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Angioplasty: When It's Performed And What to Expect

Angioplasty: When It's Performed And What to Expect
Key Takeaways
  • Angioplasty is a minimally invasive procedure used to treat atherosclerosis, a plaque buildup in the artery walls, as well as peripheral artery disease, by opening the coronary arteries and restoring blood flow to the heart and the rest of the body. 

  • During an angioplasty, a catheter with a balloon tip is inserted to open narrowed or blocked arteries. A stent or tube is often placed inside to keep the artery open.  

  • While angioplasty has a high success rate (over 90%), lifestyle changes, including a healthy diet, regular exercise, and smoking cessation, are essential to prevent further cardiac events associated with other health complications. 

Angioplasty is a procedure that is done to unclog or open blood vessels which have become narrowed or blocked. It is called coronary angioplasty when the procedure is done on blood vessels called coronary arteries which supply blood to the heart muscle. However, angioplasty is also used to treat other types of atherosclerosis, such as peripheral artery disease, by opening up the arteries or veins of the arms, legs, and pelvis.  

Another name for the procedure is coronary angioplasty and stent. It is also called percutaneous coronary intervention (PCI) and percutaneous transluminal coronary angioplasty (PTCA). 

What is The Purpose of Angioplasty?  

The goal of angioplasty is to restore blood flow by unclogging blood vessels that have become narrowed or blocked due to plaque buildup.

In people with coronary artery disease, deposits of cholesterol and other substances in the artery wall cause these blood vessels to become narrow. The deposit is called a plaque. It can reduce blood flow to the heart and cause symptoms such as chest pain (angina) and shortness of breath. Over time, the buildup of plaque inside the arteries can lead to acute coronary syndrome (ACS), where an artery becomes completely blocked, often resulting in chest pain and a heart attack. As a result, a coronary angioplasty is done to restore the blood flow to the heart muscle. 

Angioplasty can be done as an elective surgery (a planned procedure) or an emergency treatment immediately after an acute coronary syndrome (myocardial infarction or heart attack).

What Are The Types of Angioplasty?

Coronary Angioplasty

Coronary angioplasty, also called balloon angioplasty, is done using a long, thin, flexible tube called a catheter, which has a tiny balloon at its tip. The balloon-tipped catheter is guided to the site of the blockage, and the balloon is inflated to widen the artery and restore blood flow. This is usually followed by stent placement. A stent is a small wire mesh tube that is left in place to keep the artery open after the deflated balloon is removed. 

Note: Atherectomy is another procedure used to open blocked arteries. However, it is different from angioplasty in that a shaver or laser device is used to cut away the plaque from the artery wall during an atherectomy.

Other Types of Angioplasty

  • Carotid artery angioplasty with stenting (CAS) is done to open the carotid arteries that supply blood to the brain, face, and neck. A basket-like device called an embolic protection device is used to catch any debris (pieces of plaque) and prevent blood clots from forming during carotid artery stenting.

  • Cerebral angioplasty is done to open partially blocked vertebral arteries in the neck or blood vessels in the brain.

  • Laser angioplasty is done using a laser device to vaporize the plaque causing a blockage.

  • Percutaneous transluminal angioplasty (PTA) of the femoral artery is done to open a narrowed or blocked femoral artery and restore blood supply to the lower leg in people with peripheral artery disease.

  • Renal artery angioplasty is done in people with chronic kidney disease to unclog the renal artery which supplies blood to the kidneys.

 

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Reasons For Angioplasty  

Angioplasty is needed to open narrowed or blocked blood vessels and restore blood flow. Without an adequate supply of oxygen-rich and nutrient-rich blood, body tissues can die. Applications of angioplasty include opening blood vessels in the heart, neck, brain, kidney, and leg.

What Does Angioplasty Treat?

Atherosclerosis: Angioplasty is done to treat atherosclerosis, a progressive condition in which plaque (cholesterol and other fatty deposits) collects in the artery wall. This causes the arteries to become narrow or blocked, thickened, and less elastic. 

Coronary heart disease: When the narrowed arteries cause symptoms like angina (chest pain), it is called coronary artery disease (CAD). A completely blocked artery can cause a heart attack. Untreated coronary artery disease increases the risk of arrhythmias (heart rhythm abnormalities) and heart failure.

Coronary Angioplasty vs CABG (Heart Bypass Surgery)

For some people with early-stage coronary heart disease, for example, if only one artery is narrowed, sometimes lifestyle changes and medications may be used to treat the condition. 

In people who have symptoms of coronary artery disease, such as chest pain (angina) or shortness of breath, the recommended treatment may be coronary angioplasty with stenting. 

People with severely narrowed or blocked arteries, multiple blockages, or blockages in one of the main arteries supplying blood to the heart (left main and right coronary artery) may need to undergo a more extensive procedure called coronary artery bypass grafting (CABG), pronounced “cabbage” and commonly called a heart bypass surgery or open-heart surgery.

