Angioplasty and related techniques are known
as percutaneous coronary intervention (PCI). Angioplasty is a procedure in
which a narrowed section of the coronary artery is widened. Angioplasty is less
invasive and has a shorter recovery time than
bypass surgery, which is also done to increase blood
flow to the heart muscle but requires open-heart surgery. Most of the time
stents are placed during angioplasty.
angioplasty is done using a thin, soft tube called a catheter. A doctor inserts
the catheter into a blood vessel in the groin or wrist. The doctor
carefully guides the catheter through blood vessels until it reaches the
blocked portion of the coronary artery.
We've all heard the stories: someone seemingly healthy, with normal
cholesterol levels and no obvious risk factors, drops dead of a heart attack.
How can this happen?
Morteza Naghavi, MD, says it's because traditional risk factors may not tell
you what you really need to know: whether your arteries are diseased.
"Why are cholesterol, smoking, family history so lousy? Because they're
just risk factors," says Naghavi, chairman of the Society for Heart Attack
Prevention and Eradication (SHAPE)...
expandable wire tube called a stent is often permanently inserted into the
artery during angioplasty. A very thin guide wire is inside the catheter. The
guide wire is used to move a balloon and the stent into the coronary artery. A
balloon is placed inside the stent and inflated, which opens the stent and
pushes it into place against the artery wall. The balloon is then deflated and
removed, leaving the stent in place. Because the stent is meshlike, the cells lining the blood
vessel grow through and around the stent to help secure it.
Open up the artery and press the plaque against
the artery walls, thereby improving blood flow.
Keep the artery
open after the balloon is deflated and removed.
Seal any tears in
the artery wall.
Prevent the artery wall from collapsing or
closing off again (restenosis).
Prevent small pieces of plaque from
breaking off, which might cause a heart attack.
Stent placement is
standard during most angioplasty procedures.
Your doctor may use a bare metal stent or a drug-eluting stent. Drug-eluting stents are coated with medicine that helps keep the artery open after angioplasty.
What To Expect After Treatment
After angioplasty, you will be moved
to a recovery room or to the coronary care unit. Your heart rate, pulse, and
blood pressure will be closely monitored and the catheter insertion site
checked for bleeding. You may have a large bandage or a compression device on
your groin or arm at the catheter insertion site to prevent bleeding. You will be
instructed to keep your leg straight if the insertion site is near your groin
You can mostly likely start walking within 12 to 24 hours
after angioplasty. The average hospital stay is 1 to 2 days for uncomplicated
procedures. You may resume exercise and driving after several days.
You will take antiplatelet medicines to help prevent another heart
attack or a stroke. If you get a stent, you will probably take aspirin plus
another antiplatelet such as clopidogrel (Plavix). If you get a drug-eluting
stent, you will probably take both of these medicines for at least one year. If
you get a bare metal stent, you will take both medicines for at least one month
but maybe up to one year. Then, you will likely take daily aspirin long-term.
If you have a high risk of bleeding, your doctor may shorten the time you take
If you choose angioplasty, you will still need to make
lifestyle changes like eating healthy, being active, and not smoking. This will give you the best chance for a longer, healthier
Why It Is Done
Although many factors are involved,
angioplasty with or without stenting is usually done if you have:
Frequent or severe chest pain (angina) that is
not responding to medicine.
Evidence of severely reduced blood flow
(ischemia) to an area of heart muscle caused by one narrowed coronary
An artery that is likely to be treated successfully with
angioplasty whether or not stenting is also used.
You are in good
enough health to undergo the procedure.
Angioplasty may not be a reasonable
treatment option when:
There is no evidence of reduced blood flow to
the heart muscle.
Only small areas of the heart are at risk, and
you do not have disabling chest pain (angina).
You are at risk of
complications or dying during angioplasty due to other health
The anatomy of the artery makes angioplasty or stenting
too risky or will interfere with the success of the procedure.
surgeon or hospital does not perform enough procedures to ensure
The hospital does not have access to emergency cardiac
How Well It Works
Angioplasty relieves chest pain and
improves blood flow to the heart. Stents lower the risk of the artery narrowing again (restenosis). If restenosis occurs, another angioplasty or
bypass surgery may be needed.
Long-term outcomes of angioplasty on
single-vessel disease are similar to those of coronary artery bypass
you'll feel relief from chest pain sooner than with medicines and lifestyle changes. But over time, both treatments work
about the same to ease chest pain and improve quality of life.1
Angioplasty can ease chest pain, but it has not been
proved to help you live any longer than medical therapy does. Also, angioplasty
does not lower the risk of having a heart attack any more than medical therapy
Risks of angioplasty may include:
Bleeding at the puncture
Damage to the blood vessel at the puncture
Sudden closure of the coronary artery.
tear in the inner lining of the artery.
Need for additional procedures. Angioplasty may increase the risk
of needing urgent bypass surgery. In addition, the repaired artery can renarrow
(restenosis) and a repeat angioplasty may need to be performed.
Reclosure of the dilated blood vessel (restenosis).
Death. The risk of death is higher when more than one artery is
What To Think About
Medical therapy and lifestyle changes may be a better option than angioplasty for some people. To help you decide if angioplasty is right for you, see the topic: