Coronary Angioplasty

Summary

For facilities that do angioplasties but not angiographies, this version takes patients through the angioplasty procedure only. The program shows the difference between a bare metal stent and a drug eluting stent. It reviews how the heart works, what atherosclerosis is, the risks of the procedure, and recovery.

Details

You've been diagnosed with coronary artery disease and scheduled for a procedure to treat it called coronary angioplasty.

The heart is a muscle which pumps blood throughout the body. The heart needs oxygen and nutrients. These are supplied by large blood vessels, called coronary arteries. The arteries and their branches wrap around the surface of the heart.

Fatty deposits called plaque can build up on the artery wall. The artery can become partially blocked, reducing the flow of blood to the heart. This narrowing of the artery is called atherosclerosis.

Reduced blood flow can cause chest discomfort, called angina pectoris, especially during physical activity. It's a warning sign that you may be at risk for a heart attack.

To open up the artery your doctor will perform an angioplasty procedure.

A thin tube called a catheter will be threaded through an artery in your arm or leg to the narrowed spot. Using various techniques your doctor will compress or reduce the plaque to widen the artery and restore blood flow.

Tests before procedure:

• blood test
• chest x-ray
• electrocardiogram

It is important to let your health care team know if you are allergic to iodine or to shellfish. Iodine is in the contrast material used in the procedure and is also in shellfish.

An I.V. will be started to provide you with fluids and medication during the procedure.

The place on your arm or leg where the catheter will be inserted will be cleaned and the hair clipped.

You'll be moved to the catheterization or cath lab. Throughout the procedure you'll be relaxed, but not asleep.

You'll be given a local anesthetic to numb the area of your leg or arm where the catheter will be inserted.

Then a device, called an introducer sheath, will be inserted into your arm or leg.

A catheter will be threaded through the sheath and guided towards your heart and a contrast material will be injected and travel through the arteries.

Angioplasty:

• a catheter with a tiny balloon attached to it will be guided to the narrowed spot
• balloon will be inflated to press the plaque against the artery wall
• sometimes more than one inflation is used

Angioplasty with a stent:

• a small metal device called a stent is guided to the spot
• a balloon will be inflated to expand the stent
• stays in place permanently to reduce the risk of re-narrowing
• a platelet inhibitor is given to prevent blood clots from forming

Atherectomy:

• an instrument is guided to the narrowed spot to cut or shave the plaque from the artery wall

Sometimes both the atherectomy and angioplasty procedures are used to achieve the best result.

Risks:

• treated artery narrows again - restenosis
• the artery closes up during the procedure, requiring emergency bypass surgery
• heart attack, stroke or death
• a blood clot may form on the stent, medication will reduce this risk

If the catheter was inserted into your leg, you'll be asked to keep your leg still and straight for a few hours. You may bend your other leg to make your back more comfortable.

Stent implanted:

• blood thinning medication needs to be taken for the next two to four weeks

You may be advised not to drive for the first couple of days after the procedure, so arrange to have someone take you home.

While angioplasty and stenting are not a cure for coronary artery disease these treatments will allow you to get back to leading a normal, active life.