Angioplasty

Also known as percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA)

Angioplasty is a procedure using a special balloon to widen the narrowing in a coronary artery to improve blood flow to the heart muscle.

A stent (metal mesh or coiled tube) is often also inserted to keep the artery open. Narrowing is caused by a build up of fatty deposits (plaque) in the artery walls.

Why would angioplasty be performed?

Angioplasty is a procedure to relieve angina symptoms and thus improve your quality of life. By improving the blood flow to the heart muscle, an angioplasty can result in a more active and better quality of life, with less or no angina and less requirement for medication. However, it's wise to still make and maintain healthy lifestyle changes to help prevent a recurrence. 

Occasionally, an angioplasty is performed as an emergency procedure to try to improve blood flow during a heart attack, or if you are experiencing unstable angina. Your cardiologist will discuss whether an angioplasty can help you, on the basis on your symptoms and results of other tests. Of these, the most important test is a coronary angiogram.

What to do before your angioplasty

Before an angioplasty, you should consider what changes you can make to your lifestyle to benefit fully from the procedure. This will reduce your risk factors and help reduce the possibility of further heart problems after an angioplasty. You can discuss your risk factors with your doctor or nurse.

There will a be routine examination and some tests before the procedure, eg, blood tests and an electrocardiogram (ECG). When you're admitted to hospital the doctor or nurse will explain the procedure and answer any questions you may have. They will record your medical history and note your medications and any allergies.

If you are taking medication, especially warfarin, your doctor will advise you on whether to continue or stop taking it. If in doubt, ask your doctor, nurse or cardiologist. You should take all your medications to hospital with you.

What happens in an angioplasty?

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The start of the procedure is the same as for a coronary angiogram. A catheter, a fine, flexible hollow tube with a small inflatable balloon at its tip, will be passed into an artery in either your groin or arm. The doctor then uses x-ray screening to direct the catheter into a coronary artery until its tip reaches a narrow or blocked section. The balloon is then gently inflated to compress the plaque against the artery wall, opening the artery to allow blood to flow more easily.

During this time you may experience mild, angina-type symptoms as the blood supply to the heart muscle is temporarily interrupted. It is important to let the doctor know if this happens. Once the artery has been sufficiently opened, the balloon is deflated and removed.

Stent implantation

A stent – a metal mesh or coiled tube – can also be inserted into the narrowed artery at this time. It acts as a metal scaffold by pressing the plaque against the artery wall, widening it and keeping it open. The stent is mounted over the catheter's balloon, so that when the balloon is inflated in the narrowed section, the stent opens. The balloon is then deflated and removed, leaving the expanded stent(s) in place, keeping the artery open.

If a stent is inserted, you will be given a course of tablets to prevent blood clots forming on the stent.

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Drug-eluting stents

These stents are coated with a special substance which is slowly released into the surrounding area, helping reduce the chance of tissue growing over and narrowing the artery again. Drug-eluting stents are inserted in the same way as a regular stent. Your doctor will discuss the different options with you and decide which is most suitable for you.

After the procedure

When you return to the ward the nursing staff will closely monitor you until you are fully recovered. If the insertion sheath was in your groin, it is usually removed about two to four hours after returning to the ward. However, if the sheath was in your arm, it will be removed at the end of the procedure and a pressure band applied, followed by a pressure dressing.

When the sheath is removed, pressure is applied to the area for about 20 minutes to stop any bleeding - it is very important that you lie still during and after the removal process.  Follow the directions of the nurses, as they will let you know when it is safe to slowly move around. If you feel any bleeding, pain, dizziness, sweating or a warm, wet feeling around the insertion site, call the nurse immediately.

It is normal to have some bruising around the site and for it to be slightly tender. If you experience discomfort at the site, inform the nurse and you will be given pain relief. You may feel a small lump where the sheath was inserted, but this should disappear over the next few months. If this increases in size or becomes painful, seek medical advice.

Before leaving hospital

Before going home, a nurse will teach you how to check the site for bleeding and explain what to do if this happens, although this is unlikely if you have been walking around the ward. You will be advised not to do any heavy lifting or straining for about a week, to prevent bleeding from the insertion site.

After an angioplasty you may go home that evening or stay the night in hospital and go home the following day. You will need to arrange for someone to take you home.

Before leaving hospital you will be started on medications, which must be continued when you go home. These will help prevent further heart problems. To prevent blood clots forming, you will be given medications including Aspirin and either Clopidogrel or Ticagrelor. You should also take cholesterol-lowering medications (statins) which help protect you from further narrowings in the heart arteries and often you will also be prescribed medicines to lower your blood pressure. Always follow your doctor's instructions and do not stop taking medication without discussing with your doctor first.

Getting maximum benefit from your angioplasty

After an angioplasty most people return to normal everyday activities within one to two days of returning home, and can usually return to work after a week. Remember that having an angioplasty is not a cure for heart disease.

Your symptoms may have stopped, but you will still need to make and maintain changes to your lifestyle to prevent the angina returning. The best way to prevent further heart disease is by reducing or removing any risk factors. Every risk factor you reduce or remove can have a major effect on lowering your chances of having further heart disease problems, such as angina or a heart attack.

You may also be invited to go on a cardiac rehabilitation programme.

When can I drive again?

The New Zealand Transport Agency (NZTA) cardiovascular guide state you must not drive for at least two days after an angioplasty.

If you have complications arising from the procedure, or you have had a heart attack resulting in angioplasty, you must not drive until you have been given medical clearance, which is generally two weeks for a car licence.

If you hold a vocational licence, for example, drive passenger vehicles, trucks, forklifts, courier vans or fly aeroplanes, then different rules apply. Your licence needs to be approved by a cardiologist or specialist who will examine you and make sure it is safe for you to drive.

It also pays to check with your insurance company to ensure you are fully covered.

References

 

  1. Heart Foundation of New Zealand (2013) Angioplasty and Stents.
  2. Pursnani, S. Korley, F. et al. Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Stable Coronary Artery Disease. A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Circulation: Cardiovascular Interventions.  2012; 5: 476-490  [Full article]
  3. Iqbal J, Gunn J, Serruys PW. Coronary stents: historical development, current status and future directions. Br Med Bull. 2013;106:193-211. doi: 10.1093/bmb/ldt009. Epub 2013 Mar 26. [Abstract]  [Full article, needs subscription]
Credits: Heart Foundation, NZ, Images from 123rf.com. Reviewed By: Andrew McLachlan, Nurse Practitioner Cardiology February 2016 Last reviewed: 01 Feb 2016