Angioplasty

Angioplasty is a medical procedure used to treat narrowing of the arteries that supply blood to the heart. This is accomplished by inflating a small balloon inside the artery to increase the blood flow to the heart. It may be performed on an emergency basis following a heart attack, or on an elective basis when conservative treatment measures have failed to relieve symptoms of Coronary Artery Disease such as chest pain and shortness of breath.

Angioplasty Procedure

If conservative treatment options are unsuccessful and you continue to have chest pain or are at risk of having a heart attack, your cardiologist may recommend a procedure called balloon angioplasty.

Angioplasty is performed by an Interventional Cardiologist in the Cardiac Catheterization Lab of the hospital under local anesthesia and IV sedation. You will be awake but relaxed and drowsy.

During Angioplasty, the patient is placed lying on their back on an x-ray table.

The catheter insertion area, groin or arm, is shaved, disinfected, and injected with a local anesthetic to numb the area.

Your Cardiologist will perform an angiogram first to determine the extent and location of blockage within the coronary arteries prior to proceeding to an angioplasty.

Your surgeon will make a tiny cut over the insertion site and insert a small tube called a sheath into a blood vessel in the groin (or arm, depending on your surgeon's preference).

A flexible tube called a catheter is then gently passed through the sheath into the vessel until the blockage is reached.

A special dye is then injected through the catheter and into the artery so x-ray pictures can be obtained showing the location and extent of the blockage.

At this point, the cardiologist can proceed with the Angioplasty.

Your cardiologist will now insert a guide wire through the catheter advancing it across the blockage.

The catheter with a deflated balloon on its end is then threaded over the guide wire into the blockage.

The balloon is then inflated to push the plaque against the artery walls. This opens up the artery allowing increased blood flow to the heart.

Your cardiologist may deflate and inflate the balloon more than once within an artery to ensure the best result.

Often, the cardiologist will place a stent within the artery. A stent is a wire mesh tube placed within the artery to help keep the artery open. The stent is placed over the deflated balloon at the tip of the catheter before inserting the catheter into the blockage. When the balloon is inflated, the stent is pushed in place against the artery wall. Some stents are coated with medicine to keep blood clots from forming or the artery from closing.

Once your doctor is satisfied with the results, the balloon is deflated and the guide wire and catheter are withdrawn. The stent remains in place within the artery.

Pressure will be applied to the insertion site for 15 minutes followed by a tight pressure bandage to prevent bleeding.

Post Operative Guidelines

After Angioplasty you will be taken to the recovery room and be told to lie still for 6-8 hours to prevent bleeding from the puncture site. If the puncture site was performed in the arm area, you will be able to get out of bed.

Recovery time varies depending on whether your procedure was an angiogram or an angiogram with angioplasty. If only an angiogram was done, you may be able to go home with a driver after a few hours. If angioplasty was performed, you will likely spend 1-2 days in the hospital.

Common post-operative guidelines following Angioplasty include the following:

• You will need someone to drive you home after you are released. You should not drive for 1-2 days after the procedure
• Do not remove the dressing over the puncture site until instructed to do so. Keep the area clean and dry
• Your surgeon may give you activity restrictions such as no heavy lifting for a few days to prevent bleeding from reoccurring
• You may have soreness and bruising around the puncture site
• If a stent is placed, your doctor will prescribe blood-thinning medicines to prevent blood clots from forming around the stent. It is very important that you adhere to your prescribed medications to prevent blood clots from forming

Contact your doctor immediately if you have a fever, chills, redness, bleeding, irregular heart beat, chest pain, shortness of breath, weakness, or dizziness.

Risks & Complications

• As with any medical procedure there are potential risks involved. The decision to proceed with the procedure is made because the advantages outweigh the potential disadvantages
• It is important that you are informed of these risks before the procedure takes place

Most patients do not have complications after Angioplasty; however complications can occur and depend on what type of procedure your doctor performs as well as the patient's health status. (i.e. obese, diabetic, smoker, etc.)

Complications can be medical (general) or specific to Angioplasty.

Medical complications include those of the anesthesia and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:

• Allergic reaction to medications or dye
• Blood loss requiring transfusion with its low risk of disease transmission
• Heart attack, strokes, kidney failure, pneumonia, bladder infections
• Complications from insertion site such as infection or nerve damage
• Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death

Specific complications for Angioplasty include:

• Bleeding from the insertion site
• Irregular heart beat
• Chest pain during procedure
• Blood vessel damage from the catheter requiring an operation for repair
• Kidney damage from dye used with angiogram
• Restenosis- usually occurring within 6 months, restenosis is the re-accumulation of plaque or scar tissue causing narrowing or blockage again of the coronary artery. This risk is lessened with the use of a stent
• Blood clots
• Stent moves from its placed location
• Need for an emergency Coronary Artery Bypass Graft (CABG or open heart surgery)

Risk factors that can increase the chance of complications following angioplasty include:

• Diabetes, especially if taking a medication called Glucophage
• Women are at higher risk than men to develop complications
• History of kidney disease
• Poor cardiac function
• Extensive heart disease
• Poor nutrition
• Smoking
• Obesity
• Age (over 75)
• Alcoholism
• Chronic Illness
• Steroid Use