeding may be minor or a major problem.

Rare risks of angioplasty include:

  • Heart attack
  • Coronary artery damage - The coronary artery may become torn or ruptured. This may necessitate getting bypass surgery.
  • Kidney problems - The dye that the doctor uses may cause kidney damage.
  • Stroke - During the procedure, a stroke can happen if plaques come loose when the catheters are pushed through the aorta. Blood clots may also occur in catheters and go to the brain if they come loose.
  • Abnormal heart rhythms - While you have the procedure, the heart may beat too quickly or too slowly. Medication can help resolve this problem.

The Procedure

Angioplasty only requires a very small incision in the skin over a blood vessel in the leg, arm, or wrist. Through this incision, a small catheter is inserted. The procedure can last from 30 minutes to several hours. It all depends on the number of blockages or any complications occur.

A cardiologist performs an angioplasty and a team of specialized nurses and technicians in a room called the Cath lab. It is many times performed through an artery in the groin area. Occasionally, it is done through an artery in the arm or wrist. A local anesthetic is injected to numb the area where the catheter is inserted. Your heart is monitored during the procedure.

General anesthesia is not necessary for this procedure. These are the steps in the procedure:

  • A small needle is used to get to an artery in your leg or arm.
  • The doctor inserts a wire followed by a catheter into the artery and guides it up to where the blockage is.
  • A small amount of dye is injected through the catheter. This is used so that the doctor can see the area on images that are taken.
  • A little balloon at the end of the catheter is inflated. This will widen the artery. After this is done, then the balloon will be deflated and removed.

The Results

Angioplasty should increase blood flow through the occluded artery. Your chest pain will diminish, and you should have an easier time exercising. Angioplasty does not take away your heart disease. You need to maintain a healthy lifestyle and use the medication that the doctor gives you.

Some important lifestyle changes to maintain your health after the angioplasty include:

  • Quitting smoking
  • Lowering your cholesterol levels
  • Maintaining a healthy body weight
  • Controlling diabetes and hypertension
  • Getting regular exercise

Prognosis

The survival rates 10 years after bypass surgery and angioplasty are similar. There are different kinds of complications for the two procedures, though. Five years after the procedures, 90.7 percent of the bypass patients and 89.7 percent of the angioplasty patients were still alive.

Conclusion

Angioplasty and the placement of stents can be a life-saving procedure. The survival rate is very high and the complications are not so common. Both bypass surgery and angioplasty have their pros and cons. Bypass surgery is longer lasting and more durable. Angioplasty is a simpler procedure, and the recovery time is faster. Of course, your doctor will always discuss your options with you so that you can make the best choice that you can.