What is angioplasty?
Angioplasty, also called percutaneous coronary intervention (PCI), is a procedure used to open blocked coronary arteries (caused by coronary artery disease) and restore blood flow to the heart muscle without open-heart surgery.
For angioplasty, a special catheter (a long, thin, hollow tube) is inserted into a blood vessel and guided to the blocked coronary artery. The catheter has a tiny balloon at its tip. Once the catheter is in place, the balloon is inflated at the narrowed area of the coronary artery. This presses the fatty tissue against the sides of the artery making more room for blood flow.
The use of fluoroscopy (a special type of X-ray that’s like an X-ray "movie") helps the doctor find the blockages in the coronary arteries as a contrast dye moves through the arteries.
The doctor may determine that another type of procedure is necessary. This may include the use of atherectomy (removal of plaque) at the site of the narrowing of the artery. In atherectomy, there may be tiny blades on a balloon or a rotating tip at the end of the catheter. When the catheter reaches the narrowed spot in the artery, the plaque is broken up or cut away to open the artery.
Coronary stents are now used in nearly all angioplasty procedures. A stent is a tiny, expandable metal mesh coil that is put into the newly-opened area of the artery to help keep the artery from narrowing or closing again.
Once the stent has been placed, tissue will begin to form over it within a few days after the procedure. The stent will be completely covered by scar tissue within a month or so. Medication must be taken to decrease the "stickiness" of platelets (special blood cells that clump together to stop bleeding), to keep blood clots from forming inside the stent. Your doctor will give specific instructions on which medications need to be taken and for how long.
Some stents are coated with medication to prevent the formation of too much scar tissue inside the stent. These stents, called drug-eluting stents, or DES, release medication within the blood vessel that inhibits the overgrowth of tissue within the stent, and helps deter re- narrowing of the blood vessel.
Because stents can become blocked, it is important for you to talk with your doctor about what you need to do if you have chest pain after a stent placement.
If scar tissue does form inside the stent, a repeat procedure may be needed, either with balloon angioplasty or with a second stent. In some cases, radiation therapy may be given through a catheter placed near the scar tissue to stop the growth of scar tissue and open up the vessel.
What are the risks of angioplasty?
Possible risks associated with angioplasty, stenting, atherectomy, and related procedures include, but are not limited to:
- Bleeding at the site where the catheter is put into the body (usually the groin, wrist, or arm)
- Blood clot or damage to the blood vessel from the catheter
- Blood clot within the treated blood vessel
- Infection at the catheter insertion site
- Arrhythmias (abnormal heart rhythms)
- Heart attack
- Chest pain or discomfort
- Rupture of the coronary artery or complete closing of the coronary artery, requiring open-heart surgery
- Allergic reaction to the contrast dye used
You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-rays and/or treatments over a long period.
For some people, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
What happens after angioplasty?
In the hospital
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will stay flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.
Tell your nurse right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.
Bed rest may vary from 2 to 6 hours depending on your specific condition. If your doctor placed a closure device, your bed rest may be shorter.
In some cases, the sheath or introducer may be left in the insertion site. If so, the bedrest will be last until the sheath is removed. After the sheath is removed, you may be given a light meal.
You may feel the urge to urinate often because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bed rest so that your affected leg or arm will not be bent.
After the specified period of bed rest has been completed, you may get out of bed. The nurse will help you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up to avoid any dizziness from the long period of bed rest.
You may be given pain medication for pain or discomfort at the insertion site or from having to lie flat and still for a long time.
You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.
You may go back your usual diet after the procedure, unless your doctor decides otherwise.
You will most likely spend the night in the hospital after your procedure. Depending on your condition and the results of your procedure, your stay may be longer. You will get detailed instructions for your discharge and recovery period.
Once at home, monitor the insertion site for bleeding, unusual pain, swelling, abnormal discoloration, or temperature change. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your doctor.
If your doctor used a closure device at your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the site. There will be a small knot, or lump, under the skin at the site. This is normal. The knot should slowly disappear over a few weeks.
It will be important to keep the insertion site clean and dry. Your doctor will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities. Your doctor will instruct you about when you can return to work and resume normal activities.
Notify your doctor if you have any of the following:
- Fever and/or chills
- Increased pain, redness, swelling, bleeding, or other drainage from the insertion site
- Coolness, numbness and/or tingling, or other changes in the affected arm or leg
- Chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness, and/or fainting
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.