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Angioplasty:
Procedure, Risks, Recovery

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1.What is Angioplasty?

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.

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2.Types of Angioplasty

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.

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3.Understanding the Procedure - How is Angioplasty Done?

Angioplasty Procedure

What is angioplasty surgery?

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.

How to prepare for angioplasty surgery

Apart from the regular checkup of medical history, doctors perform a series of tests as preparation steps for the angioplasty. These tests include:

  • Chest X-Ray
  • Electrocardiogram
  • Blood tests

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 doctor may advise the patient to stop or pause the intake of certain medications like aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners
  • It is required for the procedure to stop eating or drinking six to eight hours before the surgery is about to start
  • Some prescribed medications need to be taken in the morning of the procedure. Patients should ensure to drink only small sips of water for this

What happens during the angioplasty procedure?

  • The patient is administered with fluids, medications and blood-thinning substances or anticoagulants through an IV catheter
  • Blood pressure, heart rate and amount of oxygen in the body is also monitored throughout the procedure
  • Local anesthesia is performed in the area through which a small and thin guide wire is to be inserted. A small incision is made in this area
  • The cardiologist uses the abilities of a live X-ray which guides the doctor to place the catheter tip at the narrowed area of the artery
  • This cag procedure then involves the insertion of a contrast dye through the catheter that produces X-ray images of the insides of the artery. This allows the doctor to locate the plaque and identify the blockage. These images are called angiograms.
  • After the specific angiogram is obtained, the doctor inflates the balloon located at the tip with or without the stent which pushes back on the plaque, hence widening the blood vessel and restoring normal blood flow of the heart.
  • The balloon is then deflated and the catheter is removed.

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.

Coronary angioplasty and Stenting

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?

  • The stent for angioplasty is located at the tip of the catheter that is inserted and is placed in a collapsed structure around the balloon.
  • When the catheter reaches the narrowed walls of the artery during heart angioplasty and the balloon is inflated, the stent springs forward and locks into the walls of the artery.
  • The stent expands along with the expansion of the artery walls and helps keep the walls in place.
  • X-ray images or angiograms are consistently taken to keep a note of the quality of blood flow through the passage

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.

What happens after the angioplasty procedure?

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.

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4.Is Angioplasty right for you

Angioplasty conditions

Certain symptoms are seen in patients who are advised to undergo the angioplasty procedure. These symptoms of clogged arteries may involve the following:

  • Acute chest pain or angina
  • Shortness of breath or general difficulty in breathing
  • Heart palpitations or heart flutter
  • Extreme fatigue and weakness
  • Inability to do heavy physical activities
  • Nausea and tendencies of vomiting
  • Sweating

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:

  • The proper administration of medicines and doctor-recommended lifestyle changes has not improved the heart health
  • Patients suffering from extensive and regular chest pain or angina
  • Incidents of heart attack

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.

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5.Risks of Angioplasty

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:

Re-narrowing of the heart arteries:

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.

Blood clot formation:

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:

  • Aspirin
  • Clopidogrel
  • Ticagrelor
  • Prasugrel

Bleeding:

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:

  • Heart attack
  • Coronary artery damage: The coronary artery may be torn or disrupted during the procedure. This condition requires immediate bypass surgery
  • Kidney issues: The contrast dye that is used during the angioplasty stent placement, can cause kidney troubles in the patient. This occurs especially to those who are already suffering from kidney problems.
  • Stroke: A stroke may occur if the artery plaques break loose when the catheter is being threaded through the blood vessels. Blood clots can also form in the catheter which may reach the brain through the blood vessels. This is a rare complication and blood thinners or anticoagulants are used to reduce the risk of the occurrence of a stroke.
  • Abnormal heart rhythms: During angioplasty surgery, the heart may beat too quickly or too slowly. This is often a short-lived problem but sometimes medicines and temporary pacemakers can be needed to ease the heartbeat.

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6.Recovery after Angioplasty

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:

  • Bruises or discoloration in the area where the catheter was inserted
  • Excessive fatigue and lack of energy

When should patients call the doctor during the recovery period?

  • Extensive chest pains that the patients used to feel before the surgery
  • If the puncture wound at the area where the incision was made swells up and develops a lump. It can also become sore and may start leaking blood
  • Incidences of fever

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7.Angioplasty FAQs: All your concerns addressed

Q.  What is angioplasty of the heart?

  1. Medically known as percutaneous coronary intervention, angioplasty is a minimally invasive surgical procedure that is performed to remove the obstruction or blockage formed by plaques in the coronary arteries. Angioplasty helps restore the normal blood flow in the body.

Q.   How much rest is required after angioplasty?

  1. After angioplasty how many days rest should be taken depends on the procedure of angioplasty that was performed. Many patients can return back to normal life within a few days to a maximum of a week after the procedure was performed.

Q.  What is double vessel coronary artery disease?

  1. A type of coronary disorder, in this case, it means that two important arteries near the heart have simultaneous formations of plaques that are restricting the blood flow. For this condition, angioplasty is not performed and doctors advise the more invasive coronary bypass surgery.

