Angioplasty

Angioplasty is a medical procedure to open narrowed or blocked blood vessels of the heart. These blood vessels are called the coronary arteries.

Angioplasty is not considered to be a type of surgery. It is called a percutaneous coronary intervention (PCI).

See also:

• Angiogram
• Cardiac catheterization

Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Cardiac angioplasty; PTCA; Percutaneous transluminal coronary angioplasty; Heart artery dilatation

Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis.

If the blockage is not too severe, an angioplasty procedure can be used to open the artery. Traditional angioplasty involves the use of a balloon catheter -- a small, hollow, flexible tube that has a balloon near the end of it.

Before the balloon angioplasty procedure begins, you will be given some pain medicine. Occasionally, blood thinning medicines are also given to prevent formation of a blood clot.

You will lie down on a padded table. The health care provider will make a small cut on your body, usually near the groin, and insert the catheter into an artery. You will be awake during the procedure.

The health care provider will use x-rays to look at your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps reveal any blockages in the vessels leading to the heart. The balloon catheter is moved into or near the blockage, and the balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart.

In some cases, a device called a stent is also placed at the site of narrowing or blockage in order to keep the artery open. A common type of stent is made of self-expanding, stainless steel mesh.

Rarely, a special device with a small, diamond tip is used to drill through the hard plaque and calcium that are causing the blockage. This is called rotational atherectomy.

Angioplasty may be used to treat:

• Persistent chest pain (angina)
• Blockage of one or more coronary arteries
• Blockage in a coronary artery during or after a heart attack

Note: Recent studies show that medicine and angioplasty with stenting have equal benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of coronary artery disease. Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack

Risks of angioplasty include:

• Allergic reaction to the x-ray dye
• Bleeding in area where the catheter was inserted
• Blockage of blood flow to an area of the heart (very rare)
• Damage to a heart valve or blood vessel
• Death
• Kidney failure (higher risk in those with existing kidney problems)
• Irregular heart beats (arrhythmias)
• Stroke (rare)

The risks for any anesthesia are:

• Breathing problems
• Reactions to medications

The risks for any surgery are:

• Bleeding
• Infection

Angioplasty greatly improves blood flow through the coronary arteries and the heart in most patients. It may eliminate the need for coronary artery bypass surgery (CABG). However, CABG may be recommended for persons whose arteries can not be widened enough with angioplasty or who have severe blockages.

Angioplasty does not cure the cause of the blockage. The arteries may become narrow again, which may or may not require another procedure. Stents coated with medicines (drug-eluting stents) may help prevent future narrowing (drug-eluting stents) and reduce the rates of repeated angioplasty.

You should diet, exercise, stop smoking (if you smoke), and reduce stress to help lower your chances of re-narrowing. Your health care provider may prescribe medicine to help lower your cholesterol.

Most patients receive aspirin and another medicine called clopidogrel (Plavix) after this procedure. It is very important to take the medicines exactly as your doctor tells you. Failure to do so can result in blood clotting in the stent (stent thrombosis) and a heart attack.

Usually, the average hospital stay is less than 2 days. Some people may not have to stay overnight in the hospital at all.

In general, persons who have angioplasty are able to walk around within 6 hours after the procedure. Complete recovery takes a week or less. Keep the area where the catheter was inserted dry for 24 to 48 hours.

Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].