Angioplasty and Stenting – Preparation,Procedure , Results and Risk
- Minimally invasive, endovascular procedures such as angioplasty can reduce risk and offer shorter recovery times, compared to open surgery.
- Angioplasty is sometimes done alone, without stenting.
- Doctor will choose a therapy based on your ability to exercise, your risk of open surgery, and the type, number and degree of blockage(s).
ANGIOPLASTY (PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY)
- Angioplasty may be performed for coronary artery disease or peripheral artery disease. When it is performed for peripheral arty disease, the procedure is called percutaneous transluminal angioplasty (PTA).
- At the start of the procedure, a thin tube called a catheter enters the femoral artery through a small puncture in the thigh.
- Your physician uses X-rays to guide the catheter to the blockage, then inflates a balloon at the tip of the catheter.
- The balloon presses the clogging material flat against the artery wall, expanding the artery and allowing more space for the blood to flow.
- Your physician may use a plain balloon or one coated with medication (drug-eluting balloon), which helps prevent scarring while the artery heals.
STENTING
- A stent is a tube of metal mesh that holds your artery open and may improve the results of angioplasty alone.
- In a minimally invasive, endovascular procedure, a catheter delivers the stent to the blockage site.
- Stents can be bare metal, covered with fabric and/or coated with medication (drug-eluting stent), which helps prevent scarring while the artery heals.
- Stents may also be placed as part of open surgery.
Preparation :
- Some routine tests first, including a chest X-ray, electrocardiogram and blood tests.
- instructions about eating or drinking before angioplasty.
- Doctor may instruct you to stop taking certain medications before angioplasty, such as certain diabetes medications.
- Attender is must because Angioplasty usually requires an overnight hospital stay, and you won’t be able to drive yourself home the next day.
Why Angioplasty ?
Angioplasty is used to treat a type of heart disease known as atherosclerosis. Atherosclerosis is the slow buildup of fatty plaques in your heart’s blood vessels. Your doctor might suggest angioplasty as a treatment option when medications or lifestyle changes aren’t enough to improve your heart health, or if you have a heart attack, worsening chest pain (angina) or other symptoms.
Angioplasty isn’t for everyone. If the main artery that brings blood to the left side of your heart is narrow, if your heart muscle is weak or if you have multiple diseased blood vessels, then coronary artery bypass surgery may be a better option than angioplasty. In coronary artery bypass surgery, the blocked part of your artery is bypassed using a blood vessel from another part of your body.
Procedure :
Angioplasty can take up to several hours, depending on the difficulty and number of blockages and whether any complications arise.
Angioplasty is performed by a heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians in a special operating room called a cardiac catheterization laboratory. This room is often called the cath lab.
Angioplasty is commonly performed through an artery in your groin (femoral artery). Less commonly, it may be done using an artery in your arm or wrist area. Before the procedure, the area is prepared with an antiseptic solution and a sterile sheet is placed over your body.
A local anesthetic is injected to numb the area where the catheter will be inserted. Small electrode pads are placed on your chest to monitor your heart during the procedure.
General anesthesia isn’t needed. You’ll be sedated but awake during the procedure. You’ll receive fluids, medications to relax you and blood-thinning medications (anticoagulants) through an IV catheter. Then, the procedure begins:
- After numbing the incision area, a small needle is used to access an artery in your leg or arm. A small cut is made in the skin.
- Your doctor then threads a thin guidewire followed by a catheter into the artery until it reaches the blockage in your heart.
- You might feel pressure in the area where the catheter is inserted, but you shouldn’t feel sharp pain. Tell your doctor if you do. You also won’t feel the catheter in your body.
- A small amount of dye is injected through the catheter. This helps your doctor look at the blockage on X-ray images called angiograms.
- A small balloon at the end of the catheter is inflated, widening the blocked artery. After the artery is stretched, the balloon is deflated and removed. Your doctor might inflate and deflate the balloon several times before it’s removed, stretching the artery a bit more each time.
If you have several blockages, the procedure may be repeated at each blockage. Because the balloon temporarily blocks blood flow to part of your heart, it’s not uncommon to experience chest pain while it’s inflated.
Stent placement
Most people who have angioplasty also have a stent placed in their blocked artery during the same procedure. The stent is usually inserted in the artery after it’s widened by the inflated balloon.
The stent supports the walls of your artery to help prevent it from re-narrowing after the angioplasty. The stent looks like a tiny coil of wire mesh.
Here’s what happens:
- The stent, which is collapsed around a balloon at the tip of the catheter, is guided through the artery to the blockage.
- At the blockage, the balloon is inflated and the spring-like stent expands and locks into place inside the artery.
- The stent stays in the artery permanently to hold it open and improve blood flow to your heart. In some cases, more than one stent may be needed to open a blockage.
- Once the stent is in place, the balloon catheter is removed and more images (angiograms) are taken to see how well blood flows through your newly widened artery.
- Finally, the guide catheter is removed, and the procedure is completed.
After your stent placement, you may need prolonged treatment with medications, such as aspirin or clopidogrel (Plavix) to reduce the chance of blood clots forming on the stent.
Results : To keep your heart healthy after angioplasty, you should:
- Quit smoking
- Lower your cholesterol levels
- Maintain a healthy weight
- Control other conditions, such as diabetes and high blood pressure
- Get regular exercise
Successful angioplasty also means you might not have to undergo a surgical procedure called coronary artery bypass surgery. In a bypass, an artery or a vein is removed from a different part of your body and sewn to the surface of your heart to take over for the blocked coronary artery. This surgery requires an incision in the chest, and recovery from bypass surgery is usually longer and more uncomfortable.
Risks of Angioplasty:
Although angioplasty is a less invasive way to open clogged arteries than bypass surgery is, the procedure still carries some risks.
The most common angioplasty risks include:
Re-narrowing of your artery (restenosis). With angioplasty alone — without stent placement — restenosis happens in about 30 percent of cases. Stents were developed to reduce restenosis. Bare-metal stents reduce the chance of restenosis to about 15 percent, and the use of drug-eluting stents reduces the risk to less than 10 percent.
Blood clots. Blood clots can form within stents even after the procedure. These clots can close the artery, causing a heart attack. It’s important to take aspirin, clopidogrel (Plavix), prasugrel (Effient) or another medication that helps reduce the risk of blood clots exactly as prescribed to decrease the chance of clots forming in your stent.
Talk to your doctor about how long you’ll need to take these medications. Never discontinue these medications without discussing it with your doctor.
Bleeding: May have bleeding in your leg or arm where a catheter was inserted. Usually this simply results in a bruise, but sometimes serious bleeding occurs and may require a blood transfusion or surgical procedures.
Other rare risks of angioplasty include:
Heart attack: Though rare, may have a heart attack during the procedure.
Coronary artery damage: Coronary artery may be torn or ruptured (dissected) during the procedure. These complications may require emergency bypass surgery.
Kidney problems. The dye used during angioplasty and stent placement can cause kidney damage, especially in people who already have kidney problems.
Stroke: During angioplasty, a stroke can occur if plaques break loose when the catheters are being threaded through the aorta. Blood clots also can form in catheters and travel to the brain if they break loose. A stroke is an extremely rare complication of coronary angioplasty, and blood thinners are used during the procedure to reduce the risk.
Abnormal heart rhythms. During the procedure, the heart may beat too quickly or too slowly. These heart rhythm problems are usually short-lived, but sometimes medications or a temporary pacemaker is needed.
