Angioplasty with Stenting
Angioplasty with stenting is a procedure performed during a cardiac catheterization in which a small balloon at the tip of the catheter is inserted near the blocked or narrowed area of the coronary artery. The technical name for balloon angioplasty is percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the heart. A small, metal, mesh-like device called a stent is also implanted into the coronary artery to reduce the chance that the blockage will recur. Coronary angioplasty/stent can relieve blockages to allow a person to be active without chest discomfort and prevent a heart attack.
In most cases, balloon angioplasty is performed in combination with the stenting procedure. The stent acts as a scaffold to provide support inside the coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed, and the stent stays in place permanently. During a period of several weeks, the artery heals around the stent.
Angioplasty with stenting is most commonly recommended for patients who have a blockage in one or two coronary arteries. If there are blockages in more than two coronary arteries, coronary artery bypass graft surgery may be recommended.
Although an interventional procedure opens up blocked arteries, it does not cure coronary artery disease. Patients must still reduce risk factors and make certain lifestyle changes to prevent future disease development or progression.
Cardiac catheterization and interventional procedures are not considered to be surgical procedures because there is no large incision used to open the chest, and the recovery time from catheterization is much shorter than that of surgery. In some cases, surgery may be recommended afterward, depending on the results of the procedure.
If you need to have a cardiac catheterization or an interventional procedure, your cardiologist will discuss the specific risks and potential benefits of the recommended procedure with you.
The procedure is used to:
Increase blood flow to the heart, diminish chest pain and decrease the risk of a heart attack.
Preparing for the procedure:
Prior to the procedure, you will be instructed regarding restrictions for food and drink consumption. You should take your regular medicines unless instructed otherwise; in particular, take your aspirin (and the medication Plavix) on the day of the catheterization.
Please inform your doctor if you have had a previous allergic reaction to X-ray contrast dye or shellfish. He or she will prescribe medications to reduce the risk of an allergic reaction. Also, let the doctor know if you have kidney dysfunction.
In most cases, you will be asked to come to the hospital in the morning, and depending on the results, you may be able to leave later that afternoon. Bring toiletries and a change of clothes in case you need to stay in the hospital.
What to expect during the procedure:
You will be taken to the hospital's cardiac catheterization laboratory for the procedure. This is a sterile room with special cameras to take X-ray pictures of your heart. You will be given a mild sedative to relax, but you will be awake and conscious during the entire procedure.
The doctor will use a local anesthetic to numb the catheter insertion site. Most PTCAs are done through a large artery in the groin; however sometimes they are done from the wrist or elbow area. The nurse or technician will cleanse and shave the groin (or arm) area and cover you with sterile drapes. The doctor will then numb the area and insert a small hollow tube (called a sheath) into the artery in your groin (or arm). The physician can then thread special catheters (long, thin plastic tubes) up to the heart.
Through these specially shaped catheters, the physician can thread a wire across the blockage in the artery. Then, a thin expandable balloon is placed over the wire and inflated to open up the blockage. Several balloons of increasing size may be used to reduce the blockage. During a stent procedure, the stent, which is tightly mounted on a balloon, is placed across the blockage and the balloon is inflated, opening the stent. Several other devices may be used during the procedure.
Some people may notice mild chest discomfort while the balloon is inflated. You may be given a medication through your IV for several hours to reduce the chances of blood clots forming. The entire procedure can take as little as 30 minutes or sometimes more than two hours, but the preparation and recovery time add several hours.
If you had previous coronary artery bypass graft (CABG) surgery, you can expect your interventional procedure to last longer. Please plan on staying at the hospital all day for the procedure and remaining in the hospital overnight.
What to expect after the test:
After the procedure, you will be transferred to a post-procedure care area where the sheaths are removed from the groin when the blood thinners have worn off. You will be asked to lie flat and still for several hours after the procedure to allow the hole in the artery to seal. Some physicians use a type of vascular closure device to seal the puncture in the artery.
You should follow your physician's specific instructions about activity following the use of one of these devices. After your procedure, it is normal for the puncture site to be a bit tender and bruised, and a small knot may even develop. If you notice redness, drainage, severe pain or swelling, talk to your doctor to see if further evaluation is indicated.