A coronary angioplasty is a non-invasive surgical procedure to increase blood flow to your heart by widening narrowed or blocked arteries. An alternative to a heart bypass surgery, it involves threading a balloon-mounted catheter through your veins to the narrowed or blocked artery. The balloon is then inflated to widen the artery.
It is usually accompanied by a stent implantation procedure, which keeps your artery open. A stent, which a tube-like metal scaffold, is wrapped around the balloon. When the balloon inflates, the stent also expands. This adheres it to the artery walls, propping it open. Over time, tissue grows around the stent, holding it in place.
Some stents are coated with medication to prevent the growth of scar tissue in the artery, which promotes good blood flow.
Some people may not be suitable for an angioplasty. Your cardiologist may recommend you to undergo a heart bypass surgery instead.
A stent is a short, wire-mesh tube that acts like a scaffold to help keep your artery open. There are 2 main types of stent:
- bare metal (uncoated) stent
- drug-eluting stent– which is coated with medication that reduces the risk of the artery becoming blocked again.
Before having a coronary angioplasty you’ll need an assessment to make sure the operation is possible.
This also gives you an opportunity to discuss any concerns with your cardiologist (heart specialist).
During your pre-operative assessment, you may have blood tests and a general health check to ensure you’re suitable for surgery.
You may also have a procedure called an angiogram before your angioplasty. You have the angiogram first to look inside your arteries to check where the blockages are.
Sometimes your cardiologist will do the angiogram first but then continue on to do the angioplasty as part of the same procedure.
You’ll be asked not to eat or drink anything for 4 to 6 hours before a coronary angioplasty.
You’ll usually be able to take most medications as normal up to the day of the procedure, with the exception of blood-thinning medication (anticoagulants), such as warfarin.
You may also need to alter the timing of any diabetes medication you take.
Speak to your medical team for more information about whether you need to change the way you take your medicines before your operation.
A coronary angioplasty usually takes place in a room called a catheterisation laboratory, rather than in an operating theatre. This is a room fitted with X-ray equipment to allow the doctor to monitor the procedure on a screen.
A coronary angioplasty usually takes between 30 minutes and 2 hours, although it can take longer.
You’ll be asked to lie on your back on an X-ray table. You’ll be linked up to a heart monitor and given a local anaesthetic to numb your skin. An intravenous (IV) line will also be inserted into a vein, in case you need to have painkillers or a sedative.
The cardiologist then makes a small incision in the skin of your groin, wrist or arm, over an artery where your pulse can be felt. A small tube called a sheath is inserted into the artery to keep it open during the procedure.
A catheter is passed through the sheath and guided along the artery into the opening of your left or right coronary artery.
A thin, flexible wire is then passed down the inside of the catheter to beyond the narrowed area. A small, sausage-shaped balloon is passed over the wire to the narrowed area and inflated for about 20 to 30 seconds. This squashes the fatty material on the inside walls of the artery to widen it. This may be done several times.
While the balloon is inflated, the artery will be completely blocked and you may have some chest pain. However, this is normal and is nothing to worry about. The pain should go away when the balloon is deflated. Ask your cardiologist for pain medication if you find it uncomfortable.
You shouldn’t feel anything else as the catheter moves through the artery, but you may feel an occasional missed or extra heartbeat. This is nothing to worry about and is completely normal.
If you’re having a stent inserted (see below), it will be already fitted onto a balloon and opens up as the balloon is inflated. The stent will be left inside your artery after the balloon is deflated and removed.
When the operation is finished, the cardiologist will check that your artery is wide enough to allow blood to flow through more easily. This is done by monitoring a small amount of contrast dye as it flows through the artery.
The balloon, wire, catheter and sheath are then removed and any bleeding is stopped with a dissolvable plug or firm pressure. In some cases, the sheath is left in place for a few hours or overnight before being removed.
- Compared to bypass surgery, balloon angioplasty and stent placement are much less invasive and relatively low-risk, low-cost procedures.
- These procedures are performed using local anesthesia. Because general anesthetic is not required in most patients, there is no extended stay in the hospital.
- No surgical incision is needed—only a small nick in the skin that does not have to be stitched.
- You will be able to return to your normal activities shortly afterwards.
- Major complications after angioplasty are rare. However, inserting the catheter may injure the artery. There is also a very small risk of blood clots or tearing the artery.
- When angioplasty is done alone, blockages can recur. Most of these arteries can be opened again successfully. This can also occur when a stent is placed in the artery at the time of the angioplasty.
- Heavy bleeding from the catheter insertion site may require special medication or a blood transfusion.
- There is a risk of stroke when angioplasty and/or stenting are performed on the carotid artery.
- A rare complication associated with angioplasty is abrupt vessel closure. This blockage in the treated area typically occurs within 24 hours of the procedure. If it happens, medication to dissolve clots followed by angioplasty or stenting may be used. In some cases, emergency bypass surgery may be needed.
- Other rare complications include heart attack and sudden cardiac death.
- Any procedure where the skin is penetrated carries a risk of infection.
- There is a very slight risk of an allergic reaction if contrast material is injected.
- Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. However precaution is taken to mitigate these risks.
- Contrast material may cause a decrease in kidney function, particularly if it already exists. Your doctor will check your kidney function before the procedure in order to lower this risk