by Jenilee Matz, MPH
A coronary angioplasty procedure (also called percutaneous coronary intervention, PCI) is done to open up arteries in the heart that are clogged by plaque. Vessels on outer surface of the heart, called coronary arteries, supply the heart with blood. In coronary angioplasty, an interventional cardiologist opens up the coronary arteries and restores blood flow to the heart.
Sometimes, coronary arteries become clogged by cholesterol, protein, calcium, and/or inflammatory cells. This buildup eventually forms plaque. Plaque buildup in the arteries is called atherosclerosis. Over time, plaque hardens, causes arteries to narrow, and reduces blood flow to the heart. This is called coronary artery disease (CAD) or coronary heart disease (CHD).
If you suffer from angina (chest pain caused by reduced blood flow to the heart), it means that your heart isn’t getting enough oxygenated blood. Without adequate nourishment, the heart muscle starts to die. This lessens the heart’s ability to supply blood and oxygen to the rest of the body.
Coronary angioplasty is a procedure that is often recommended to treat heart disease when medications and lifestyle modifications haven’t been enough. Angioplasty is done to improve your quality of life. The procedure may alleviate symptoms like chest pain or shortness of breath.
Coronary angioplasty may also be done in an emergency situation during a heart attack to reduce the damage around the heart and possibly save your life.
Angioplasty is performed in the hospital and takes about one to two hours. Your doctor will let you know any specific instructions you need to follow prior to surgery. You may be asked to fast or temporarily stop taking certain medications such as metformin.
Before an angioplasty, you will need a coronary arteriography (also called cardiac catheterization).
This testing involves threading a temporary, long, thin tube (catheter) through the artery in your leg (femoral artery) or arm (radial artery). The catheter injects contrast dye into the blood of the arteries. This dye appears on special x-rays, called angiograms, and shows the cardiologist which arteries are blocked and how severe the blockage is. Based on the results of arteriography, your doctor may proceed immediately with angioplasty.
If angioplasty is needed, the surgeon will navigate a catheter with a balloon on the end through your vessels to the narrow or blocked artery. Your doctor will then inflate the balloon, which compresses and pushes the plaque up against the artery wall, opening up the narrowed artery and restoring blood flow to the heart.
After the artery is opened up, and stent is placed in if needed, the balloon is deflated and removed along with the catheter.
Most of the time, a stent, a metal mesh tube-like object, is inserted permanently to keep the artery open and lower the chance of it narrowing again. The stent is placed around the deflated balloon your cardiologist will thread to the area of blockage. As the balloon inflates and compresses the plaque against the artery wall, the stent expands. The balloon is then deflated, leaving the stent in place to help support the artery and hold the plaque in place. Some stents contain a medication (drug-eluting stents) that helps to reduce the risk of excessive scar tissue growth. Tissue can grow over time and cause re-narrowing of the artery (restenosis), which sometimes can lead to another intervention in the future.
Like all surgeries, coronary angioplasty comes with the risk of complications. The most common side effects are pain and bleeding at the catheter insertion site. Other possible problems include restenosis (a recurrence of narrowing of the artery) and blood clots. More serious complications, such as heart attack, stroke, kidney issues, and artery damage, are relatively rare. Your doctor will let you know what steps to take before and after surgery to reduce the risk of complications.
Keep in mind that if your doctor recommends coronary angioplasty it’s because he or she believes the benefits outweigh the potential risks.
While coronary angioplasty opens up blocked arteries, it does not cure heart disease. After the surgery, it’s still important to take all medications and follow lifestyle modifications as directed by your doctor to care for your heart’s health.
Coronary angioplasty works best for people who have moderate to severe narrowing of the arteries. It’s usually recommended when only one or two of the arteries are severely narrowed. The procedure is not typically advised for people with diabetes or multiple blockages because it’s not as effective. In this case, your doctor may suggest bypass surgery or other treatments instead.
Published July 7, 2014