(MayoClinic.com) Coronary angioplasty, also referred to as percutaneous coronary intervention (PCI), is a medical procedure used to open clogged heart arteries.
Coronary angioplasty can improve some of the symptoms associated with blocked arteries, such as chest pain and shortness of breath, or can be used during a heart attack to quickly open a blocked artery and minimize heart damage.
Angioplasty (AN-je-o-plast-tee) involves temporarily inserting and expanding a tiny balloon at the site of your blockage to help widen a narrowed artery. Angioplasty is usually combined with implantation of a small metal coil called a stent in the clogged artery to help prop it open and decrease the chance of it narrowing again (restenosis).
Coronary angioplasty has become a common medical procedure with more than 1 million done in the United States every year.
When medications or lifestyle changes aren't enough to reduce the effects of artery blockages, or if you have a heart attack, worsening chest pain or other symptoms, your doctor might suggest angioplasty. First you'll have an imaging test called a coronary angiogram to determine if your blockages can be treated with angioplasty.
You may be a good candidate for an angioplasty if:
If the main artery supplying the left side of your heart is narrowed, if your heart muscle is weak or if you have small, diffusely diseased blood vessels, then coronary artery bypass surgery (CABG) may be a better option. In addition, if you have diabetes and multiple blockages, your doctor may suggest coronary artery bypass surgery. The decision of angioplasty versus bypass surgery will depend on the details of your heart disease and overall medical condition.How do you prepare for angioplasty?
Before a scheduled angioplasty, your doctor will review your medical history and perform a physical exam. You'll receive instructions on what you can or can't eat or drink before the procedure. Typically, you have to stop eating or drinking by midnight the night before. Your preparation may vary slightly if you're already hospitalized.
Whether the angioplasty is prescheduled or done as an emergency, you'll likely have some routine tests first, including a chest X-ray, electrocardiogram (EKG or ECG) and blood tests.
Angioplasty is performed by a heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians, usually in a cardiac catheterization laboratory. Ideally, an angioplasty will be done only at a medical institution with backup cardiac surgical facilities or access to rapid emergency transport services because of a small risk of complications that could require emergency heart surgery.
Generally, the more practice in doing a procedure, the better the outcome. Research has shown the best angioplasty outcomes are those done by doctors who do at least 75 angioplasties a year and in hospitals that perform at least 400 angioplasties annually.What happens during an angioplasty?
Coronary angioplasty isn't considered surgery because it's less invasive — your body isn't cut open except for a very small puncture in a blood vessel in the leg, arm or wrist through which a small, thin tube (called a catheter) is threaded and the procedure performed. The entire procedure can take 30 minutes to several hours.
Angioplasty is commonly performed through an artery in your groin (femoral artery). Less commonly, it may be done using an artery in your arm or wrist area.
General anesthesia isn't needed, so you're awake during the procedure. You'll receive fluids and medications for relaxation and mild sedation through an intravenous catheter. You'll get blood-thinning medications (anticoagulants) to reduce blood clotting, and then the procedure begins:
Because the balloon temporarily blocks blood flow to part of your heart, it's common to experience chest pain while it's inflated. If you have several blockages, the procedure may be repeated at each site.Stents provide added support
Once the artery is widened, a device called a stent is usually placed in the artery to act as scaffolding to help prevent it from re-narrowing after the angioplasty. The stent looks like a very tiny coil of wire mesh. Stents can be coated with medication that's slowly released to help prevent arteries from re-clogging. These coated stents are called drug-eluting stents, in contrast to noncoated versions, which are called "bare-metal" stents.
Here's what happens:
After your stent placement, you may need prolonged treatment with medications to reduce the chance of blood clots forming on the stent material.The recovery period
You'll probably remain hospitalized a day — in rare cases two or more days — while your heart is monitored and your vital signs are checked frequently. Your doctor will likely prescribe medications (anticoagulants) to prevent blood clots, relax your arteries and protect against coronary spasms.
When you return home, drink plenty of fluids to help rid your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for several days afterward. Ask your doctor or nurse about other restrictions in activity.
Call your doctor's office or hospital staff immediately if:
You should be able to return to work or your normal routine the week after angioplasty.Results
For most people, coronary angioplasty greatly increases blood flow through the previously blocked artery. Your chest pain should subside, and you may have a better ability to exercise.
Lifestyle modifications will help you maintain your good results, including:
Successful angioplasty also means you might not have to undergo a more invasive surgical procedure called coronary artery bypass surgery. In a bypass, an artery or a vein is removed from a different part of your body and sewn to the surface of your heart to take over for the blocked coronary artery. This surgery requires a large incision in the chest. Recovery from bypass surgery is usually longer and more uncomfortable.
If you have many blockages or narrowing of the main artery leading to the heart, reduced heart function, or diabetes, then your doctor may recommend bypass surgery instead of angioplasty and stent placement. In addition, for technical reasons some blockages may be better treated with bypass surgery.Benefits of angioplasty
As with most medical procedures, angioplasty has both benefits and risks.
Among the benefits are:
Restenosis. Angioplasty isn't without some risks. A major drawback of coronary angioplasty is the potential for your artery to re-narrow (restenosis) within months of the procedure. With angioplasty alone — without stent placement — restenosis happens in as many as 30 percent to 40 percent of cases. Stents were developed to reduce restenosis. The original bare-metal stents reduce the chance of restenosis to less than 20 percent, and the use of drug-eluting stents has reduced the risk to less than 10 percent.
Blood clots. Recent studies have raised concern about the risk of blood clots forming within stents long term — meaning weeks or months after angioplasty. These clots may cause a heart attack — the exact opposite goal of angioplasty. Some studies have suggested that drug-eluting stents increase this clotting risk, compared with bare-metal stents, but the findings of other studies have not been conclusive. This issue is being studied by the Food and Drug Administration (FDA). Because drug-eluting stents are relatively new, long-term results are not yet available. Regardless of the type of stent placed, it is absolutely necessary to take aspirin, clopidogrel (Plavix) and other medications as prescribed to decrease the chance of clots forming in the stent.
Other risks of angioplasty include:
It is very important that you closely follow your doctor's recommendations concerning duration of treatment with anti-platelet agents — aspirin and clopidogrel or similar medications.
Most people who have undergone angioplasty with or without stent placement will need to take aspirin for life. Those who have had stent placement will need clopidogrel for six to 12 months or longer in some cases. If you have any questions or if you need noncardiac surgery, you should talk to your cardiologist before stopping any of these medications.
Most people who have angioplasty and stent placement do well, often for many years. However, if you have recurrent symptoms of chest pain or shortness of breath, or other symptoms similar to before your procedure, you should contact your doctor. If you have chest pain at rest or pain that doesn't respond to nitroglycerin, you should call 911 or emergency medical help.What's ahead
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