Angioplasty: Types, Procedure, Recovery
What Is Angioplasty?
Angioplasty usually refers to a procedure that opens or widens blocked or narrowed coronary arteries (arteries supplying the heart with oxygen-rich blood). It is done to restore or improve blood flow to the heart muscles without open-heart surgery. Angioplasty can be done as an elective procedure to prevent the deterioration of coronary artery disease or as an emergency procedure to treat a heart attack.
Angioplasty is done to improve blood flow in the coronary arteries. Most individuals tend to find significant improvements in their symptoms and can handle regular amounts of physical exertion / stress. Angioplasty can also improve an individual’s chances of survival during a heart attack compared to clot-breaking medications (thrombolysis) alone. It also reduces the chances of having another heart attack besides reducing the need for open-heart surgery.
What Are the Types of Angioplasties?
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Coronary balloon angioplasty (Percutaneous Transluminal Coronary Angioplasty / PCTA)
- Coronary balloon angioplasty involves using a balloon to stretch open a narrowed or blocked coronary artery.
- A thin, flexible balloon tube (catheter) is inserted into an artery in the groin, arm or wrist and is guided to the affected coronary artery using X-ray images / video.
- A small balloon at the tip of the catheter is then inflated to break / clear fatty plaques or blood clots and widen the affected artery to improve the delivery of oxygen-rich blood to the heart muscles.
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Coronary angioplasty with stenting (Percutaneous Coronary Intervention / PCI)
- Coronary angioplasty with stenting involves placing a stent in the affected coronary artery.
- A stent refers to a tiny, expandable, metal mesh. The stent is wrapped around the balloon before it is inserted into the coronary artery via the groin, arm, or wrist. The stent is expanded when the balloon is inflated and remains in the artery. Subsequently, the balloon is deflated and removed.
- Most stents are coated with medicine to prevent scar tissue from growing inside the stent. These stents are known as drug-eluting stents (DES). They release medicine to the blood vessel wall to slow the overgrowth of tissue within the stent to prevent the treated vessel from narrowing again.
- Stents that do not have this medicine coating are called bare metal stents (BMS). These stents have a higher chance of narrowing but do not require the patient to take long-term blood thinners. BMS are suitable for patients who have high risk of bleeding.
What Is the Difference Between an Angiogram and Angioplasty?
An angiogram is a diagnostic procedure that involves the imaging of blood vessels to detect narrowing / blockage using a special dye (contrast medium) and a series of X-ray images.
Angioplasty refers to a treatment method to widen a narrowed coronary artery to improve blood flow to the heart muscles.
How Is the Angioplasty Procedure Conducted?
Angioplasty is not considered a major surgery. It is usually done under local anaesthesia and takes between 30 minutes to two hours, although it can take longer in certain situations.
If angioplasty is being done for stable ischaemic heart disease, you should be able to go home on the day of the procedure or the day after. If you have been admitted to the hospital due to a heart attack, you would most likely need to stay in the hospital for several days until you are deemed fit to be discharged.
Before the procedure
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- A pre-operative assessment will be done by your cardiologist. This usually involves a general examination and blood tests to ensure that you are fit for surgery.
- You will be checked for allergies to the contrast medium used for the procedure, medications, and local / general anaesthesia.
- Your cardiologist may advise you to stop taking certain medications.
- You will be advised to stop drinking / eating for a few hours prior to the angioplasty.
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During the procedure
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- Your heart rate, blood pressure, breathing rate and oxygen levels will be monitored throughout the procedure.
- You will be given a local anaesthetic to numb your skin at the catheter insertion site.
- The cardiologist will make a small incision in the skin of your groin / wrist / arm where a catheter is inserted into an artery.
- The catheter is then guided along the artery to the narrowed / blocked coronary artery with the help of the contrast dye and X-ray images.
- The balloon at the tip of the catheter is then inflated to squash and move plaques out of the way and off to the side of the walls of the affected artery.
- The balloon is then deflated and removed from the affected vessels.
- If stenting is intended, a coronary stent premounted on a deflated balloon will be advanced to the treated segment of the artery and deployed by inflating the balloon. The stent is then left in said artery to prevent further narrowing or blockage when the balloon is deflated and removed.
- Once the procedure is done, the cardiologist will check to see if the affected artery is now wide enough to allow sufficient blood through it. This is monitored by observing the contrast dye as it flows through the artery.
- The catheter is then removed from the insertion site and bleeding is stopped with a dissolvable plug or firm pressure and the puncture site.
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Recovery after the procedure
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- You will be advised to rest and not to exert yourself for the next 24 hours. It is also recommended that you are accompanied by someone for the next 24 hours.
- You will need to take blood thinners after the procedure as prescribed by your cardiologist.
- You should be able to drive / exercise / go back to work about a week after your angioplasty. Do not participate in any strenuous activity if unsure and remember to seek your cardiologist’s opinion to be safe.
- Stop smoking.
- Consume food that is low in saturated fat and rich in vegetables, fruits, whole grains, and healthy oils. Avoid sugary food / beverages, refined / processed grains, fatty / salty food, and processed meats.
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What Are the Risks and Complications Associated with Angioplasty?
It is rare to have serious complications during or after an angioplasty. However, it is important to note that every invasive procedure / surgery comes with risks of complications. Complications happen in approximately one in 100 angioplasty procedures. These include:
- Pain / bleeding / bruising at the catheter entrance site
- Infection at the catheter entrance site
- Abnormal heart rhythms
- Heart attack
- Stroke
- Rupture or complete blockage of coronary artery requiring open heart-surgery
- Allergic reaction to the contrast dye used
- Kidney damage from the contrast dye
The cardiology team will thoroughly assess each individual patient for their risk of complications and precautions will be taken as needed.
Book an Appointment at Pantai Hospitals
Angioplasty is a vital treatment method that complements the use of medications in preventing deterioration of coronary artery disease and for reducing the risks of developing a heart attack.
A dedicated and expert team of cardiologists at Pantai Hospitals is available for consultation to provide the best care and assistance to patients through heart health screening, diagnosis, and treatment. Get in touch with us to book an appointment with a cardiologist today.
Pantai Hospital Malaysia is accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.
This article has been medically reviewed by Cardiology specialist, Dr Chan Chong Guan.
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