What Is Coronary Angioplasty? | How is it done, alternatives and complications

A coronary angioplasty is a procedure used to treat a narrowing or blockage in one or more of your coronary arteries (the vessels that supply blood to the heart muscle). This treatment is done by using a small balloon to stretch open a narrowed or blocked artery, and usually also involves inserting a small wire mesh tube that stays in place to keep the artery open. Coronary angioplasty may also be referred to as stent insertion.
Coronary angioplasty may also be referred to as stent insertion.




Technical names for angioplasty are PTCA or PCI. These letters stand for:

PTCA:
Percutaneous – through the skin
Transluminal – inside the blood vessel
Coronary – having to do with the heart
Angioplasty – opening the artery
PCI:
Percutaneous – through the skin
Coronary – having to do with the heart
Intervention – the type of procedure used to open a narrowed artery

Why am I having a coronary angioplasty?




You may have already been diagnosed with (or are suspected of having) a narrowing or blockage in one or more of your coronary arteries. This may be restricting the flow of blood to your heart muscle. You may have also heard this called heart disease, and this may be giving you symptoms of angina (chest pain). Your cardiologist (specialist heart doctor) has decided that this needs to be treated, and a coronary angioplasty is the best way to do this. It can help relieve your symptoms of angina and reduce your risk of having a heart attack.

What are the benefits of angioplasty?

Over 90% of angioplasties are successful. This means that out of 10 people who get this procedure, 9 do very well. Blood flow through the artery returns to normal or near normal. Most people get complete relief from angina. People with severe coronary artery disease may still have symptoms, but they feel much better. This allows people to be more active and comfortable.

People recover much quicker from angioplasty than from heart surgery.

During angioplasty, there is no incision (cut) or general anesthesia (being put to sleep). Most people are up walking on the same day. Most people go home the next morning. Some may be discharged the same day.

How is it done?

1. A doctor numbs a spot on your groin or arm and inserts a small tube (catheter) into an artery.
2. The catheter is threaded through the arterial system until it gets into a coronary (heart) artery.
3. Watching on a special X-ray screen, the doctor moves the catheter into the artery. Next, a very thin wire is threaded through the catheter and across the blockage. Over this wire, a catheter with a thin, expandable balloon on the end is passed to the blockage.
4. The balloon is inflated. It pushes plaque to the side and stretches the artery open, so blood can flow more easily. This may be done more than once.
5. In many patients a collapsed wire mesh tube (stent) mounted on a special balloon, is moved over the wire to the blocked area.
6. As the balloon is inflated, it opens the stent against the artery walls. The stent locks in this position and helps keep the artery open.
7. The balloon and catheters are taken out. Now the artery has been opened, and your heart will get the blood it needs.

Does angioplasty hurt?

• No, angioplasty causes very little pain. The doctor will numb the place where the catheter will be inserted. You may feel some pressure as the catheter is put in.
• You’ll be awake and alert but may be given medicine to help you relax.
• The place where the catheter was put in may be sore afterwards. Bruising is also common. If you notice any bleeding or increasing pain or swelling, tell your doctor.

Will my arteries get narrow again?

Yes, an artery may become narrow again after angioplasty. This is called restenosis. If the artery narrows enough, you may feel angina again. Stents may help reduce restenosis. If 20 people get a stent, it would work for about 5 people. Restenosis can happen as the wall of your artery heals after angioplasty. A new layer of tissue grows over the site of the angioplasty. This is the normal healing process. In most cases this normal healing process slows down and stops within a few weeks.
Restenosis happens if the new lining does not stop growing. This can narrow your artery. Most cases of restenosis happen in the first 3 to 6 months after angioplasty. Restenosis is usually easily treated with a second angioplasty.


As with all types of medical procedures, having a coronary angioplasty carries a risk of complications. We will discuss these with you when you come in for your procedure, but please bear them in mind. 

These include the following.
• Bruising or bleeding under the skin at the wound site, known as a haematoma. This may take up to a couple of weeks to heal, and may cause some tenderness or discomfort. This is fairly common but not serious.
• Kidney damage or impairment due to the use of the contrast dye. This is fairly common but is usually short term (although long-term damage is possible).
• Damage to the artery at the wound site, sometimes known as a false aneurysm. You may need another procedure to fix this and it could increase your length of stay in hospital. This is uncommon but is more serious.
• Bleeding around the artery under the skin, leading to significant blood loss.
• Allergic reaction to the contrast dye. It is important to discuss any allergies you do have with your cardiologist or nurse, including food groups. This is uncommon, but can be more serious.

There is a very small chance of a serious complication as a result of a coronary angioplasty, including the following.
• Damage to one of the coronary arteries, or a heart attack caused by blocking off one of the arteries. We would try to repair the artery during the procedure, but in some cases emergency heart bypass surgery may be needed.
• A stroke caused by a small blood clot being displaced and travelling to the brain.
These risks are considered rare, but they are very serious and in very rare circumstances may be fatal.

Are there any alternatives?

In some cases heart disease can be treated with medication alone, but this depends on the individual. Your cardiologist will decide, based on the results of any tests or your symptoms, whether you need to have treatment. You may have had a coronary angiogram or you may be having one at the same time as your coronary angioplasty. This will show your cardiologist where the artery may be narrowed, and how severe this may be. Some people with heart disease will need coronary bypass surgery, or heart bypass, as opposed to coronary angioplasty. The treatment you need will have been determined carefully by your cardiologist, but please discuss your options with them.




Reference
https://www.mayoclinic.org/tests-procedures/coronary-angioplasty/about/pac-20384761
https://www.nhs.uk/conditions/coronary-angioplasty/
https://www.heart.org/-/media/data-import/downloadables/f/7/a/pe-abh-what-is-coronary-angioplasty-ucm_300437.pdf
https://medicine.umich.edu/dept/cardiac-surgery/patient-information/adult-cardiac-surgery/adult-conditions-treatments/coronary-angioplasty-stenting
https://medlineplus.gov/ency/article/007473.htm
https://www.svhhearthealth.com.au/procedures/procedures-treatments/coronary-angioplasty-and-stenting
https://www.cardiosmart.org/Healthwise/hw10/1356/hw101356
What Is Coronary Angioplasty? | How is it done, alternatives and complications What Is Coronary Angioplasty? | How is it done, alternatives and complications Reviewed by gafacom on July 11, 2020 Rating: 5

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