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Angioplasty: Procedure, Risks, Recovery
An Angioplasty means a surgical, endovascular procedure that is minimally invasive and is used to widen obstructed or narrowed blood vessels (arteries and veins) around the heart in order to restore the natural flow of blood. In pathological terms, angioplasty is called percutaneous coronary intervention or PCI.
Angioplasty definition - By simple definition, the term ‘angio’ means anything related to blood vessels whereas ‘plasty’, in medical terms refers to the molding or grafting of any body part, which in this case relates to the heart arteries.
Angioplasty can help relieve symptoms of blocked and clogged arteries is often performed immediately after a heart attack. Coronary angioplasty procedure uses a small balloon catheter to open up the clogged heart arteries, in turn improving the blood flow to the heart. Sometimes, this process is clubbed with the placement of a metal stent in the artery to help keep the coronary artery wall open.
There are several types of procedures of angioplasty that doctors can choose from depending on the type of the condition that the patient is suffering from. These procedures include:
● Angioplasty balloon procedure
For this procedure, the doctors insert a small catheter with a balloon in heart arteries. The deflated balloon is fixed at the tip of the catheter and it is placed close to the plaque or the blockage in the blood vessel. The doctors then inflate the balloon to gradually open up the obstruction and hence, boost blood flow into the heart. This balloon surgery for heart is performed in rare cases when the doctors are unable to make use of the stenting procedure.
● Stent placement in heart
This cardiac stent placement procedure involves the use of a stent or a small tube that is made out of wire mesh. This acts as a platform to support the insides of the coronary artery. Using a deflated balloon catheter, in this case, a stent balloon, the doctors utilize a guidewire to carefully place the stent in the blocked part of your artery. When in position, the balloon is inflated and the angioplasty stents expand to hold up the artery walls. Over a period of time, the artery heals around the stent.
A stent used in angioplasty is usually made of metal and it is placed permanently in the arteries but it can be designed with materials that are absorbable by the body. Some stents used in angioplasty contain medicine that helps to reduce the risk of the artery getting blocked again.
● Rotablation procedure
In this process of angioplasty, a special catheter with an acorn-shaped, diamond-coated tip is guided near the plaque in the heart. The tip then rotates at high speed to disintegrate the blockage or the plaque into microscopic particles. These particles are then absorbed by the bloodstream.
This process is repeated as many times as needed to clear the blood passage of obstacles. Rotablation is not a common procedure as angiography stents and heart balloon procedures yield better results and are easier to perform by the doctor.
● Atherectomy of the artery
A complicated procedure of using balloon therapy for heart arteries, this entails the use of a hollow cylinder at the tip of the catheter in which one side has an open window whereas the other has a deflated balloon. When placed near the narrowed artery, the balloon is inflated and the window is pushed towards the blockages or plaques in the artery. A blade present inside the cylinder rotates, hence cutting through and shaving off any plaque that protrudes inside the hollow tube. The shavings get stored inside the chamber and are removed from the body. Just like Rotablation, this procedure is rarely performed.
● Cutting Balloon Angioplasty
Cutting balloon angioplasty surgery means the usage of a special balloon catheter fitted with a deflated balloon and small blades. When situated near the plaque, the inflation of the balloon activates the blades which distort and cut through the plaque in the heart artery. Meanwhile, the plaque is pushed to the artery wall by the now inflated balloon.
An angioplasty operation is carried out in a special cardiac catheterization laboratory by a trained cardiologist. The balloon catheter insertion is generally done through the groin, arm or wrist area. The patient is often not anesthetized during the surgery. They are provided with a sedative to help relax. Most often, patients can also be awake during the procedure but it depends on how deeply they have been sedated.
Apart from the regular checkup of medical history, doctors perform a series of tests as preparation steps for the angioplasty. These tests include:
Doctors also advise patients to undergo a specific X-ray imaging test before the procedure. This test is called the coronary angiogram. It is a medical imaging technique that is employed by doctors to see the inside of any blood vessel in detail. These images provide the doctors with the information they need to decide the course of the treatment. Through coronary angiogram, doctors can locate the area where the artery has narrowed and by how much. The test also offers information about whether the artery has a blockage or the walls have undergone stenosis.
As the treatment after angiogram is about to start, these are some steps that the patient should follow:
The time taken for angiography and the entire angioplasty procedure if often 1-3 hours. The variation depends on the number of blockages and the complexity of the artery condition.
