Angioplasty

What is angioplasty?

Angioplasty is a procedure for stretching open a blocked artery using a thin catheter with a balloon at the end. A metal mesh device called a stent is usually left in the artery to help keep the blood vessel open.

The blocked artery may be anywhere in the body. If the blocked artery is a blood vessel that supplies blood to the heart, the procedure is called percutaneous coronary intervention (PCI). It may also be called coronary angioplasty or percutaneous transluminal coronary angioplasty (PTCA).

When is it used?

Arteries can become blocked or narrowed by plaque. Plaque is a buildup of fats, cholesterol, and other substances on the inside walls of the arteries.

Angioplasty is used to treat symptoms caused by:

• coronary artery disease (narrowing or blockage of the arteries that supply blood to the heart)
• peripheral vascular disease (blocked arteries supplying blood to the limbs, especially the legs)
• carotid artery disease (narrowing or blockage of the arteries in your neck.)
• renovascular disease (narrowing or blockage of the arteries going to the kidneys).

PCI may be done during a heart attack to reduce heart muscle damage from the heart attack.

How do I prepare for this procedure?

• Talk with your healthcare provider about what medicines you should take before the procedure. Your healthcare provider may prescribe medicine to prevent blood clots from forming during the procedure. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.
• Plan for your care and transportation after the procedure and during recovery at home.
• Tell your healthcare provider if you have had any kidney problems or reactions to iodine-containing foods or chemicals, such as seafood or X-ray contrast dye.
• Before the procedure, your healthcare provider will ask you to sign a consent form for angioplasty and angiography. (Angiography is an X-ray study of the blood vessels using dye.)
• Your healthcare provider will ask you not to eat or drink anything after midnight on the night before the procedure.
• You may have blood tests, an electrocardiogram (ECG), and a chest X-ray before the procedure.

What happens during the procedure?

You will be given medicine to help you relax and a local anesthetic to numb the place where the catheter will be inserted. You will stay awake during the procedure.

Someone at the hospital will shave and wash the area where the catheter will be inserted (the elbow area of the arm or the groin) to help prevent infection.

Your healthcare provider will put a catheter into a blood vessel in your arm or groin. A catheter is a very thin, flexible tube. X-rays and a dye injected through the catheter may be used to help show where the catheter is as your provider moves the catheter to the blocked artery. A thin wire is then guided through the tube into the narrowed blood vessel. Another catheter is advanced over the wire. This second catheter has a deflated balloon at its tip.

When the balloon reaches the narrow part of the artery, the healthcare provider inflates the balloon. Inflating the balloon stretches the walls of the narrowed artery. If a stent is left in the artery, it may be coated with medicine to help keep the blood vessel open.

The healthcare provider then deflates the balloon and removes the catheter and wire. The stretching of the artery greatly improves blood flow through the artery.

What happens after the procedure?

After the procedure you will go back to your hospital room and rest in bed. You will have a pressure dressing on the area where the catheter was inserted to prevent bleeding.

The length of time that you will need to stay in the hospital will depend on the reason you needed the procedure and how well you recover. This is often between 1 to 3 days after you have the procedure.

Angioplasty is successful over 95% of the time. However, there are times when the balloon cannot enter the severely narrowed artery. Sometimes the narrowed or blocked artery will not widen.

People with successful angioplasty have good long-term results. However, your arteries may narrow again. If this happens, it usually happens within 6 months after the first procedure.

What are the benefits of this procedure?

• Angioplasty can restore blood flow in the artery without major surgery.
• The procedure can be performed without using general anesthesia.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• You may have an allergic reaction to the dye. An allergic reaction may cause hives, trouble breathing, a drop in blood pressure, unconsciousness, or swelling of the skin. This reaction can be treated with medicine.
• The dye could damage the kidneys. If you have diabetes or kidney disease, you may have a higher risk for kidney damage. Your healthcare provider may want you to take medicine before and after the test to help protect your kidneys.
• The test can cause irregular heart rhythms, which could need treatment.
• You may have bleeding where the catheter was put into your blood vessel.
• If the catheter is placed in an artery, a blood clot could form around the catheter. A clot could block the artery.
• The catheter may damage an artery, for example, the blood vessel in the groin or arm where the catheter was inserted.
• In rare cases, you may have an allergic reaction to the drug used in the anesthesia.
• While not common, a heart attack or stroke might be triggered by the test.

Every procedure or treatment has risks. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.

How can I take care of myself?

• Do not smoke.
• Eat a healthy diet that is low in fat and cholesterol.
• Exercise according to your healthcare provider's recommendation.
• Keep your appointment for your scheduled post-discharge office visit.

When should I call my healthcare provider?

Call 911 for emergency help right away if:

• You have chest discomfort (pressure, fullness, squeezing, or pain) that lasts more than 5 minutes or goes away and comes back.
• You have chest discomfort with lightheadedness.
• Your chest pain goes beyond your chest to one or both arms or to your neck or jaw.
• You have chest discomfort and are sweating a lot or having trouble breathing or are sick to your stomach.
• You have shortness of breath.
• Your arm or leg becomes blue and cold.

If you have any of these symptoms, do not drive yourself.

Call your provider right away if:

• You have constant or worsening pain or numbness in your arm or leg.
• You have a fever.
• You have bleeding, excess bruising, or a lot of swelling where the catheter was inserted.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.