Coronary & Vascular Angioplasty and Stents

What Happens During Angioplasty?

AngioplastyFirst, you’ll have what’s called a cardiac catheterization. Medication will be given to relax you, then the doctor will numb where the catheter will go with anesthesia.

Next, a thin plastic tube called a sheath is inserted into an artery — sometimes in your groin, sometimes in your arm. A long, narrow, hollow tube called a catheter is passed through the sheath and guided up a blood vessel to the arteries surrounding the heart.

A small amount of contrast liquid is put into your blood vessel through the catheter. It’s photographed with an X-ray as it moves through your heart’s chambers, valves, and major vessels. From those pictures, doctors can tell if your coronary arteries are narrowed and, in some cases, whether the heart valves are working correctly.

If the doctor decides to perform angioplasty, he will move the catheter into the artery that’s blocked. He’ll then do one of the procedures described below.

The whole thing lasts from 1 to 3 hours, but the preparation and recovery can add much more time. You may stay in the hospital overnight for observation.

What Types of Procedures Are Used in Angioplasty?

There are several your doctor will choose from. They include:

Balloon: A catheter with a small balloon tip is guided to the narrowing in your artery. Once in place, the balloon is inflated to push the plaque and stretch the artery open to boost blood flow to the heart.

Stent: This is a small tube that acts as a scaffold to support the inside your coronary artery. A balloon catheter, placed over a guide wire, puts the stent into your narrowed coronary 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 then deflated and removed while the stent stays in place. Over several weeks, your artery heals around the stent.

These are often placed during angioplasty to help keep the coronary artery open. The stent is usually made of metal and is permanent. It can also be made of a material that the body absorbs over time.

Some stents contain medicine and are designed to reduce the risk of the artery getting blocked again (your doctor may call that restenosis). The doctor will decide if this is the right stent for your blockage.

Rotablation: A special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of the narrowing in your coronary artery. The tip spins at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed away in your bloodstream. This process is repeated as needed to improve blood flow.

This is rarely used because balloon angioplasty and stenting have much better results. They’re also easier for the cardiologist to perform.

Atherectomy: The catheter used here has a hollow cylinder on the tip with an open window on one side and a balloon on the other. When the catheter is put into the narrowed artery, the balloon is inflated, pushing the window against the plaque. A blade in the cylinder rotates and shaves off any plaque that protrudes into the window. The shavings are caught in the catheter chamber and removed. This process is repeated as needed to allow for better blood flow.

Like rotablation, this procedure isn’t used much.

Cutting balloon: This catheter has a special balloon tip with small blades. When the balloon is inflated, the blades are activated. The small blades score the plaque, then the balloon presses the plaque against the artery wall.

What Can I Expect Before an Angioplasty?

Most people will need a routine blood test and electrocardiogram. These may require separate appointments and are usually scheduled the day before the procedure.

You won’t be able to eat or drink after midnight the evening before.

If you wear dentures or a hearing aid, plan to wear them during your angioplasty to help with communication. If you wear glasses, bring them, too.

Please tell your doctor or nurse if you are taking diuretics (water pills), insulin, or warfarin (Coumadin).

Also let them know if you are allergic to anything, especially:

  • Iodine
  • Shellfish
  • X-ray dye
  • Latex or rubber products (such as rubber gloves or balloons)
  • Penicillin-type medications.

You’ll need to take aspirin before the procedure. Make sure to tell your doctor or nurse if you didn’t.

You’ll be awake during it, but you’ll get medication to help you relax.

What Happens After an Angioplasty?

If the catheter was put into the artery at your groin, you’ll have to lie flat (without bending your legs) while the groin sheath is in place. A sheet may be placed across your leg with the sheath to remind you to keep it straight.

After the sheath is removed, you’ll have to lie flat for about 6 hours to prevent bleeding, but your nurse can raise your head about two pillows high after 2 hours. Your nurse will tell you when you can get out of bed. It may be sooner than 6 hours if a collagen “plug” was put into your artery. Your team will let you know.

You shouldn’t eat or drink anything except clear liquids until the groin sheath is removed. That’s because you can get nauseated while it’s on. Once you can eat, you’ll be urged to follow a heart-healthy diet.

If your catheter was put into the artery at your wrist or arm, your doctor will put a special bandage on to make sure it heals properly. You’ll wear this for a couple of hours. The doctor or a nurse will remove it and check to see if your artery has healed enough.

You may be admitted to the hospital overnight for observation after the procedure.

Let your doctor or nurse know right away if you get a fever or have:

  • Chest pain
  • Swelling
  • Pain in your groin or leg

If your groin starts to bleed after you get back home, call 911 and lie down right away. Take the dressing off and push down where you can feel your pulse in the affected area.

If a stent was placed, you’ll need to take medications to reduce the odds of a blood clot forming near it.

Gradually get back to your regular activities. You should be able to resume your normal stuff after about a week.

If your catheter was put into the artery at your wrist or arm, your doctor will put a special bandage on to make sure it heals properly. You’ll wear this for a couple of hours. The doctor or a nurse will remove it and check to see if your artery has healed enough.

Can Angioplasty Cure Coronary Artery Disease?

It will open a blocked artery, but it won’t cure coronary artery disease. Lifestyle details like smoking and diet will still need some tweaking. You’ll be given an exercise program to follow. You may need to take one or more medicines, too.