Angioplasty

Asian Heart Institute

Asian Heart Institute

AHI Cardiac Surgery Team is the best in the world and has performed more than 18,000 heart surgeries and 3,000 complex cases, many of them considered inoperable and the Team was selected for PM’s Redo surgery.

Angioplasty

Definition:

It is a non surgical treatment used to open narrowed coronary arteries to improve blood flow to the heart.

It is an interventional procedure and it starts out the same way as an angiography.

Types:

1) Balloon angioplasty: A procedure in which a small balloon at the tip of the catheter is inserted near the blocked or narrowed area of the coronary artery. The technical name for balloon angioplasty is Percutaneous Transluminal coronary Angioplasty (PTCA) or percutaneous Coronary Intervention (PCI).

When the balloon is inflated, the fatty plaque or blockage is compressed against the wall of the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the heart.

2) Balloon angioplasty with stenting: In most cases, balloon angioplasty is performed in combination with the stenting procedure. A stent is a small metal mesh tube that acts as a scaffold to provide support inside the coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed, and the stent stays in place permanently. During a period of several weeks, the artery heals around the stent. In this way restenosis is diminished.

Angioplasty with stenting is recommended in patients having one or two blockages in the coronary arteries. For multiple blockages it is suggested to undergo a bypass surgery.

Stents:

DES= Drug eluting stents: they contain a medication that is actively released at the stent implantation site. Drug eluting stents have a thin surface of medication to reduce the risk of restenosis.

If you implant a drug eluting stent, your doctor will prescribe certain medications for several months after your procedure to prevent the risk of clotting in the stent. It is important to keep taking the medicines as prescribed until your doctor tells you otherwise

Are these procedures considered surgical procedures?

No. they are not considered as surgical procedures because there is no large incision used to open the chest. There is access made to the coronary arteries through femoral artery (from the groin) or the radial artery (from the hand).

Will I be awake during the procedure?

Yes, you will be given a mild sedative to relax you but you will be awake and conscious during the entire procedure. The doctor will use a local anesthesia to numb the catheter insertion site.

Where is the procedure performed?

The procedure is performed in the Cath lab.

Who performs the procedure?

A specially trained interventional cardiologist and a team of fellow physicians, nurses and technicians perform the procedure.

How long does the procedure take to perform?

The procedure may take anywhere between half an hour to one hour. The preparation and recovery time may add several hours in the cathlab.

What are the possible risks of the procedure?

If you need to have an angioplasty your cardiologist may discuss the following risks with you:

  • Bleeding at the catheter insertion site
  • Infection
  • Mild to moderate skin reaction from x ray exposure
  • Continued chest pain or angina
  • Irregular heart rhythm
  • Kidney failure
  • Blood clots
  • Stroke
  • Acute closure of coronary artery

Does an interventional procedure cure coronary artery disease?

For most people, these procedures increase blood flow to the heart, diminished chest pain and decrease the risk of a heart attack.

But it does not cure a coronary artery disease.

To achieve the best result you must be committed to leading a heart healthy life style as follows:

  • Take your medications as prescribed
  • Make dietary changes
  • Quit smoking
  • Exercise regularly
  • Keep your follow up appointments
  • Be an active member of the rehabilitation for a healthy heart.

Preparing for the procedure:

Allergies: Please discuss all your allergies with your cardiologist specially the ones mentioned below

  • Iodine allergy
  • Dye allergy
  • Contract agent allergy
  • Latex or rubber products allergy

Medications: discuss the medications that you take with your cardiologist as he may want to add or alter a few, the major ones being:

  • Anti-coagulants
  • Aspirin
  • Diabetes medicines

Pre-procedure tests: you need to undergo the following before the procedure:

  • Blood tests which include serology, sugar levels and creatinine levels
  • ECG
  • Chest x-ray

What happens during he procedure?

Angioplasty is done in a cathlab as follows:

The patient is rolled into the cathlab after the initial preparations are done after admission

In the cathlab the patient is given a few medications and IV line is inserted for administration of medicines if required during the procedure

In the procedure room the cardiologist begins by giving local anaesthesia at the catheter insertion site

Using x-ray imaging, a guide wire is passed from the insertion site after it is punctured and over the wire a catheter is threaded all the way to the coronary arteries

Through this catheter another tube with an inflatable balloon is passed such that it reaches the blocked artery and it is positioned such that the deflated balloon is right at the level of the lesion

The balloon is then inflated till the fatty blockage is compressed against the wall of the artery. Most balloons are mounted with a stent so after the balloon is inflated the stent expands and takes its place and the balloon can be pulled out after deflating it

The stent remains in place and the catheter is pulled out slowly and the procedure is completed.

What to expect after the procedure?

After the procedure you will be expected to stay in the ICU for one day for observation and monitoring of vitals as the first 24 hours is the time when complications if any may throw up.

After the first 24 hours in case of no complications you may be shifted to the wards where you may stay for another 24 hours till you are made stable and then you may be discharged.

A responsible adult must drive you home after discharge.

You may not be allowed to drive for a few weeks. You may consult your doctor about when to start driving.

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