Angioplasty: What is it and How is it Done?

Angioplasty, also called coronary angioplasty or percutaneous coronary intervention, is a surgical procedure for unclogging partially blocked heart arteries. Arteries of the heart may get blocked by a sticky layer known as plaque. Removing the plaque through angioplasty surgery ensures the restoration of blood circulation through the arteries.

Lack of smooth blood circulation in the arteries of the heart causes breathlessness, pain in the chest, and various other symptoms. It makes it difficult for the heart to pump blood to all other parts of the body and also can cause a heart attack.  

What is angioplasty for?

Below are the primary reasons why doctors may advise an angioplasty:

• To treat narrowing of heart arteries and control the risk of a heart attack and subsequent damage to heart muscles
• Lifestyle changes and/or medical interventions, as prescribed by a doctor, have not improved the heart condition
• Remove plaque built-up in the heart, a condition called atherosclerosis
• Control chest pain (angina, in medical terms) and loss of breath due to reduced blood flow to the heart

Risks of this procedure

Angioplasty is not as invasive as other serious heart surgeries like coronary bypass surgery. However, like with any other surgical procedure, it has risks. Some of the most common risks are:

Recurrence of arterial blockages

Angioplasty, on being combined with drug-eluting stent placement does not prevent the same artery becoming clogged again. However, the risk of reappearance of blockage ranges between 10% and 20% when bare-metal stents have been used.

Stroke

The risk of stroke may increase when plaques break loose while the catheter is threaded through the aorta. Blood clots can develop in the catheter and may reach the brain on breaking loose.

Blood thinners are used to control the risk of stroke, although it is a rare risk of coronary angioplasty.

Bleeding

Bleeding may occur in the arm or groin where the catheter was inserted. Bruising is a common side effect and bleeding occurs only in severe cases. However, blood transfusion may become necessary in case of severe bleeding.

Blood clots

Blood clots may appear within stents even after a coronary angioplasty surgery, making the arteries close down and causing a heart attack.

Doctors usually prescribe aspirin, along with other medications like clopidogrel (Plavix) or other similar drugs. This is to control the risk of blood clots developing in the stent.

Don’t stop or change the dosage of these medications without consulting your doctor.

Abnormal heart rate

Abnormal rhythms of the heart are not common but can happen during a coronary angioplasty. It gradually gets restored to normal within a short span of time. However, in severe cases, medications or a temporary pacemaker may become necessary.

Heart attack

In very rare cases, a heart attack may occur during a coronary angioplasty surgery in case an artery tears or ruptures. Under such emergencies, bypass surgery may become necessary. 

Kidney conditions

Stent placement and usage of dye during angioplasty surgery may raise the risk of damage to the kidney, especially amongst those with kidney problems.

In case you already have been diagnosed with a medical condition of the kidneys, your cardiologist may restrict the use of contrast dye. He/she will ensure that you are sufficiently hydrated during the coronary angioplasty surgery. 

How to prepare for angioplasty

Keep in mind the following to prepare for angioplasty:

• Your doctor will evaluate your personal and family medical history, and also conduct a physical examination. 
• You will probably be recommended certain medical examinations like electrocardiogram, chest X-ray, and blood tests before you undertake the surgery.
• You may also be advised to take additional imaging tests like a 2-D echocardiogram followed by a coronary angiogram to observe and analyze the extent of blockage in your arteries. This will enable the doctor to determine whether the plaques need to be removed immediately, or can be removed with angioplasty, or need a more serious surgery like bypass. In case, during angiogram, the doctor decides that the blockages need to be removed, he/she may perform angioplasty and stenting immediately after the angiogram while the heart is catheterized.
• Your doctor may advise you to stop taking certain medications before angioplasty. These include aspirin, blood thinner, and non-steroidal anti-inflammatory drugs (NSAIDs). Remember to tell your doctor about all the medications you may be taking – prescription drugs, OTC drugs, vitamins, supplements, and herbals. 
• Like with other procedures, angiography requires fasting from food and drinks six to eight hours before the procedure. This is because these substances can show up and affect the image results. Also ensure that you take medications as advised by your doctor before the procedure.

What happens during angioplasty?

The following is the surgical procedure for angioplasty:

• The patient will be medicated to relax him/her before angioplasty. The area where the catheter will be inserted is numbed with anesthesia.
• A narrow plastic tube, known as a sheath, is inserted into an artery through the arm or groin, as per the discretion of the cardiac surgeon. Next, a long and thin tube is then connected to the arteries around the heart through the sheath and up a blood vessel. 
• A small quantity of contrast liquid is released into the blood vessel through the catheter. An X-ray photographs the entire process as the contrast liquid travels through the chambers of the heart, valves, and major blood vessels. This enables the doctor to get accurate information about the number and extent of heart blockages, and whether the valves of the heart are working effectively. 
• In case the doctor decides to perform angioplasty, he/she will direct the catheter into the artery where there is blockage. Next, he/she will undertake the angioplasty surgery through any of the following procedures, as he/she thinks necessary:
• Balloon – A catheter, with a tiny balloon at one end, is passed through a blocked artery in which angioplasty will be performed. The balloon is then inflated to displace the plaque and push the artery open to improve blood circulation to the heart.
• Stent – A small tube is inserted as support to the inner surface of the coronary artery. A balloon catheter, fixed over a guide wire, helps the stent into your blocked coronary artery. After it has been accurately inserted, the balloon is inflated to make the stent expand to the size of the artery and hold it open. The balloon is removed after it is deflated while the stent stays in the artery permanently. The artery gradually heals around the stent in the next few weeks. Stents are usually made of metal or synthetic materials.

What is the recovery period for angioplasty?

For someone who has undergone angioplasty or stenting, is usually discharged from the hospital within 12 to 24 hours after the removal of the catheter. They can resume their normal life within a few days to a couple of weeks after being cleared by their doctor.

After an angioplasty surgery, you need to lead a regulated lifestyle to prevent the recurrence of blockages and reduce the risk of a more invasive coronary bypass surgery. Here are the essential post-surgical tips:

• Take prescription drugs on time and at the advised dosage
• Quit smoking and drinking
• Follow a regular fitness routine 
• Eat a healthy diet that is low in saturated fat
• Keep a close watch over health conditions like cholesterol, diabetes, and high blood pressure

Learn more about heart health, here.