Most people who require this procedure often have to use stents for angioplasty. The stent in angioplasty generally looks like a thin coil of wire mesh that is used to hold up the walls of the artery after the balloon catheter pushes back and removes the plaque that was narrowing down the walls. The stent is placed permanently, allowing the artery to heal around it over a period of time and preventing any re-narrowing attempts of the artery wall.
What happens during the procedure of angioplasty with stent?
In some cases, more than one stent is used. Most of the stents used during the procedure are often coated with medicines. These medications are released into the artery and help prevent any further build-up of plaque and re-narrowing of the walls of the artery.
When the angioplasty surgery has been performed in non-emergency conditions, then the patient is kept overnight at the hospital with blood and heart situations monitored and assessed continuously. In usual cases, patients can choose to even go back to work one week after the surgery.
Patients are advised to drink plenty of fluids and they should avoid doing any strenuous activity at least a day or two after the operation.
Certain symptoms are seen in patients who are advised to undergo the angioplasty procedure. These symptoms of clogged arteries may involve the following:
In the event of a sudden heart attack, doctors often perform the angioplasty procedure. Having this procedure done within the first few hours of a heart attack can reduce the risk of complications like heart failure that can arise later. This is because angioplasty takes only 1-3 hours to be completed and it is by far the safest and the most efficient way to get the blood flowing back to the heart in a matter of hours.
Coronary angiography or cag test is done in order to remove or clear fatty buildups of plaques in the heart’s blood vessels. The plaques are generally made up of cholesterol, fat, and calcium that are found in the blood itself. These affected blood vessels are a result of a condition called atherosclerosis. Cag cardiology - angioplasty is required if the following conditions are visible in the patients:
Angioplasty treatment is not for everyone. In cases of double vessel disease, the two blood vessels simultaneously face narrowing or stenting issues. For such a condition, coronary artery bypass surgery is recommended which is a much more invasive surgical procedure.
Cardiac angioplasty is a minimally invasive procedure and it is way less risky than a coronary artery bypass surgery. Even then, it has post angioplasty risks. These include:
During the angioplasty recovery period, there is a slight chance of the heart artery walls narrowing again if drug-coated stents were placed during the procedure. According to estimates, drug-eluting stents can reduce the event of re-narrowing of the artery to 5 percent only. For procedures that use a bare-metal stent, the chances of re-narrowing of the artery during the angioplasty recovery time can range from 10-20 percent.
In the heart stent recovery period, blood clots can form within the stents that have been placed inside the artery. These clots can lead to a sudden heart attack due to artery collapse. To prevent these, properly prescribed medications should be taken. As a part of restrictions after stent placement, patients should never skip or discontinue these medications in order to prevent the event of a heart attack.
Doctors provide certain medicine are angioplasty to reduce any event of blood clot formation near the stent placed inside the coronary arteries. Compositions of medicines administered during the heart stent recovery period are commonly the following:
The area from where the catheter was inserted into the artery may bleed during the rest period after angioplasty. Simple bruises can occur but in cases of profuse bleeding, blood transfusion or surgical procedures might be needed.
The angioplasty procedure also poses some risks even though they are rare. These include:
After angioplasty and stenting, the heart stent recovery time is almost 12-24 hours after the catheter is removed. Patients can return to normal life within a few days or a week after the procedure. Coronary artery disease status post PCI is that chest pain decreases significantly and patients regain the ability to exercise. This occurs because the healthy blood flow into the heart has been restored and the body is capable of functioning normally and with more energy.
After the angioplasty procedure is over, the patients can expect the occurrence of some common symptoms at home. These include:
When should patients call the doctor during the recovery period?
Care after angioplasty procedure is needed to ensure a healthy life of the patient. The period of rest after angioplasty requires certain lifestyle changes. These include:
Diet after angioplasty - There are certain precautions to be taken after angioplasty related to the diet of the patients. Patients should avoid consuming sugary food after angioplasty and should also restrict their salt intake. This helps to lower the blood pressure and boosts fluid retention of the body. A healthy diet consisting of proteins and whole grains is advised.
Medicine after angioplasty - To lower the risks of further cardiac complications medicinal precautions after angioplasty are advised to patients during the angioplasty aftercare period. These medicines include:
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