Coronary
angioplasty (AN-jee-oh-plas-tee) is a medical
procedure in which a balloon is used to open a
blockage in a coronary (heart) artery narrowed by
atherosclerosis
(ATH-er-o-skler-O-sis). This procedure improves
blood flow to the heart.
Atherosclerosis is a
condition in which a material called plaque (plak)
builds up on the inner walls of the arteries. This
can happen in any artery, including the coronary
arteries, which carry oxygen-rich blood to your
heart. When atherosclerosis affects the coronary
arteries, the condition is called
coronary
artery disease (CAD).
Angioplasty is a
common medical procedure. It may be used to:
Improve symptoms of CAD, such as
angina
and shortness of breath.
Reduce damage to the heart muscle from a
heart
attack. A heart attack occurs when blood
flow through a coronary artery is completely
blocked. Angioplasty is used during a heart
attack to open the blockage and restore blood
flow through the artery.
Reduce the risk of death in some patients.
What are the indications
for Coronary angioplasty? There
are various reasons for performing angioplasty. It
may be performed to treat:
Angina - Persistent chest pain
Blockage of one or more coronary arteries
Residual obstruction in a coronary artery
during or after a heart attack
Why Is Angioplasty Done?
The two main reasons angioplasty is performed
are for:
Angina
(chest pain) - A person may experience chest
pain, or angina, during exercise or stress
because the heart's arteries are too narrow to
carry enough blood and oxygen to meet the
increased demand. Different types of angina are
discussed below. In those suffering angina, who
have not responded to standard medical
treatments, and continue to have symptoms,
angioplasty will be recommended.
Heart
attack - During a heart attack, an artery
becomes completely blocked, cutting off blood
and oxygen to part of the heart and causing that
tissue to die. This is why heart attacks cause
such severe pain. Reopening the artery right
away can minimize the amount of heart tissue
that is damaged during a heart attack. But this
is not applicable for everyone after a heart
attack.
Angioplasty will generally not be offered to
people without symptoms (but who may have some
blockage in a coronary artery), and angioplasty to a
number of coronary arteries
('multilevel angioplasty') is usually not performed
in diabetics.
The
Procedure
Coronary angioplasty is
performed in a cardiac catheterization laboratory,
generally by an interventional cardiologist, who has
received special training and certification in the
procedure.
Before the procedure, patients are given a
sedative to help them relax.
An intravenous line is started in a vein in
the arm, so that fluids and medications can be
easily given during the procedure.
A local anesthetic is injected in the skin
near the femoral artery, the artery that leads
from the groin to the coronary arteries.
(Sometimes, the artery in an arm, the brachial
artery, is used instead).
To start the angioplasty procedure, the
interventional cardiologist makes an incision
and inserts a thin, hollow catheter through the
artery, threading it up toward the heart and
into the coronary artery that contains the
blockage. X-ray photography enables the
cardiologist to view the movement of the
catheter on a TV monitor.
After the catheter arrives at the site of the
blockage, a second, thinner catheter is inserted
into the first one. There is a small, deflated
balloon at the tip of the second catheter.
Once the balloon is in position at the site
of the narrowing, it is inflated. The temporary
widening of the artery either crushes or breaks
the plaque, and the balloon is
then removed. The artery is widened by the
balloon inflation, and blood flow improves.
The balloon may be reinflated one or two
times to keep the artery open. If a coronary
stent is used, a new catheter
is inserted to guide the stent into place. Once
in place, the stent pushes against the wall of
the artery to keep it open.
The procedure usually takes about two hours,
depending on the number and severity of the
blockages.
What Happens Afterward?
Sedatives take a while to wear off, so many
patients sleep after the procedure. After the
catheter is removed, the cardiologist or another
hospital worker will apply heavy pressure to the
incision in the groin or arm for about 20 minutes to
stop any bleeding, while the patient lies in bed,
remaining still.
In some hospitals, a special device is used
to apply pressure, rather than a person.
It is important to stay in bed for about six
hours after angioplasty. Later, a nurse or
medical technician will assist the patient in
getting out of bed and walking around.
The patient usually stays in the hospital
overnight. If no problems such as bleeding or
chest pain occur, the patient usually goes home
the following day.
A family member or friend should drive the
patient home.
After Arriving Home
After angioplasty, it's a good idea to relax
and take it easy for a few days.
Avoid driving a car with a standard
transmission for a few days to rest the leg
where the catheter was inserted.
It is safe to return to a desk job almost
immediately. However, your doctor may advise
waiting for several days before returning to a
job that involves using the legs a lot or
bending or lifting.
Many patients take some type of
blood-thinning drug to prevent blood clots
angioplasty. Talk to the doctor about exactly
how to take the drug.
The cardiologist will probably schedule a
return visit at six weeks for an exercise stress
test or other form of stress test. This is done
to make sure that the arteries have remained
open, and also to furnish results that can be
used for comparative purposes if chest pain or
other symptoms develop later on.
If chest pain or other cardiac symptoms
return, contact the doctor immediately.
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