Here are the key differences between coronary angioplasty and CABG:

 Coronary angioplasty with stent placementCoronary artery bypass grafting (CABG) or Heart Bypass Surgery
Type of procedureMinimally invasive formMajor open surgery
IncisionSmall incision in the groin or wristLarge 6-8 inch incision down the middle of the chest
AnesthesiaLocal anesthesia with sedationGeneral anesthesia
Hospital stayYou can go home the same day or the next dayYou will stay in the hospital for at least one week
Recovery time1 week for planned (non-emergency) coronary angioplasty6-12 weeks

The Angioplasty Procedure: What To Expect  

Preparation Before The Procedure  

For an emergency angioplasty done for a heart attack, there is no time to prepare. However, for planned angioplasties, the pre-procedure evaluation involves: 

  • A thorough evaluation by a cardiologist (specialist in cardiovascular medicine).

  • Tests such as cardiac catheterization and coronary angiography to diagnose coronary artery disease and plan treatment based on the severity of the blockage, number of blood vessels involved, etc. 

  • Other tests to identify health conditions and assess your risk of complications from angioplasty.

If your healthcare team decides coronary angioplasty is necessary, you should prepare as follows: 

  • Medication List: Make a list of all your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal remedies. Bring it with you to the hospital.

  • Allergies: Tell your doctor if you have ever had an allergic reaction to contrast dye used during imaging studies.

  • Medication Use: Stop certain medicines before your angioplasty. For example, you may need to stop taking blood thinning medication, aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs) (pain relievers). 

  • Eating and Drinking: Stop eating and drinking for several hours before your procedure. Your cardiologist will give you specific instructions based on the type of anesthesia that will be used. For example, they may ask you to stop eating solid foods 6 hours before the procedure and liquids 2 hours before the procedure. You may, however, take allowed medicines with a small amount of water on the morning of your angioplasty.

  • Smoking: Stop smoking for at least 24-48 hours before your angioplasty. This may be a good time to think about quitting for good.

  • Ride Home: Arrange for someone to drive you home.

Step-By-Step Process of Undergoing an Angioplasty  

  1. You will change into a hospital gown.

  2. An intravenous (IV) line will be placed in a vein to give you fluids and medications during the angioplasty. 

  3. You will receive sedation medications to help you relax. The procedure is done using local anesthetic, which means you will be awake during the angioplasty.

  4. Before beginning the angioplasty, a member of your healthcare team will talk to you about the procedure and answer any questions.

  5. A team led by an interventional cardiologist or interventional radiologist will perform the angioplasty. 

  6. A catheter will be inserted into an artery through a small incision (cut) in your wrist or groin. This procedure does not involve making major incisions and doesn’t leave visible scars.

  7. A guidewire will be passed through the catheter into the blood vessel.

  8. A contrast dye will be injected to allow your doctors to see blood flow in your coronary arteries.

  9. A balloon catheter will be passed over the guide wire to the site of the narrowing or blockage.

  10. The balloon will be inflated to open the blood vessel.

  11. A wire mesh tube called a stent will be put in place to keep the artery open.

  12. The balloon will be deflated and removed.

  13. A coronary angiogram will be done to compare blood flow after the angioplasty to before the procedure.

  14. The catheter site will be covered with a dressing.

What Happens After Angioplasty?  

  • You will return from the procedure room to a recovery room where your healthcare team will observe you for some time.

  • Some people have an outpatient angioplasty and are able to go home the same day, about 6 hours after the procedure. However, most people who undergo coronary angioplasty spend one night in the hospital. 

Use of Stents In Angioplasty

Different types of stents are used in coronary angiography, such as:

  • Bare metal stents which are uncoated metal mesh tubes that keep the artery open.

  • Drug-eluting stents that are coated with a medication that helps to keep the artery open. A drug-eluting stent prevents the immune system from seeing the stent as a foreign body and attacking it by causing excessive tissue growth and swelling around the stent.

  • Bioresorbable vascular scaffolds (BRS) which are temporary scaffolds that open the artery but dissolve over time, leaving the artery in its natural state.

  • Dual therapy stents that use a combination of antibody-coated stent and drug-eluting stent. The antibody-coated stent promotes healthy endothelial regeneration (growth of healthy cells in the inner lining of the blood vessel). The drug-coated stent prevents re-narrowing after vascular stenting.

Benefits of Angioplasty  

Benefits of angioplasty include: 

  • Improved blood flow to the heart muscle.

  • Improved symptoms such as angina (chest pain, tightness, heaviness) and shortness of breath.

  • Reduced risk of heart attack.

  • Reduced risk of complications from untreated coronary artery disease, such as cardiac arrhythmias and heart failure. 

  • Less invasive procedure than heart bypass surgery (open-heart surgery) with a shorter hospital stay and recovery time.

  • Lower cost compared to a major open surgery like CABG (heart bypass). 

  • Improved quality of life and mental health as everyday tasks and physical activities become easier and more enjoyable. 

