by Fucci MJ

Coronary Angioplasty

(Balloon Angioplasty; Percutaneous Transluminal Coronary Angioplasty [PTCA]; Percutaneous Coronary Revascularization )

Click here to view an animated version of this procedure.

Definition

A coronary angioplasty is a procedure to open an artery in the heart that has become narrowed. This allows better blood flow through the artery and to the heart muscle. It is often done with a balloon that is passed through a special catheter (tube).
Balloon Angioplasty
IMAGE
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Reasons for Procedure

Atherosclerosis is a disease of the arteries. Cholesterol and fatty deposits build up on the walls of the arteries. This restricts blood flow. When this buildup happens in the heart, it may lead to a heart attack . Lifestyle changes and medicines can be used to treat atherosclerosis. If they are not enough, an angioplasty may be done.

Possible Complications

If you are planning to have an angioplasty, your doctor will review a list of possible complications which may include:
  • Bleeding at the point of catheter insertion
  • Damage to the walls of arteries, causing you to need more procedures or surgery
  • Heart attack or abnormal heart beats called arrhythmia
  • Allergic reaction to x-ray dye
  • Blood clots
  • Infection
  • Stroke
  • Temporary kidney failure
Some factors that may increase the risk of complications include:

What to Expect

Prior to Procedure

Your doctor will likely do the following.
  • Your doctor may need to test your bodily fluids. This can be done with blood tests.
  • You may need heart pictures and function tests. This can be done with:
In the days leading up to your procedure:
  • Talk to your doctor about your current medicines. Certain medicines may need to be stopped before the procedure, such as:
    • Anti-inflammatory drugs (eg, ibuprofen) for up to one week before surgery
    • Blood-thinning medicines such as warfarin (Coumadin)
    • Metformin (Glucophage) or glyburide and metformin (Glucovance)
  • You should take aspirin before and during the procedure. Your doctor may also prescribe clopidogrel (Plavix) before the procedure.
  • The night before, eat a light meal. Do not eat or drink anything after midnight.
  • Arrange for a ride to and from the procedure.
  • Arrange for help at home after returning from the hospital.

Anesthesia

Local anesthetic will be given. It will numb the area of the groin or arm where the catheter will be inserted. You will also be given sedation and pain medicine through an IV. This will help to keep you comfortable during the procedure.

Description of Procedure

The area of the groin or arm where the catheter will be inserted will be shaved, cleaned, and numbed. A needle will be inserted into the artery. You will receive blood-thinning medicines during the procedure. A wire will be passed through the needle and into the artery. The wire will be guided through until it reaches the blocked artery in the heart. A soft, flexible catheter tube will then be slipped over the wire and threaded up to the blockage.
The doctor will be taking x-rays during the procedure to know where the wire and catheter are located. Dye will be injected into the arteries of the heart. This will provide a better view of the arteries and blockages.
After the blockage is reached, a small balloon at the tip of the catheter will be rapidly inflated and deflated. This will stretch the artery open. The deflated balloon, catheter, and wire will be removed.
Your doctor may also insert a small mesh tube called a stent into the artery where there was a narrowing. A stent acts to keep the artery open by providing support inside it.
After the procedure is done and the blood-thinning medicines have worn off, the catheter will be removed. Pressure will be applied for 20-30 minutes to control bleeding.
A bandage will be placed over the groin or arm.

How Long Will It Take?

30 minutes to three hours

Will It Hurt?

The anesthetic should numb the area where the catheter is inserted. You may feel a burning sensation when the anesthesia is given. You may also feel pressure when the catheters are moved. Some people have a flushed feeling or nausea when the dye is injected. You may feel some chest pain during inflation of the balloon.

Average Hospital Stay

The usual length of stay is overnight. If the catheter is inserted in your arm or wrist, you may be able to go home the same day. Speak to your doctor to see if this is an option for you.

Post-procedure Care

At the Hospital
You will likely need to lie still and flat on your back for a period of time. A pressure dressing may be placed over the area where the catheter was inserted. This will help prevent bleeding. Or, a vascular closure device may be used to seal the site. This will allow earlier movement and hospital discharge. It is important to follow directions.
At Home
  • You may be sent home on blood-thinning therapy. This may include one or more of the following:
    • Aspirin
    • Warfarin
    • Clopidogrel
    • Prasugrel (Effient)
    • Dabigatran etexilate (Pradaxa)
  • Ice may help decrease discomfort at the insertion site. You may apply ice for 15-20 minutes each hour for the first few days.
  • You can make lifestyle changes to lower your risk of complications of heart disease. These include eating a healthier diet, exercising regularly, and managing stress.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Be sure to follow your doctor’s instructions .
Sometimes the procedure is not successful or the artery narrows again. You may require repeat angioplasty or coronary artery bypass grafting (CABG) .
Sometimes the procedure is not successful or the artery narrows again. You may require repeat angioplasty or coronary artery bypass grafting (CABG) .

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Your arm or leg becomes painful, blue, cold, numb, tingly, swollen, or increasingly bruised
  • Nausea and/or vomiting
  • Pain that you cannot control with the medicines you have been given
  • Cough, shortness of breath, or chest pain
  • Joint pain, fatigue, stiffness, rash, or other new symptoms
In case of an emergency, call for medical help right away.

RESOURCES

American Heart Association http://www.heart.org

National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Public Health Agency of Canada http://www.phac-aspc.gc.ca

Heart and Stroke Foundation of Canada http://www.heartandstroke.com

References

American College of Cardiology Task Force. American College of Cardiology/Society for Cardiac Angiography and Interventions clinical expert consensus document on cardiac catheterization laboratory standards: a report of the American College of Cardiology Task Force on clinical expert consensus documents. J Am Coll Cardiol . 2001 Jun 15;37(8):2170-2214.

Angio-Seal VIP. St. Jude Medical Website. Available at: http://www.sjmprofessional.com/products/us/hemostasis-management/angio-seal-vip.aspx . Accessed February 7, 2013.

Baim D, Grossman W. Coronary Angioplasty, in Cardiac Catheterization, Angiography, and Intervention . 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2000.

Bain S, Moheet AM, Rasmussen P. Which patients benefit from carotid stenting? What recent trials show. Cleve Clin J Med . 2008 Oct;75(10):714-20. Review.

Bravata DM, Gienger AL, McDonald KM, Sundaram V, Perez MV, Varghese R, Kapoor JR, Ardehali R, Owens DK, Hlatky MA.Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med . 2007 Nov 20;147(10):703-16. Epub 2007 Oct 15. Review.

Chaer RA, Makaroun MS. Current indications for carotid angioplasty and stenting. Perspect Vasc Surg Endovasc Ther . 2008 Sep;20(3):239-44. Review.

Hochman J, Lamas GA, Buller CE, et al. Coronary intervention for persistent occlusion after myocardial infarction. N J Eng Med . 2006;355:2395-2407. Available at: http://content.nejm.org/cgi/content/abstract/NEJMoa066139 . Accessed February 7, 2013.

Kasper DL, et al. Harrison's Principles of Internal Medicine . 16th ed. New York, NY: McGraw-Hill Professional;2004.

Smith SC, Dove JT, Jacobs AK, et al. ACC/AHA guidelines of percutaneous coronary interventions. J Am Coll Cardiol . 2001;37:2215.

Weaver WD. Heart Disease: A Textbook of Cardiovascular Medicine . 5th ed. Philadelphia, PA:WB Saunders; 1997.

What is coronary angioplasty? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/angioplasty/ . Updated February 1, 2012. Accessed February 7, 2013.

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