Angioplasty often called Balloon Angioplasty and Percutaneous Transluminal Angioplasty (PTA), is a minimally invasive procedure used to expand constricted or obstructed vessels that are created as a result of plaque deposition in atherosclerosis. In this procedure, a tube is introduced into the coronary artery from which a balloon is inserted and inflated into the artery widening it and preventing any further arteriosclerosis. Sometimes, a stent accompanies the balloon for the same purpose, after which the balloon is withdrawn.
According to the data accumulated by a study pertaining to Indian settings, there has been a steady (25-30 percent annually) increase in the number of coronary procedures over the past several decades. Approximately 70,000 angioplasties were done in 2007 out of which 73% were drug-eluting stents. Of these, 10% of the patients were <40 years, and another 10% were older than 70 years of age.
After taking a proper medical history and considering the general health status, the procedure is recommended in cases with
- Atherosclerosis – The literal meaning of atherosclerosis is the hardening of arteries. Sometimes due to pathology, a plaque-like substance gets deposited in the lumen of the arteries, this is called Atherosclerosis. The disease leads to narrowed arterial lumen which in turn raises the pressure with which the blood flows. If the lumen is completely choked, the organ may not get any blood supply. The plaque may burst and move to smaller arteries blocking them completely.
- Angioplasty is recommended in cases where medications and lifestyle have already been tried failing to produce results.
- Is accompanied by heart pain which is getting worse.
- During a heart attack, angioplasty is recommended to limit the extent of the damage.
- Re-blockage of the same artery: Even with balloon and stent in place, the minimal chance is there that the same artery may develop blockage again. The above risk is much high in bare-metal stents.
- Blood clots or thrombus are also a possibility that can block the complete blood supply of the heart or brain producing severe manifestations. Platelet De-aggregators like Aspirin is therefore prescribed right from the day of surgery till the patient lives.
- Bleeding: Internal or external bleeding may happen if any artery involved in the surgery is not properly secured. Another case where uncontrolled bleeding may happen is patients with clotting disorders. Immense security measures are practiced to eliminate problems caused in both situations, but they are possibilities. That is the reason at least 1 unit of patient blood type is secured before any major surgery is scheduled.
- Damage to the coronary artery is a possibility which if happens needs an emergency bypass procedure.
- Heart attack
- Arrhythmias during and after the surgery.
The surgical procedure:
- The patient should be fasting over-night.
- It is mostly performed under local anesthesia or a mild sedative.
- Fluids and blood thinners are placed.
- All vital statistics and the surgical approach are under visual monitoring on the screens (image-guided).
- It is mostly threaded through groin but uncommonly through the arms or wrist. The area is cleaned and a small incision is made.
- The guidewire is then inserted into the blood vessel, followed by a catheter. Proper visibility is assured using a contrast dye.
- A balloon (stent in some cases) is then inserted which inflates after reaching the blockage site, achieving vessel widening. These stents gradually release medication that prevents future re-blockages.
A day (24 hours) of hospital stay is enough. Normal personal and professional rehabilitation is achieved in less than a week.
Angioplasty does not give the person, a license to non-stop consume junk food or keep healthy lifestyle changes at bay. A successful angioplasty means that the person may not have to undergo other invasive procedures provided they are sticking well to all the prescribed medications and the above talked about lifestyle and dietary changes.
Dr. Anand Kumar Pandey | Director & Senior Consultant – Cardiology – Adult | Dharamshila Narayana Superspeciality Hospital, Delhi