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Angioplasty is a non-surgical treatment designed to open clogged arteries. There are several procedures that can be performed. A balloon angioplasty (also called PTCA, or percutaneous transluminal coronary angioplasty) is a procedure where the area of the vessel blockage is widened with the use of a special balloon.
A coronary stent is a small, expandable mesh, metal tube. This acts as a type of scaffolding and holds the artery open and improves the blood flow. Stents come in a variety of sizes, strengths, and textures. Stents are frequently inserted after a balloon angioplasty. Also used are drug-eluting stents. These differ from regular stents in that they are coated with medications which decrease the potential for re-blockage of the artery.
Before the procedure
Your doctor will be able to tell you how long you may expect to be in the hospital. Usually patients stay for a day or two. Here are some general guidelines:
- You may get specific instructions about the food you can have. Generally, you may not have anything to eat or drink for six to eight hours before the procedure.
- You may be asked to start taking certain medications.
- Make arrangements for someone to drive you to and from the hospital.
- Pack a small bag for your hospital stay including a robe, pajamas, slippers, and toiletries.
- Bring a list of all medications you are currently taking, including exact names, frequency, and dosages. Include any herbs and over-the-counter medications such as aspirin.
- Do not bring valuables or money to the hospital.
- You may wear your dentures, hearing aids, or glasses.
- Be sure to let your doctor know if you have any allergies to drugs or if you have a history of bleeding problems. Be sure to tell your nurse or doctor if you are allergic to iodine, shellfish, or contrast.
- The nurse will get a medical history and discuss your medications with you.
- The nurse will clean and shave the area where the catheter will be inserted.
- An IV will be put in your arm or hand to administer fluids and medications.
- You may be given medications to relax you.
In addition to an examination of your medical history, an EKG, blood tests, and a chest x-ray are usually done before angioplasty or stenting.
During an Angioplasty
The procedure is done in one of our two catheterization laboratories. The doctor inserts a thin, flexible tube (called a catheter) through the sheath. The catheter is then threaded gently through the artery toward your heart.
A fluid called contrast is injected and allows the doctor to view your coronary arteries. Blood-pressure recordings may be made in the various chambers of your heart, and valve function can be examined. Pictures will be taken with specialized cameras. When the blockage is located, a balloon catheter is placed in the narrowed artery and slowly inflated to press fatty deposits against the artery walls. This allows the blood to flow more freely to the heart muscle.
After an Angioplasty
You will go to the fourth floor after your angioplasty. You will be asked to drink plenty of fluids to help flush the contrast out of your system, and to remain lying down for several hours. A collagen closure device may be placed at the insertion site, where it works as a plug and prevents bleeding.
Your doctor will talk to you about healing at the insertion site, the possibility of your symptoms returning, medications, and restrictions and changes in daily habits to reduce the risk of more arteries narrowing. Cardiac Rehabilitation will further instruct you on the cardiac risk factors and answer your questions. The doctor will inform you when to make follow-up visits.
Are there any potential complications?
There can be some risk involved with certain diagnostic procedures. Please ask your doctor to discuss the risks and benefits so that you are fully informed. Call your doctor or seek medical treatment if:
- The insertion site begins to bleed.
- You feel chest pain or discomfort.
- Your arm or leg feels numb or cold.
- The bruising or swelling gets worse or increases.
- You have a fever of 101ºF or more.
- You see signs of infection (redness, oozing, hot to the touch) at the insertion site.
- You see any other unusual symptoms.
During Stent Insertion
Along with angioplasty, the procedure takes place in a catheterization laboratory in the hospital. The balloon angioplasty procedure is usually performed first and then the stent is inserted. The stent is placed on another balloon catheter and guided to the area of blockage. The stent is then expanded in the artery by the inflation of the balloon, which usually takes anywhere from several seconds to a few minutes. The stent will adhere to the wall of the artery, and will be left in place to become part of your artery.
After Stent Insertion
- You will probably go to the fourth floor and be asked to lie still with your legs straight.
- You will remain connected to a heart monitor.
- The nurse will be checking the catheter insertion site and taking your blood pressure frequently.
- You will most likely still have the IV in for fluids and medications.
Within about a month, a thin layer of the artery’s inner lining cells will cover the stent. With stents, you do not need to worry about mechanical medical devices or metal detectors, as they won’t affect you. With drug eluting stents, this process may take up to a year. This is why it is important for you to take an anti-platelet drug (like Plavix) prescribed by your physician.
Are there any potential complications?
There can be some risk involved in this procedure, such as damage to the vessel when the stent is implanted, blood clots, or restenosis. Restenosis occurs when the artery builds up with plaque again in the stent, or at one end of the stent. Usually your doctor will prescribe an anti-platelet medication after the stent is inserted to prevent blood clots from forming. Call your doctor or seek medical treatment if:
- The insertion site bleeds.
- You feel chest pain or discomfort.
- Your arm or leg feels numb or cold.
- The bruising or swelling gets worse or increases.
- You have a fever, or signs of infection (redness or oozing) at the insertion site.
- You have any other unusual symptoms.
