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Angioplasty

Coronary Angioplasty

Coronary angioplasty, also called percutaneous coronary intervention (PCI), is a procedure used to open clogged heart arteries. Angioplasty involves temporarily inserting and blowing up a tiny balloon where your artery is clogged to help widen the artery.

Angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent to help prop the artery open and decrease the chance of it narrowing again. Some stents are coated with medication to help keep your artery open (drug-eluting stents), while others are not (bare-metal stents).

Angioplasty can improve some of the symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart.

Indications:

As you age, a waxy substance called plaque can build up inside your arteries. This condition is called atherosclerosis. Atherosclerosis can affect any artery in the body. When atherosclerosis affects the coronary arteries, the condition is called Coronary Heart Disease (CHD) or Coronary Artery Disease (CAD).

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.

Angioplasty can restore blood flow to the heart. During the procedure, a thin, flexible catheter (tube) with a balloon at its tip is threaded through a blood vessel to the affected artery. Once in place, the balloon is inflated to compress the plaque against the artery wall. This restores blood flow through the artery.

Doctors may use the procedure to improve symptoms of CHD, such as angina. The procedure also can reduce heart muscle damage caused by a heart attack.

Serious complications from angioplasty don’t occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure. The most common complications are discomfort and bleeding at the catheter insertion site.

Research on angioplasty is ongoing to make it safer and more effective and to prevent treated arteries from narrowing again.

Other Names for Coronary Angioplasty

  • Balloon Angioplasty
  • Coronary Artery Angioplasty
  • Percutaneous Coronary Intervention
  • Percutaneous Intervention
  • Percutaneous Transluminal Angioplasty
  • Percutaneous Transluminal Coronary Angioplasty

Risks:

Coronary angioplasty is a common medical procedure. Serious complications do not occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure.

Angioplasty complications can include:

  • Discomfort and bleeding at the catheter insertion site
  • Blood vessel damage from the catheters
  • An allergic reaction to the dye used during the angioplasty
  • An arrhythmia (irregular heartbeat)
  • The need for emergency Coronary Artery Bypass Grafting during the procedure(less than 1 percent of people). This may occur if an artery closes down instead of opening up
  • Kidney damage caused by the dye used during the angioplasty
  • Heart attack (1 percent of people)
  • Stroke (0.1 percent of people)

Sometimes chest pain can occur during angioplasty because the balloon briefly blocks blood supply to the heart. As with any procedure involving the heart, complications can sometimes be fatal. However, this is rare with coronary angioplasty. Less than 2 percent of people die during the procedure.

Procedure:

Before you have coronary angioplasty, your doctor will need to know the location and extent of the blockages in your coronary (heart) arteries. To find this information, your doctor will use coronary angiography.

This test uses dye and special x rays to show the insides of your arteries. During angiography, a small tube (or tubes) called a catheter is inserted into an artery, usually in the groin (upper thigh). The catheter is threaded to the coronary arteries. Special dye, which is visible on x-ray pictures, is injected through the catheter. The x-ray pictures are taken as the dye flows through your coronary arteries. The dye shows whether blockages are present and their location and severity.

For the angioplasty procedure, another catheter with a balloon at its tip (a balloon catheter) is inserted in the coronary artery and placed in the blockage. Then, the balloon is expanded. This pushes the plaque against the artery wall, relieving the blockage and improving blood flow.

A small mesh tube called a stent usually is placed in the artery during angioplasty. The stent is wrapped around the deflated balloon catheter before the catheter is inserted into the artery. When the balloon is inflated to compress the plaque, the stent expands and attaches to the artery wall. The stent supports the inner artery wall and reduces the chance of the artery becoming narrow or blocked again.

Some stents are coated with medicine that is slowly and continuously released into the artery. They are called drug-eluting stents. The medicine helps prevent scar tissue from blocking the artery following angioplasty.

After coronary angioplasty, you’ll be moved to a special care unit. You’ll stay there for a few hours or overnight. You must lie still for a few hours to allow the blood vessel in your arm or groin (upper thigh) to seal completely. While you recover, someone on your health care team will check your blood pressure, heart rate, oxygen level, and temperature. The site where the catheters were inserted also will be checked for bleeding. That area may feel sore or tender for a while. Most people recover from angioplasty and return to work within a week of leaving the hospital.

Complications:

The risk of complications is higher in:

  • People aged 65 and older
  • People who have chronic kidney disease
  • People who are in shock
  • People who have extensive heart disease and blockages in their coronary (heart) arteries
  • Research on angioplasty is ongoing to make it safer and more effective and to prevent treated arteries from narrowing again
  1. Restenosis

    Another problem that can occur after angioplasty is too much tissue growth within the treated portion of the artery. This can cause the artery to become narrow or blocked again, often within 6 months. This complication is called restenosis (RE-sten-o-sis).
    When a stent (small mesh tube) is not used during angioplasty, 30 percent of people have restenosis. When a stent is used, 15 percent of people have restenosis.

  2. Stent Restenosis

    The tissue growth through and around the stent over time causes a partial blockage of the artery and abnormal blood flow. Stents coated with medicine (drug-eluting stents) reduce the growth of scar tissue around the stent. These stents further reduce the risk of restenosis. When these stents are used, about 10 percent of people have restenosis.

    Other treatments, such as radiation, can help prevent tissue growth within a stent. For this procedure, a wire is put through a catheter to where the stent is placed. The wire releases radiation to stop any tissue growth that may block the artery.

  3. Blood Clots

    Studies suggest that there’s a higher risk of blood clots forming in medicine-coated stents compared with bare metal stents. However, no firm evidence shows that these stents increase the chance of having a heart attack or dying if used as recommended. Researchers continue to study medicine-coated stents.

    Taking medicine as prescribed by your doctor can lower your risk of blood clots. People who have medicine-coated stents usually are advised to take antiplatelet medicines, such as clopidogrel and aspirin, for up to a year or longer.

    As with all procedures, you should talk with your doctor about your treatment options, including the risks and benefits.

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