Coronary Angioplasty

What is coronary angioplasty?

Coronary angioplasty, also known as percutaneous coronary intervention or PCI, is a minimally invasive, non-surgical procedure used to open narrowed arteries.



It involves the use of a flexible catheter with a balloon at the tip which is inflated at high pressure on the narrowed arterial wall. Usually a stent (metallic wire mesh) will be placed in the artery after angioplasty. This will force the arterial plaque against the blood vessel and improve the blood flow to the heart muscle.

Benefits of Coronary Angioplasty

- Relief from Symptoms: Angioplasty can relieve symptoms of blocked arteries, such as chest pain (angina) and shortness of breath, improving quality of life for patients with heart disease.

- Minimally Invasive: Unlike coronary artery bypass surgery, angioplasty does not require an incision on the chest wall. It is performed using a catheter inserted through a small puncture in a leg or arm artery, making the recovery time shorter and less painful.

- Improved Blood Flow: This procedure can significantly improve blood flow through the previously narrowed or blocked coronary artery, enhancing heart function and reducing the risk of a heart attack.

- Short Recovery Period: Patients typically spend less time in the hospital after angioplasty and can return to normal activities more quickly than surgery.

- Stent Placement: Often during angioplasty, a stent is placed within the coronary artery to keep the artery open. There are some stents which are coated with medication which reduce the rate of re-narrowing and suitable for certain groups of patients who are at a higher risk of their arteries narrowed again after stenting procedures.

Limitations of Coronary Angioplasty

- Risk of Complications: Although generally safe, angioplasty can occasionally cause serious complications such as artery damage, kidney damage from the contrast dye, bleeding at the catheter insertion site, heart attack, or even stroke.

- Re-narrowing of Your Arteries: There is a chance that the artery will re-narrow, known as restenosis, which occurs in about 3% of cases with drug-eluting stents and up to 20% for bare-metal stents.

- Need for More Procedures: Some patients may require additional angioplasties or other procedures like coronary artery bypass surgery if the artery re-narrows, or if other arteries become blocked.

- Not a Cure: Angioplasty does not cure coronary artery disease. Without a healthy lifestyle change, the process of atherosclerosis that caused the initial blockage can continue, potentially leading to future blockages.

- Post-procedure Care and Medication: Patients will typically need to take antiplatelet drugs (such as aspirin and another blood thinner) to prevent blood clots in the stent. This can increase the risk of bleeding, especially if another surgery is needed.

How can you prepare for coronary angioplasty?

You are required to go for pre-admission testing which includes: 

Coronary Angioplasty – During the Surgery

What can you expect during coronary angioplasty surgery?

How is the procedure done?

The procedure is performed under local anaesthesia. A small puncture is made, usually in the groin, wrist or elbow. A sheath is inserted into the opening and a guiding catheter is placed through the sheath into the blood vessel. Contrast is injected through the catheter so that the doctor can see the arteries on the X-ray screen. 

Once the catheter reached the narrowed artery, the doctor will position the balloon within the blocked section of the artery. The balloon is then inflated to squash the blockage so that blood flow can be restored to normal.

You should try and get a good night’s sleep. 

Day of the procedure

Mild sedation may be prescribed by your doctor.

You will be instructed not to eat or drink anything for a period of at least six hours before the procedure.

On the day of the procedure, you will be asked to remove your dentures, contact lenses and any jewellery. Please do not bring money or valuables on the day of your procedure. Additional shaving may take place (over the groin area) if necessary.

The duration of this procedure varies depending on the case but usually takes about an hour.

What can you expect after coronary angioplasty surgery?

After the procedure is completed, you will be taken back to the ward for recovery. You will be nursed in the High Dependency Unit (HDU), Intermediate Care Area (ICA) or in the Coronary Care Unit (CCU), where you will be observed for bleeding, heart rhythm disturbances and complications that may occur in the period immediately following the coronary angioplasty. A nurse will frequently check your pulse, blood pressure, and observe the procedure site for bleeding.

Your doctor will discuss the results and outcome of your procedure, and advise you on further treatment if necessary. If the point of access was your groin, a small plastic sheath may be left in place for several hours after the procedure, and once removed, will be compressed manually thereafter in order to achieve adequate wound healing and prevent bleeding.

If the procedure is uncomplicated, most patients can be discharged on the same day or the next day. Patients are usually discharged from the hospital within two to four days. On discharge, you should continue to take the medicines (especially the blood thinners) given to you by your doctor regularly and come for the scheduled follow-up appointments.

What must I look out for after going home? 

What does coronary angioplasty involve?

Coronary angioplasty is a procedure used to open blocked or narrowed coronary arteries. A small balloon is inflated within the artery to improve blood flow to the heart, and in many cases, a stent is placed to keep the artery open.

Who might require coronary angioplasty?

This procedure is often recommended for individuals with coronary artery disease, particularly those experiencing chest pain (angina), breathlessness or a heart attack. It is typically considered when medication and lifestyle adjustments are not enough to manage symptoms.

How long does coronary angioplasty take to complete?

The procedure generally lasts between 30 minutes and 2 hours, depending on the complexity of the blockage. While most patients can return home the next day, some may need to stay in hospital longer based on their condition.

Video

Coronary Angiography and Angioplasty:

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Cardiovascular Rehabilitation & Preventive Cardiology (CVR & PC) Programme

You are encouraged to attend the Cardiovascular Rehabilitation & Preventive Cardiology Programme after your coronary angioplasty procedure. The programme will enable, encourage and assist you on the road to recovery.

For more information on our programme, click here.

References

1. Percutaneous coronary intervention. Heart and Stroke Foundation of Canada. (n.d.). https://www.heartandstroke.ca/heart-disease/treatments/surgery-and-other-procedures/percutaneous-coronary-intervention
2. Coronary angioplasty and Stents (PCI). British Heart Foundation. (n.d.). https://www.bhf.org.uk/informationsupport/treatments/coronary-angioplasty-and-stents
3. U.S. National Library of Medicine. (n.d.). Angioplasty | Balloon Angioplasty. MedlinePlus. https://medlineplus.gov/angioplasty.html
4. Coronary angioplasty and stenting: Cardiac surgery: Michigan medicine. Cardiac Surgery. (2016, July 20). https://medicine.umich.edu/dept/cardiac-surgery/patient-information/adult-cardiac-surgery/adult-conditions-treatments/coronary-angioplasty-stenting