Angioplasty & Stenting Procedure

What is the Angioplasty Procedure?

Angioplasty is a minimally invasive cardiac procedure. It is conducted to help open any narrowed or blocked arteries in your heart without surgery. A cardiologist will place a small catheter into your blood vessels, which leads to the location of the narrowed artery.

The catheter will be guided to the blocked artery using medical imagery. Once at the location, a small balloon will inflate and deflate to open up the blocked area. Depending on the severity, it may be done multiple times.

A medical stent may be inserted to help keep the artery open. A stent is a small metal mesh tube that can expand and work as an artificial structural support to help keep the artery open.

The procedure may vary depending on the complexity of your condition.

Why is it done?

The most common reason for having this procedure is to help treat narrowed arteries in the heart, but may also be placed in arteries elsewhere in the body if needed. Arteries may become narrowed or blocked due to several other health and heart conditions, such as:

  • Atherosclerosis
  • Renal vascular hypertension
  • Peripheral artery disease (PAD)
  • Carotid artery stenosis

How does the procedure work?

An introducer, or sheath, will be inserted into the blood vessel in the wrist or groin. Once in place, a catheter will be inserted into the introducer, which leads to the aorta and the heart.

Next, the catheter will be inserted into the coronary arteries where dye will be released. The dye will flow through the coronary arteries and allow the cardiologist to pinpoint any locations where the arteries have narrowed. The arteries are imaged with a quick series of x rays called angiography.

Once the blocked artery is located, the cardiologist will advance a balloon through the catheter to the blocked area. Once in place, the balloon will be inflated and deflated to widen the narrowed artery.

Depending on the severity of the blockage, this may take multiple efforts. When the balloon inflates, you may feel discomfort, but it should go away once the balloon is deflated.

It’s common to have a stent placed during the procedure. The stent will be delivered through the same catheter and will be deployed by another balloon. Once the stent balloon has inflated, the stent will spring open and lock into place, improving blood flow in the artery.

The stent works as scaffolding to help support the artery after the procedure is complete. The cardiologist will then monitor the blood flow through the artery with the new stent in place.

Blood-thinning medications will be prescribed to prevent blood clotting around the stent.

The Procedure Process

Because this is a minimally invasive cardiac procedure, it does not require general anesthesia. The incision location, pain, and recovery will also likely be minimal.

Preparing for the Procedure

Preparation depends on your provider, but here is a general outline for preparing for a procedure.

First, you will need to notify your cardiologist of any pre-existing issues, including:

  • Known allergies: Your physician will need to be aware of any known allergies, including allergies to medications, latex, anesthesia, contrast dye, or iodine.
  • Pre-existing medical conditions: Notify your physician of all medical conditions, including any previous heart conditions, pregnancy, bleeding disorders, anxiety, diabetes, etc.
  • Medications: Make your physician aware of any medications that you currently take or have previously taken, including herbal supplements and all over-the-counter drugs. Some medications may need to be limited or stopped before the procedure to ensure your safety.

Next, you’ll need to fast for up to 12 hours before your procedure. Fasting will vary depending on the instructions your cardiologist provides. Consuming clear liquids will most likely be allowed for up to 2 hours before the procedure.

On the day of the procedure, you will need to head to the cardiac catheterization lab, where the procedure will take place. You will be required to take a standard blood test and electrocardiogram. The blood test will give the medical team a baseline of your current blood panel and ensure you’re still okay to proceed.

An IV will be placed to provide you with liquids and a mild sedative to help keep you relaxed. The IV will remain in place until the procedure has ended.

The procedure may take up to several hours, depending on the severity of your condition.

Post Care

After the procedure, your care team will move you to a hospital room for recovery and observation. Your stay will normally last a day but can vary depending on your condition. If the cardiologist inserts the catheter around the groin area, you might be required to lay supine for several hours to prevent bleeding or other complications.

Because of the contrast dye, you will be advised to drink liquids to help expel any remaining dye. Ask your cardiologist about any restricted activity.

Recovery

Recovery is typically quick and straightforward. In most cases, you will be able to return to normal activity, such as work, within a week. Activities, such as driving, heavy lifting, and physically straining activities, should be avoided for at least two days and up to a week after the procedure.

Some cardiologists recommend taking blood-thinning medication for up to a year after the procedure. The medication is to prevent further blockages in the artery and stent.

You can resume a  heart-healthy diet almost immediately.  If you do not have a history of heart failure, consuming plenty of liquids is advised.

Risk Factors

Due to the minimally invasive nature of the procedure, risk factors are small. However, as with most types of procedures, it does come with risk factors.

A common complication is bleeding or bruising at the incision location. Infections are rare. These factors are usually easy to treat, but if they continue, you should contact your cardiologist.

Further blood clots

Even after stents are placed in the artery, you still have a chance of further blocked arteries. Rarely, stents themselves can cause clots because of their constant contact with the bloodstream.

Atrial Fibrillation (AFib)

AFib is a less common risk factor and may indicate underlying heart failure.

Chest pain

Mild chest pain is common. Most patients report mild chest pain immediately after the procedure, but this resolves quickly. If you noticed prolonged chest pain or discomfort, tell your doctor right away.

Damage or artery rupture

Artery damage or rupture is a rare complication.  If this happens, you’ll require an emergency bypass surgery.

Results

A successful procedure will help increase blood flow to reduce symptoms and may help reduce further heart complications. If you had chest pain, shortness of breath, fatigue, or other common symptoms, you should notice a reduction in those issues afterwards.

Although the symptoms are relieved, your heart disease will not go away. It’s essential to maintain a healthy lifestyle and follow doctor-recommended treatments. Some common health upkeep includes:

  • Lowering your cholesterol
  • Eating a DASH/Mediterranean diet
  • Improving low-intensity exercise frequency/duration
  • Quitting smoking
  • Controlling stress levels

 

If you feel prolonged chest pain at home, after the procedure, get emergency help immediately.