Angioplasty is a medical procedure that opens up a blocked or narrowed artery around the heart. It is a standard treatment for narrowed or blocked arteries in this area of the body. Doctors also refer to angioplasty as percutaneous coronary intervention, or PCI.
During angioplasty, a surgeon inserts a tube into an artery in the groin or wrist. They then thread the tube towards the affected artery around the heart. Finally, they insert a balloon or stent (metal tube) to open the artery. Doctors perform more than 1.2 million angioplasties a year in the United States, according to the American College of Cardiology.
Here, we give an overview of angioplasty or PCI, including its uses, types, risks, procedure, and recovery.
What is angioplasty?
In the term angioplasty, “angio” means blood vessel, and “plasty” is opening up. In PCI, the “P” stands for percutaneous or “through the skin” while coronary refers to the location of blood vessels around the heart.
Angioplasty is a conventional treatment for coronary heart disease (CHD) and heart attacks (acute coronary syndrome). In these conditions, there is a buildup of plaque, or atherosclerosis, on the walls of the arteries.
As plaque accumulates, the arteries narrow and can become blocked. In a heart attack, the plaque may rupture, spilling cholesterol into an artery, potentially leading to a clot that stops blood flow.
During a standard angioplasty, the doctor makes an incision in the groin or wrist and inserts a tube, or catheter, into an artery. Next, they thread the catheter upwards and into the affected blood vessel around the heart. Usually, the catheter contains an inflatable balloon that displaces the plaque or clot, effectively opening up the artery. Doctors use live X-rays and a contrast dye to guide the catheter and assess the arteries they need to treat.
Compared with heart surgery, angioplasty is a minimally invasive as it does not involve opening up the chest.
Doctors may recommend angioplasty to:
·treat an abnormal stress test
·increase blood flow to the heart
·reduce chest pain, or angina
·improve blood supply to the heart muscle during or after a heart attack
·support more activity for people with chest pain
Types
There are two main types of angioplasty:
Balloon angioplasty, which involves using the pressure of an inflating balloon to clear plaque that is blocking an artery. This is rarely done alone except in cases when doctors are unable to place a stent in the required position.
Stent placement in the artery, which involves a tube, or stent, made out of wire mesh. Stents help to prevent an artery narrowing again after angioplasty.
Stents may be made of bare metal or have a coating of medication. When they include medication, they are called drug eluting stents (DES) and are less likely to plug up again.
DES are now used almost exclusively with very little use of bare metal stents.
Research from 2018 estimates that doctors in the U.S. implant over 1.8 million stents each year.
How to prepare
Angioplasty is a minimally invasive procedure, but it is still surgery, and people must follow their doctor’s instructions carefully beforehand.
People need to inform their doctor about any medications and supplements they are taking. In some cases, they may need to stop taking these drugs, especially blood thinners, before the procedure.
Also, an individual may need to avoid food or drinks for several hours before the angioplasty procedure as doctors will need to sedate them.
Kidney tests may be needed beforehand, too, as the contrast dye that the surgeons use can affect kidney function.
Procedure
Before beginning angioplasty, a healthcare professional will clean and numb the area where the catheter enters the body, usually the groin but sometimes the wrist.
Next, a doctor inserts the catheter into the artery and directs it towards the coronary artery, watching its progress on an X-ray feed.
Once the catheter is in position, the doctor injects a contrast dye through the artery, which helps identify blockages around the heart. Once they locate the blockages, the doctor inserts a second catheter and a guidewire, usually with a balloon at the tip.
When the second catheter is in position, the doctor inflates the balloon, which pushes the plaque buildup away and opens up the artery. The surgeon may insert a stent to keep the artery propped open.
According to the American Heart Association, angioplasty can take anywhere from 30 minutes to a few hours. The person may need to stay in hospital overnight.
Risks
On the whole, angioplasty is a safe procedure without complications.
One estimate says the rate of complications is 5 in every 100 people, with fewer in large institutes that specialize in angioplasty.
Although complications from angioplasty are rare, they can include:
·prolonged bleeding from the catheter insertion site in the groin or wrist
·damage to blood vessels, kidneys, or arteries
·an allergic reaction to the dye
·chest pain
·arrhythmia, or abnormal heart rhythm
·a blockage that requires an emergency bypass
·blood clot
·Stroke
·heart attack
·a tear or damage to artery or major blood vessel
·death
Older individuals have a higher risk of complications from angioplasty, as do those with the following conditions:
·heart disease
·several blocked arteries
·chronic kidney disease
There is also a chance of the artery becoming blocked with plaque again through a process called restenosis, plaque shift, or stent thrombosis, which is a clot in the stent.
Recovery
When angioplasty is complete, the cardiologist removes the catheters and bandages. Soreness, bruising, and possibly bleeding are common around the area where catheters entered the body.
Typically, a person will recover in the hospital for a few hours or overnight before going home. They must not drive as they may still have sedative medications in their system. They will also have restrictions on lifting for about a week afterward.
People can often return to work within a week, but their doctor will advise on how active they can be and when.
The follow-up visit after angioplasty is a key aspect of the treatment. The doctor will review the individual’s recovery, adjust medications as they need, and develop an ongoing treatment plan for their cardiovascular health.
Summary
Angioplasty is a standard, minimally invasive procedure that doctors use to unblock clogged arteries and improve blood flow in the heart. Doctors frequently recommend angioplasty to treat acute heart problems. It is generally a safe procedure, although arteries can become blocked again, and there is a small risk of significant complications in some cases.