Coronary angioplasty with stenting refers to a procedure done to improve blood supply to the heart. A common, usually painless procedure, it is performed by a cardiologist to open blocked or narrowed arteries (which supply blood to the heart). Before the procedure, the patient is administered a local anaesthetic. A narrow flexible tube (or catheter) is put either into the wrist or groin and then pushed up to the coronary artery. A small balloon affixed at the end of the catheter is inflated to widen the blocked or narrowed part of the artery.
If the artery is too narrow for the balloon to penetrate, a tiny drill may be utilised to remove the fatty deposits and slowly widen the passage. Angioplasty is typically clubbed with the placement of a stent (small metal tube). Once the balloon is deflated and withdrawn together with the catheter, the stent remains in place – akin to a support framework that ascertains the artery remains open.
Why a Stent May Be Required
In some individuals, fatty deposits can accumulate in coronary arteries over time, narrowing or blocking the arteries. Referred to as atherosclerosis, this can lead to coronary heart disease.
An angina or heart attack could occur if the quantum of blood passing via the coronary arteries is not enough. Therefore, coronary angioplasty is done in severe angina cases where medications are not working or as an emergency procedure when a person has suffered a heart attack.
Nevertheless, some people won’t be recommended angioplasty. Depending on a person’s health and specific heart conditions, coronary artery bypass surgery may be recommended.
Success Ratio of the Procedure
As coronary angioplasty and stenting improve the blood flow via the treated artery, many patients report an abatement or cessation of their symptoms. Occasionally, the artery may narrow down again (called restenosis), leading to the recurrence of angina symptoms. Thanks to advances in stent technology, this risk is much lower today. Consequently, many people remain free of symptoms for longer durations. Long-term success can be improved if a healthy lifestyle is followed.
The Benefits
The benefits of this procedure differ from person to person, as per the severity of the condition, age and overall health. This can include relief from pain and tiredness; reduced breathlessness; more energy as well as better mental well-being; and a lesser risk of stroke or heart attack.
Risks and Complications
A small percentage of patients may experience complications with coronary angioplasty. As stated earlier, this varies among people. Complications could include bleeding, bruising or infection in the area where the catheter was inserted into the body (wrist or groin); and blood clots, which could form within the stent even after angioplasty. In this case, it’s critical to take all the prescribed medications such as aspirin and anti-platelet drugs.
Other rare angioplasty risks may include heart attacks; coronary artery damage (the artery could tear or rupture during the procedure, requiring emergency open-heart surgery); kidney injury (due to other conditions affecting the functioning of the kidneys); stroke (during the operation, a fatty plaque piece could detach, reach the brain and block blood flow – blood thinners will be used to reduce this risk); and irregular heartbeats (the heart may beat too fast or too slowly during the procedure – this is managed with a temporary pacemaker or medicines). Nevertheless, the risk of major complications is under 1%.
What to Expect Before the Procedure
In a planned procedure, the patient is required to avoid any food or drink four to six hours before angioplasty. Before the procedure gets underway, one will also have to change into a patient gown and remove any jewellery or watch that could impede the procedure.
Electrodes (sticky patches) will be put on the patient’s chest to check his/her heartbeat. The blood pressure will also be checked. Before, during and after the procedure, the patient’s heart rate, BP, pulse and oxygen level are monitored continuously.
During the Procedure
Generally, an angioplasty takes anywhere between half an hour and two hours, though in some cases it may take longer. The patient is normally conscious during the procedure, lying on his/her back. If the patient feels nervous, a sedative is given so he/she will relax.
A local anaesthesia (injection) will be given in the wrist or groin. The thin tube will then be passed into the artery via the numbed region. A special dye (contrast dye) is injected into the tube so the coronary arteries are visible clearly on the x-ray screen. This stage is termed an angiogram.
During the procedure, an attached heart monitor will record the patient’s heart rate and rhythm while a clip on the finger will measure his/her oxygen levels. The BP will also be monitored regularly. During angioplasty, many patients may experience some pressure. At any time, if a person feels unwell or has chest pain, the medical team should be informed immediately.
The tube will be withdrawn after the angioplasty is completed. At this point, minor bleeding could occur when the tube is removed, which is nothing to worry about. The patient is then taken back to the recovery room where he/she will be monitored by the medical team.
After the Procedure
After angioplasty, the duration of stay in the hospital depends on the patient’s condition. While most patients are discharged in a day, the hospital stay may be longer in critical cases.
Before being discharged from the hospital, the cardiologist will talk to the patient about the recovery and also mention the precautions to be followed thereafter. A feeling of tiredness after angioplasty is not unusual but most individuals will return to normal within a few days. However, recovery will take more time if the person has suffered a heart attack. On returning home, one will need to have adequate rest and consume plenty of fluids so that the imaging dye is flushed out from the body.
Since a stent has been implanted, the patient will be prescribed medications to help lower the risk of blood clots being formed in/around the stent. This may include blood-thinning medicines, anti-platelet medications and cholesterol-reducing drugs.
A Heart-healthy Lifestyle is Indispensable
Further, the patient will be advised to avoid strenuous activities for some time. Cardiac rehabilitation or a personalised exercise programme may also be recommended. Note that angioplasty with stenting cannot treat any underlying causes of artery blockage.
Accordingly, all the prescribed medications must be taken daily as advised. One must also avoid cigarettes and alcohol, consume a nutritious diet low in saturated fats or trans-fats, maintain a healthy weight, exercise regularly and always control BP, blood sugar and cholesterol levels. A heart-healthy active lifestyle is the best way to avoid cardiac complications throughout life in the post-procedure period.