angioplasty What is coronary angioplasty?

Coronary angioplasty is a procedure where a narrowed section of a coronary artery is widened by using a balloon and a stent attached to a catheter. A catheter is a thin, flexible tube which is inserted into a coronary artery.

What is coronary angioplasty used for?

Coronary angioplasty is commonly used to treat people who have angina.

However, angioplasty can also be used to help in emergency situations, such as when a person has a heart attack. A heart attack occurs because part of the heart is not receiving enough blood. This is usually caused by a blockage in an artery supplying blood to the heart itself. In view of the enormous work output of the heart it is essential that the heart muscle needs a good blood supply. The coronary arteries take blood to the heart muscle.

What is angina and what causes it?

Angina is a pain that comes from the heart. The usual cause of angina is narrowing of one or more of your coronary arteries. This reduces the blood supply to a part, or parts, of your heart muscle. The blood supply may be enough when you are resting. In situations where the work of the heart increases as in during strenuous physical activity or emotional excitement this lack of adequate blood supply causes the heart muscle to enter into a state of oxygen starvation leading to damage and even cell death. The narrowing of the arteries is caused by atheroma. Atheroma is like fatty patches or 'plaques' that develop within the inside lining of arteries.

How is coronary angioplasty done?

You lie on a couch in a catheterization room. An X-ray machine is mounted above the couch. A 'guide' catheter is inserted through a wide needle or small cut in the skin into a blood vessel in the groin or arm. The doctor gently pushes the catheter up the blood vessel towards the heart. Low-dose X-rays are used to monitor the progress of the catheter tip which is gently manipulated into the correct position.

The tip of the catheter is pushed inside a coronary artery down to where there is narrowed section caused by atheroma. A second thinner 'balloon catheter' is then passed down the 'guide' catheter. There is a balloon and a stent at the tip of the balloon catheter. The balloon is blown up for 30-60 seconds. This squashes the atheroma and widens the narrowed artery. When the balloon is blown up it stops the blood flow. Therefore, you may get an angina-like pain for a short duration.

Usually, a stent is left in the widened section. A stent is like a wire mesh tube which gives support to the artery and helps to keep the artery widened. The 'collapsed' stent covers the balloon and is opened as the balloon is blown up. Some stents are coated with a chemical (tacrolimus) that helps to prevent the artery from becoming blocked again.

How do I prepare for a coronary angioplasty?
  • You may be asked to stop eating and drinking for a six hours before the procedure.
  • You may be asked to shave both groins before the procedure.
  • You will have to sign a consent form at some point before the test to confirm that you understand the procedure, understand the possible complications , and agree to the procedure being done.
How long does coronary angioplasty take?

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. Most hospitals insist that you stay in hospital overnight for observation following the procedure.

How successful is coronary angioplasty?

Coronary Angioplasty is a very successful procedure in the selected group of patients in whom it is indicated. However, coronary angioplasty cannot be used for all people with angina. This is because in many cases there are too many narrowed sections in the coronary arteries. Or, the sections that are narrowed are too long, or too narrow, or too far down a coronary artery or branch artery for this procedure.

After an angioplasty

You should avoid any heavy activities such as lifting for about a week until the small wound where the catheter was inserted has healed. You should not drive a car for a week after having an angioplasty.

Are there any possible risks, complications or side-effects?

One common problem is that a bruise may form under the skin where the catheter was inserted (usually the groin). This is not serious, but it may be sore for a few days.

Sometimes it is not possible to stretch the narrowed artery. An alternative treatment for angina called coronary artery bypass grafting may then be an option.

Risks of the procedure

In the majority of cases, there are no serious problems. However, you have to accept the risk that in some cases problems do arise:

  • The small wound where the catheter is inserted sometimes becomes infected.
  • Rarely, some people have an allergic reaction to the dye that is used to show up the coronary arteries on X-ray.
  • The procedure sometimes causes the artery to block off completely. If this occurs you may be taken for an urgent coronary artery bypass graft operation (which is usually successful).
  • A heart attack during the procedure.
  • The catheter may damage a coronary artery. If this occurs, the artery may be repaired by emergency heart surgery.
  • A stroke is another rare complication.
  • Rarely, some people die during this procedure as a consequence of one of these serious complications.

Long-term complications

In some cases, the atheroma re-forms within the stent over the next few months and years. This may narrow the artery again and angina pains may return again.

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