The angioplasty procedure is a highly successful treatment with around 45,000 operations of this type carried out in the UK every year. The technique is used to open out a narrowing artery to prevent it becoming totally blocked and causing a heart attack. If your artery remains open for a year, the chances of it blocking again decrease significantly. However, between 10% and 30% of people who undergo an angioplasty procedure with a stent will require further treatment within six months.
This article on angioplasty is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.
Why would you need an angioplasty procedure?
Fatty compounds in the blood stream, called atheroma, can sometimes cause a build up of deposits in the arteries that supply blood to the heart. This results in a condition called atherosclerosis. The fatty deposit narrows the artery and restricts blood flow, causing chest pain and angina. If left untreated, the artery can block completely, causing a heart attack.
The angioplasty procedure opens up blocked arteries allowing a more normal blood flow and reducing the risk of these two conditions. Your angioplasty may be a planned surgery or may be done after an emergency admission. The angioplasty procedure is sometimes called a PTCA, which stands for Percutaneous Transluminal Coronary Angioplasty – which literally means through the skin, along the channel.
How does the procedure work?
The angioplasty opens up a narrowed artery using a clever mechanical technique. A tube is inserted into the artery to the point where the artery narrows. A balloon contained in the end of the tube is then inflated, pushing apart the artery walls and making the lumen as wide as it used to be. Although the angioplasty procedure sounds quite invasive, it is relatively straightforward and has become a routine treatment. It does, however, need careful preparation and you will need to be aware of what will happen.
Is it right for you?
To see if the angioplasty procedure is right for you, your surgeon will perform a coronary angiogram to assess the type, size and location of the blockage in your artery. This is done by inserting a small tube into the coronary artery, via a blood vessel in the groin or arm, through which an X-ray dye is introduced. The X-ray will allow the surgeon to view the coronary artery and see where the blockages are.
Only about 30% of people who have a coronary angiogram go on to have an angioplasty procedure. This is because many factors make the angioplasty procedure unsuitable, such as naturally narrow sections of the artery or too many blocked branches off the artery. In these cases, alternatives, such as a coronary artery bypass may be suggested.
Preparing for the procedure
You should expect to be in hospital overnight prior to your angioplasty procedure. You will be asked not to eat or drink for about four hours prior to the operation. You may also be given aspirin (if you do not already take it), an anti-platelet agent, such as clopidogrel and an anti-coagulant, such as heparin.
You are unlikely to be given a full anaesthetic for an angioplasty procedure. However, you will receive a sedative to ensure you stay relaxed and a local anaesthetic will be applied to your groin or arm.
What does it involve?
Your angioplasty procedure begins with a small incision, usually in your groin but occasionally in your arm, to gain access to the major arterial system. A sheath is then put in place to maintain this opening and a thin, hollow tube about 2-3mm in diameter is inserted into the artery. This is gently guided through the blood vessels until it reaches the coronary artery. An X-ray dye is then introduced to allow the surgeon to assess what needs to be done and to decide on the size of stent and balloon catheter required.
A guide wire is then introduced along the catheter, and guided to a point just beyond the blockage, to create a rail along which the balloon catheter and stent can be passed.
The balloon catheter is just that – a rubber tube that can be inflated to push the fatty deposits back against the wall of the artery to widen the passage. It can be inflated very precisely, creating exact dimensions in response to set pressures. The stent is a flexible wire mesh tube that sits around the balloon catheter and gets pushed into place by the angioplasty procedure. It can be bare metal. In some cases, it is coated with medication that prevents the artery blocking again. When the balloon is deflated again, the wire mesh stays in place to maintain the new channel. Eventually, the artery will grow new tissue around the stent.
The whole angioplasty procedure will be monitored via X-ray movies, showing the blood flow through the coronary artery, and several blockages may be treated in one operation. The results can be seen immediately by the surgeon, in the form of improved blood flow on the X-ray monitor.
What will you feel during the procedure?
You will not be able to feel the catheter in your arteries during your angioplasty procedure but you may experience the occasional ‘missed’ heartbeat or slight pain during the inflation of the balloon, as this temporarily blocks the blood flow to the heart. You may also experience a sensation of heat when the dye is introduced. However, because you are conscious, your surgeon should be able to talk you through each step of the angioplasty procedure so you know what is happening and what to expect.
What happens after the procedure?
You will probably need to stay in hospital overnight following your angioplasty procedure to ensure there are no complications such as bleeding from the incision site, especially as the technique involves anti-coagulants. You will need to rest at home, avoiding any strenuous activity, lifting or driving for at least a week. HGV and bus drivers should avoid driving for up to six weeks and will require a medical test before they can return to work. Your condition will then be monitored and you will be offered follow-up treatment as necessary.