Possible Risks and Complications

Angioplasty is a safe procedure that has been performed on millions of people since it was developed in the 1980s. Serious complications from an angioplasty are very rare. However, like any invasive procedure, there are certain risks such as:

  • Excessive bleeding and need for blood transfusion

  • Infection

  • Reaction to the contrast dye

  • Abnormal heart rhythm

  • Blood clots

  • Heart attack

  • Stroke

  • Damage to the blood vessels

  • Kidney damage

  • Restenosis (repeat blockage or re-narrowing if a coronary artery stent is not placed)

Weighing Benefits Versus Risks  

In most people who need angioplasty, the benefits outweigh the risks. However, some people are at a higher risk of angioplasty complications. This includes people with severely blocked arteries, older adults, and those with heart failure or kidney disease. Your healthcare team will carefully weigh the benefits versus risks before recommending angioplasty.

Recovery and Life After Angioplasty  

Immediate Post-Procedure Care and Recovery  

Once you are back home after your angioplasty, take the following precautions for an uneventful recovery:

  • Return to normal life:

    • Take it easy for the first 24-48 hours.

    • Eat a regular diet unless advised otherwise by your doctors.

    • Drink plenty of fluids.

  • Wound care:

    • Keep the dressing on the catheter insertion site until your doctor says it’s okay to take it off.

    • Keep the surgical wound clean and dry.

  • Activity restrictions:

    • You can take a shower after 12-24 hours (check with your doctor).

    • Do not drive or operate machinery for at least 24 hours. 

    • Avoid strenuous exercise for 2-3 days.

    • Avoid smoking for at least 24-48 hours.

  • Prescription medications:

    • Your doctor may prescribe blood thinning medicines such as aspirin, clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta). Take these regularly as prescribed.

Long-Term Lifestyle Adjustments

Coronary angioplasty with stenting can open blocked arteries, but it will not prevent future blockages from occurring. To maintain heart health, make the following lifestyle changes: 

Follow-Up Care and Monitoring: When To Call Your Doctor After Angioplasty

Keep all your healthcare appointments after your angioplasty. 

Call your doctor without delay if you have:

  • Bleeding at the place where the catheter was inserted. Lie down and apply pressure on the area until you can see a healthcare provider.

  • Signs of infection, such as fever or redness, warmth, swelling, pain, or oozing at the catheter site.

  • Numbness, coolness, or changes in color in the limb where the catheter was inserted.

  • Chest pain.

  • Shortness of breath.

  • Fainting.  

What Is Life Expectancy After Having Stents Put In?

Life expectancy after angioplasty and stenting depends on the severity of your coronary artery disease, your overall health status, and how well you follow your doctor’s recommendations for lifestyle changes.

Long-term survival rates for angioplasty and CABG are comparable. About 90% of patients are living 5 years after either procedure. 

What is the Survival Rate for Angioplasty?

  • Success Rate: Angioplasty is successful in more than 90% of patients. However, 30-40% of patients need further treatments because of a recurrence of symptoms.

  • Survival Rate: Survival rates for angioplasty with stenting and bypass surgery are comparable (over 98% for both procedures). 

    • Bypass surgery is, however, associated with a slightly higher risk of stroke in the first 30 days after the procedure.

    • The risk of heart attack within 5 years is 12% in bypass surgery patients and about 11% in angioplasty patients.

Frequently Asked Questions About Angioplasty  

What Is The Meaning of “Angioplasty?”

The meaning of angioplasty is using a balloon-tipped catheter to stretch open a narrowed or blocked artery. “Angio” means blood vessel and “plasty” means a surgical procedure to repair or restore. An angioplasty also usually involves leaving a stent in heart arteries to help keep them open. That’s why it is called coronary angioplasty and stenting.

How Long Does An Angioplasty Take?

An angioplasty procedure takes 30 minutes to 2 hours to complete, depending on the number of blockages being treated.

How Long Does An Angioplasty Last?

An angioplasty should last a lifetime if a stent is left in place. However, this treatment will not prevent blockages from developing in new locations. Following a heart-healthy lifestyle can prevent worsening heart disease.

Is Angioplasty Very Painful? 

Angioplasty is a generally painless procedure. You will be given a local anesthetic to numb the site where the catheter is inserted. You will also receive a sedative to help you relax. You may feel a slight sensation of pressure in your chest when the balloon is inflated. After the angioplasty, there may be some slight bruising and soreness at the site where the tubes were inserted. 

Can You Live A Normal Life After Angioplasty?

Yes, most people live normal, healthy, fulfilling lives after angioplasty. The procedure can improve your quality of life by allowing you to do daily tasks and participate in activities that were previously not possible due to symptoms like chest pain and shortness of breath.

Is Angioplasty A Major Surgery?

No, angioplasty is not considered a major surgery. It is a minimally invasive procedure. The catheter is introduced through a small cut in the wrist or groin.

How Serious Is Angioplasty?

Angioplasty procedures are generally safe, but there is a small risk of complications. Serious complications after angioplasty and coronary artery stent are rare.