Angioplasty

If you have coronary heart disease, the arteries in your heart are narrowed or blocked by a sticky material called plaque. Angioplasty is a procedure to restore blood flow through the artery.

You have angioplasty in a hospital. The doctor threads a thin tube through a blood vessel in the arm or groin up to the involved site in the artery. The tube has a tiny balloon on the end. When the tube is in place, the doctor inflates the balloon to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.

Doctors may use angioplasty to

• Reduce chest pain caused by reduced blood flow to the heart
• Minimize damage to heart muscle from a heart attack

Many people go home the day after angioplasty, and are able to return to work within a week of coming home.

Risk Factors

Percutaneous coronary intervention (PCI), also called angioplasty, is a common medical procedure. Serious complications don’t occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure.

Complications can include:

• Discomfort and bleeding at the catheter insertion site.
• Blood vessel damage from the catheters.
• An allergic reaction to the dye used during the procedure.
• An arrhythmia.
• The need for emergency coronary artery bypass grafting during the procedure (less than 3 percent of people are affected by this). This may occur if an artery closes down instead of opening up.
• Kidney damage caused by the dye used during the procedure.
• Heart attack (3–5 percent of people).
• Stroke (less than 1 percent of people).

Sometimes chest pain can occur during PCI because the balloon briefly blocks blood supply to the heart.

As with any procedure involving the heart, complications can sometimes be fatal. However, this is rare with PCI. Less than 2 percent of people die during the procedure.

The risk of complications is higher in:

• People aged 65 and older
• People who have chronic kidney disease
• People who are in shock
• People who have extensive heart disease and blockages in their coronary arteries

Research on PCI is ongoing to make it safer and more effective and to prevent treated arteries from narrowing again.

COMPLICATIONS FROM STENTS

Restenosis

Another problem that can occur after PCI is too much tissue growth within the treated portion of the artery. This can cause the artery to become narrow or blocked again, often within 6 months. This complication is called restenosis.

When a stent  isn’t used during PCI, 30 percent of people have restenosis. When a stent is used, 15 percent of people have restenosis.

Stents coated with medicine (drug-eluting stents) reduce the growth of scar tissue around the stent. These stents further reduce the risk of restenosis. When these stents are used, about 10 percent of people have restenosis.

Other treatments, such as radiation, can help prevent tissue growth within a stent. For this procedure, a wire is put through a catheter to where the stent is placed. The wire releases radiation to stop any tissue growth that may block the artery.

Blood Clots

Studies suggest that there’s a higher risk of blood clots forming in medicine-coated stents compared with bare metal stents. However, no firm evidence shows that these stents increase the chance of having a heart attack or dying if used as recommended. Researchers continue to study medicine-coated stents.

Taking medicine as prescribed by your doctor can lower your risk of blood clots. People who have medicine-coated stents usually are advised to take antiplatelet medicines for up to a year or longer.

Treatment

Your doctor may recommend percutaneous coronary intervention (PCI), also called angioplasty, if you have narrow or blocked coronary arteries as a result of coronary heart disease (CHD).

PCI is one treatment for CHD. Other treatments include medicines and coronary artery bypass grafting (CABG). CABG is a type of surgery in which a healthy artery or vein from the body is connected, or grafted, to a blocked coronary artery.

The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This improves blood flow to the heart.

Compared with CABG, some advantages of PCI are that it:

• Doesn’t require open-heart surgery
• Doesn’t require general anesthesia (that is, you won’t be given medicine to make you sleep during the procedure)
• Has a shorter recovery time

However, PCI isn’t for everyone. For some people, CABG might be a better option. For example, CABG might be used to treat people who have severe CHD, narrowing of the left main coronary artery, or poor function in the lower left heart chamber.

In addition, recent studies show that people with CHD who also have diabetes may have greater benefit from CABG.

PCI also is used as an emergency treatment for heart attack. As plaque builds up in the coronary arteries, it can rupture. This can cause a blood clot to form on the surface of the plaque and block blood flow to the heart muscle. Quickly opening the blockage restores blood flow and reduces heart muscle damage during a heart attack.

Recovery

After percutaneous coronary intervention (PCI), also called angioplasty, you’ll be moved to a special care unit. The site where the catheters were inserted also will be checked for bleeding. That area may feel sore or tender for a while.

GOING HOME

Most people go home the day after the procedure. When your doctor thinks you’re ready to leave the hospital, you’ll get instructions to follow at home, such as:

• How much activity or exercise you can do. (Most people are able to walk the day after the PCI procedure.)
• When you should follow up with your doctor.
• What medicines you should take.
• What you should look for daily when checking for signs of infection around the catheter insertion site. Signs of infection include redness, swelling, and drainage.
• When you should call your doctor. For example, you may need to call if you have shortness of breath; a fever; or signs of infection, pain, or bleeding.
• When you should call 9–1–1 (for example, if you have any chest pain).

Your doctor will prescribe medicine to help prevent blood clots from forming. Take all of your medicine as your doctor prescribes.

If you got a stent during the PCI, the medicine reduces the risk that blood clots will form in the stent. Blood clots in the stent can block blood flow and cause a heart attack.

RECOVERY AND RECUPERATION

Most people recover from the PCI and return to work within a week of leaving the hospital.

Your doctor will want to check your progress after you leave the hospital. During the follow-up visit, your doctor will examine you, make changes to your medicines, do any necessary tests, and check your overall recovery.

LIFESTYLE CHANGES

Although PCI can reduce the symptoms of coronary heart disease (CHD), it isn’t a cure for CHD or the risk factors that led to it. Making healthy lifestyle changes can help treat CHD and maintain the good results from PCI.

Talk with your doctor about your risk factors for CHD and the lifestyle changes you should make. Lifestyle changes might include changing your diet, quitting smoking, being physically active, losing weight or maintaining a healthy weight, and reducing stress.

CARDIAC REHABILITATION

Your doctor may recommend cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Cardiac rehab includes exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life.