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Coronary angioplasty , also called percutaneous coronary intervention, is a procedure used to open clogged heart arteries. Angioplasty involves temporarily inserting and inflating a tiny balloon where your artery is clogged to help widen the artery.
Angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent to help prop the artery open and decrease its chance of narrowing again. Some stents are coated with medication to help keep your artery open (drug-eluting stents), while others are not (bare-metal stents).
Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart.
Why it's done
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.
If you have diabetes and multiple blockages, your doctor may suggest coronary artery bypass surgery. The decision of angioplasty versus bypass surgery will depend on the extent of your heart disease and overall medical condition.
How Well It Works
Angioplasty relieves angina and improves blood flow to the heart. Stents lower the risk of the artery narrowing again (restenosis). If restenosis occurs, another angioplasty or bypass surgery may be needed.
With angioplasty, you'll feel relief from angina sooner than with medicines and lifestyle changes. But over time, both treatments work about the same to ease angina and improve quality of life.
Angioplasty can ease angina, but it has not been proved to help you live any longer than medical therapy does. Also, angioplasty does not lower the risk of having a heart attack any more than medical therapy does.
Risks of angioplasty may include:
• Bleeding at the puncture site.
• Damage to the blood vessel at the puncture site.
• Sudden closure of the coronary artery.
• Small tear in the inner lining of the artery.
• Heart attack.
• Need for additional procedures. Angioplasty may increase the risk of needing urgent bypass surgery. In addition, the repaired artery can renarrow (restenosis) and a repeat angioplasty may need to be done.
• Reclosure of the dilated blood vessel (restenosis).
• Death. The risk of death is higher when more than one artery is involved.
How is it done?
• A doctor numbs a spot on your groin or arm and inserts a small tube (catheter) into an artery.
• The catheter is threaded through the arterial system until it gets into a coronary (heart) artery.
• 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.
• 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.
• In many patients a collapsed wire mesh tube (stent) mounted on a special balloon, is moved over the wire to the blocked area.
• 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.
• The balloon and catheters are taken out. Now the artery has been opened, and your heart will get the blood it needs.
After the procedure
If you had a non emergency procedure, you'll probably remain hospitalized one day while your heart is monitored and your medications are adjusted. You generally should be able to return to work or your normal routine the week after angioplasty. If you needed angioplasty and stenting during a heart attack, your hospital stay and recovery period will likely be longer.
When you return home, drink plenty of fluids to help flush your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for at least a day afterward. Ask your doctor or nurse about other restrictions in activity.
Call your doctor's office or hospital staff immediately if:
• The site where your catheter was inserted starts bleeding or swelling
• You develop pain or discomfort at the site where your catheter was inserted
• You have signs of infection, such as redness, swelling, drainage or fever
• There's a change in temperature or color of the leg or arm that was used for the procedure
• You feel faint or weak
• You develop chest pain or shortness of breath
Coronary angioplasty greatly increases blood flow through the previously narrowed or blocked coronary artery. Your chest pain generally should decrease, and you may be better able to exercise.
Having angioplasty and stenting doesn't mean your heart disease goes away. You'll need to continue healthy lifestyle habits and take medications as prescribed by your doctor.
If your symptoms return, such as chest pain or shortness of breath, or if other symptoms similar to those you had before your procedure recur, contact your doctor. If you have chest pain at rest or pain that doesn't respond to nitroglycerin, call 911 or emergency medical help.
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.