Angioplasty Procedure

What is angioplasty surgery?

A trained cardiologist carries out angioplasty operations in a unique cardiac catheterisation laboratory. The balloon catheter is generally inserted through the groin, arm or wrist. Often, the patient is not anaesthetised during the surgery. They are provided with a sedative to help them relax. Patients can usually be awake during the procedure, but it depends on how deeply they have been sedated.

How to prepare for angioplasty surgery

Besides regular medical history checkups, doctors perform a series of tests to prepare for 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 doctors employ 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 such as 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 must be taken on 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 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 anaesthesia is performed in the area through which a small and thin guide wire is 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 (Coronary Angiogram) 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 heart artery 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. This pushes back on the plaque, widening the blood vessels and restoring normal blood flow to the heart.
The balloon is then deflated, and the catheter is removed.

The time we were taken for angiography and the entire angioplasty procedure is 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 need stents for angioplasty. The stent in angioplasty generally looks like a thin coil of wire mesh that is used to hold up the artery's walls 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 some time and preventing any re-narrowing attempts of the artery wall.

What happens during the procedure of angioplasty with a stent?

The stent for angioplasty is located at the tip of the inserted catheter and 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 artery's walls.
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 plaque build-up and re-narrowing of the artery's walls.

What happens after the angioplasty procedure?

When angioplasty surgery is performed in non-emergency conditions, the patient is kept overnight at the hospital, and blood and heart conditions are monitored and assessed continuously. In most cases, patients can return to work one week after the surgery.

Patients are advised to drink plenty of fluids and avoid strenuous activity for at least a day or two after the operation.