Q.   Do stents have to be replaced after they have been placed in the coronary artery?

  1. Stents made of metal can last for a lifetime as normal tissues start to form after the stent is placed inside the artery. Stents do not essentially need to be replaced but if scar tissue formations and blood clots are seen occurring in the area then it can be risky for the patient and they may suffer a heart attack.

Q.  Can stents be removed after angioplasty?

  1. In some cases, if the stents close then the doctors can perform procedures to reopen the stent or even add new stents in the area. But heart stent removal is not an option as normal body tissue starts to form in and around the stent after it is placed in the artery.

Q.  What is the cost of angioplasty in India?

  1. Angioplasty surgery costs anywhere between one to three lakhs rupees in India and it varies from one hospital to another.

Q.  What is PTCA?

  1. Percutaneous transluminal coronary angioplasty or PTCA is an alternative name for percutaneous coronary intervention or PCI.

Q.  What is the success rate of angioplasty surgery?

  1. The success rate of the angioplasty procedure is exceptional. In most patients, angioplasty is successful in opening blocked blood vessels near the heart in over 90 percent of the patients. About 30 to 40 percent of such patients tend to develop re-narrowing of the blood vessel at the site of balloon inflation.

Q.  Are there any serious complications with angioplasty?

  1. Just like any other major surgery, coronary angioplasty tends to carry some risk of complications. But, the risk is very minimal. This is because the complications can take place during or after the angioplasty. It’s quite common to experience bleeding or bruising under the skin, especially where the catheter was inserted.

Q.  What is the difference between angioplasty and a stent?

  1. An angioplasty is a process that opens narrow or blocked blood vessels that supply blood to the heart, also known as coronary arteries. The coronary artery stent is a small, metal mesh tube that expands inside the coronary artery. The stent is often placed immediately after or during an angioplasty.

Q.  What are the warning signs of clogged arteries?

  1. The symptoms of clogged arteries include-
    • Chest pain
    • Trouble breathing or shortness of breath
    • Heart palpitations
    • Dizziness and fatigue
    • Nausea
    • Intense sweating

Q.  What does a blocked artery feel like?

  1. If a coronary artery is completely blocked then it will cause a heart attack. The classic signs of a blocked artery include a crushing pressure within your chest and shooting pain in your left shoulder and arm, it also includes shortness of breath and sweating. Sometimes a heart attack can occur without any glaring signs or symptoms.

Q.  Which is safer, bypass or angioplasty surgery?

  1. Since the bypass is a more invasive procedure, it is generally recommended only for patients with a high risk of more than two narrow or blocked arteries. Angioplasty is recommended to patients who are at low risk of a heart attack but have one or two narrow arteries.

Q.  How can you stay fit after getting an angioplasty?

  1. Once you recover from your angioplasty surgery, the doctor will recommend that you start taking on more heart-healthy habits. Doctors usually tell their patients to have a healthy, nutritious diet that includes no smoking and limiting alcohol. It also includes plenty of exercise like cardiac rehabilitation.
    While you may not indulge in high-intensity exercises, you can perform light exercises like going for walks. Exercising is crucial if you want to improve your long term health. Your doctor might even refer you to a cardiac rehabilitation centre which will help you set a healthy eating lifestyle; a rehab is important if you need counselling post-surgery, and if you want to quit smoking.

Q.  What are the benefits of angioplasty?

  1. When you treat narrow or blocked arteries with angioplasty and stents, you gain the following benefits:
    • Increase your life span and reduce any damage to the heart muscles, which can occur during a heart attack, by restoring blood flow to the heart.
    • It can relieve any heart disease symptoms like chest pains, shortness of breath, and lethargy. It also makes you feel energetic and active, everyday
    • Reduces the risk of stroke in the future
    • Improves kidney functions
    • Restores blood flow to the legs, this helps prevent gangrene and removes the need for amputation

Q.  What are some tips for a healthy angioplasty recovery?

    • Before you leave the hospital, you have to ensure that you have the right medicines, you know about wound care and hygiene, the changes that you need to make to your lifestyle and follow up appointments with your doctor
    • Only indulge in light activities, for the first few weeks after discharge
    • Change your diet to healthy and nutritious food
    • Quit smoking and alcohol consumption
    • Take part in cardiac rehabilitation

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8.Outlook and Prognosis

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:

  • Quitting smoking
  • Lowering the blood cholesterol levels by eating a healthy, balanced diet
  • Eating healthy food that contains low saturated fat levels
  • Taking proper care and controlling other related disorders such as diabetes and other heart problems
  • Getting regular exercise and reducing periods of inactivity
  • Taking medications as prescribed by the doctor

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:

  • Antiplatelets - Such drugs help to reduce the risk of blood clot formation which may, in turn, lead to heart attack, stroke or other complicated heart disorders
  • Lipid-lowering medications or statins - During the post angioplasty care period, statins are administered that help control the blood cholesterol level. This helps to mitigate the risks of blood vessel diseases and heart attacks
  • Medicines for blood pressure control - ACE inhibitors and beta-blockers are administered in the after angioplasty care period to lower the blood pressure and prevent angina or heart attacks.

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