Angioplasty and stent placement - heart
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary arteries.
A coronary artery stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed after angioplasty. It helps prevent the artery from closing up again. A drug eluting stent has medicine in it that helps prevent closing of the artery.
Drug-eluting stents; PCI; Percutaneous coronary intervention; Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Cardiac angioplasty; PTCA; Percutaneous transluminal coronary angioplasty; Heart artery dilatation
Before the angioplasty procedure begins, you will be given some pain medicine. You may also be given blood thinning medicines to keep a blood clot from forming.
You will lie down on a padded table. Your doctor will make a small cut (incision) on your body, usually near the groin. Then your doctor will insert a catheter (flexible tube) through the incision into an artery. Sometimes the catheter will be placed in your arm or wrist. You will be awake during the procedure.
The doctor uses live x-ray pictures to carefully guide the catheter up into your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps the doctors see any blockages in the blood vessels that lead to your heart.
A guide wire is moved into and across the blockage. A balloon catheter is pushed over the guide wire and into the blockage. The balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart.
A stent (wire mesh tube) may then be placed in this blocked area. The stent is inserted along with the balloon catheter. It expands when the balloon is inflated. The stent is then left there to help keep the artery open.
Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis.
Not every blockage can be treated with angioplasty. Some need coronary bypass (heart surgery).
Angioplasty may be used to treat:
- Persistent chest pain (angina) that medicines do not control
- Blockage of one or more coronary arteries that puts you at risk for a heart attack
- Blockage in a coronary artery during or after a heart attack
Angioplasty is generally safe, but ask your doctor about the possible complications. Risks of angioplasty and stent placement are:
- Allergic reaction to the x-ray dye
- Bleeding or clotting in the area where the catheter was inserted
- Damage to a heart valve or blood vessel
- Heart attack
- Kidney failure (higher risk in people who already have kidney problems)
- Irregular heart beats (arrhythmias)
- Stroke (this is rare)
- Allergic reaction to the stent material
- Allergic reaction to the drug used in a drug-eluting stent
- Blood clot
- Clogging of the inside of the stent (in-stent restenosis)
Angioplasty is often performed when you go to the hospital or emergency room for chest pain, or after a heart attack. If you are admitted to the hospital for angioplasty when it is not an emergency:
- Tell your doctor what drugs you are taking, even drugs or herbs you bought without a prescription.
- You will usually be asked not to drink or eat anything for 6 to 8 hours before the test.
- Take the drugs your doctor told you to take with a small sip of water.
- Tell your doctor if you are allergic to seafood, if you have had a bad reaction to contrast material or iodine in the past, if you are taking Viagra, or if you might be pregnant.
Usually, the average hospital stay is 2 days or less. Some people may not even have to stay overnight in the hospital.
In general, people who have angioplasty are able to walk around within 6 hours after the procedure. Complete recovery takes a week or less. Keep the area where the catheter was inserted dry for 24 to 48 hours.
Most people take aspirin and another medicine called clopidogrel (Plavix) after this procedure. These medicines are blood thinners, and they keep your blood from forming clots in your arteries and stent. A blood clot can lead to a heart attack. Take the medicines exactly as your doctor tells you. Do not stop taking them before talking with your doctor first.
For most people, angioplasty greatly improves blood flow through the coronary arteries and the heart. It may remove the need for coronary artery bypass surgery (CABG).
Angioplasty does not cure the cause of the blockage in your arteries. Your arteries may become narrow again. Follow your heart-healthy diet, exercise, stop smoking (if you smoke), and reduce stress to help lower your chances of having a blocked artery again. Your health care provider may prescribe medicine to help lower your cholesterol.
Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].
Winslow RD, Sharma SK, Kim MC. Restenosis and drug-eluting stents. Mt Sinai J Med. 2005 Mar;72(2):81-9.
Review Date: 12/13/2008
Reviewed By: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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