We at Ayushman Hospital are pleased that you are considering us for your Coronary Angioplasty. We would like to take the time to briefly discuss the process of undergoing Coronary Angioplasty. Your physician has discussed the indications for surgery and the criteria that must be met prior to your Coronary Angioplasty. This information is designed to offer additional information on your preparation before surgery, the surgery itself, and the road to recovery after your procedure.
What is Coronary Angioplasty?
Coronary Angioplasty, also called Percutaneous Coronary Intervention, is a procedure used to open clogged arteries supplying the heart. These arteries are called coronary arteries. Angioplasty involves temporarily inserting and inflating a tiny balloon where your artery is clogged, to help widen the artery.
Angioplasty is generally combined with the stable placement of a small wire mesh tube called a stent to help prop the artery open and reduce its chance of narrowing again. Some stents are coated with medication to help keep your artery open (drug-eluting stents), while others are not (bare-metal stents).
Angioplasty can improve symptoms caused by blocked heart arteries, such as chest pain and shortness of breath. Angioplasty can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart.
Why is a Coronary Angioplasty done?
Angioplasty is performed to treat a type of heart disease called atherosclerosis. Atherosclerosis is the slow buildup of fatty plaques in your heart’s blood vessels [coronary arteries]. Your doctor might suggest angioplasty as a treatment option when medications or lifestyle changes aren’t enough to improve your heart health, or if you have a heart attack, worsening chest pain (angina) or other symptoms.
Angioplasty isn’t for everyone. If the main artery that brings blood to the left side of your heart is narrow, if your heart muscle is weak or if you have multiple diseased blood vessels, then coronary artery bypass surgery may be a better option than angioplasty.
This critical clinical decision is based on various criteria and decided by the Apollo Heart Team. In coronary artery bypass surgery, the blocked part of your artery is bypassed using a blood vessel from another part of your body.
The judgement of angioplasty as against bypass surgery will depend on the extent of your disease, the extent of blocks in the coronary arteries and your overall medical condition.
How do you prepare?
- Before the angioplasty, your doctor will assess your medical history and do a physical exam.
- You will also have an imaging test called a Coronary Angiogram to see if your blockages can be treated with angioplasty. A Coronary Angiogram helps doctors determine if the arteries to your heart are narrowed or blocked. In a Coronary Angiogram, liquid dye is injected into the arteries of your heart through a catheter – a long, thin tube that is fed through an artery from your groin, arm or wrist right up to arteries in your heart. As the dye enters your arteries, they become visible on X-ray and video, so your doctor can see where your arteries are blocked. If your doctor finds a blockage during your Coronary Angiogram, it is possible that he or she may decide to perform angioplasty and stenting immediately after the angiogram, while your heart is still catheterized.
- Usually, you will need to stop eating or drinking six to eight hours before the procedure is scheduled. Your preparation may be different if you’re already staying at the hospital before your procedure.
- You will also have some routine tests first, including a chest X-ray, electrocardiogram and blood tests.
- Follow your doctor’s advice about regulating your current medications before angioplasty. Your doctor may instruct you to stop taking certain medications before angioplasty.
- Do inform your doctor about allergies as well as previous allergic reactions to dyes used in diagnostic investigations.
What you can expect
During the procedure
A very small incision is made on the skin over a blood vessel in the leg, arm or wrist through which a small, thin tube (catheter) is threaded and the procedure performed.
Angioplasty is performed by a heart specialist (Cardiologist) and a team of specialized cardiovascular nurses and technicians in a special operating room called a cardiac catheterization laboratory (cath lab).
Angioplasty is normally performed through an artery in your wrist area (Radial artery) or your groin area (Femoral artery) depending upon the extent of the lesion & complexity. Seldom, it may be done using an artery in your arm or wrist area. Before the procedure, the area is prepared with an antiseptic solution and a sterile sheet is placed over your body.
A local anaesthetic is injected to numb the area where the catheter will be inserted. Small electrode pads are placed on your chest to monitor your heart during the procedure.
General anaesthesia is not needed. You would be sedated but awake during the procedure. You will receive fluids, medications to relax you and blood-thinning medications (anticoagulants) through an IV line.
Then, the procedure begins:
After numbing the incision area, a small needle is used to gain entry to an artery in your leg or arm. A small cut is made in the skin.
Your doctor then inserts a thin guidwire followed by a catheter into the artery till it reaches the blockage in your heart.
You might feel stress in the area where the catheter is inserted, but you shouldn’t feel sharp pain. Tell your doctor if you do. You also won’t feel the catheter in your body.
A small amount of dye is injected through the catheter. This helps your doctor look at the blockage on X-ray images called angiograms.
Then the doctor will inflate a small balloon at the end of the catheter so that the blocked artery is widened. After the artery is stretched, the balloon is deflated and removed. Your doctor may inflate and deflate the balloon quite a few times before it’s removed, stretching the artery a bit more each time.
If you have many blockages, the procedure may be repeated at each block. Because the balloon momentarily blocks blood flow to a part of your heart, it’s not unusual to experience chest pain while it’s inflated.
Most people who have angioplasty also have a stent placed in their blocked artery during the same procedure. The stent is usually inserted in the artery after it’s widened by the inflated balloon.
The stent supports the walls of your artery to help prevent it from re-narrowing after the angioplasty. The stent looks like a tiny coil of wire mesh.
How is the stent placed?
The stent, which is collapsed around a balloon at the end of the catheter, is guided through the artery to the blockage.
At the blockage, the balloon is inflated and the spring-like stent enlarges and locks into place inside the artery.
The stent stays in the artery forever to hold it open and improve blood flow to your heart. In some cases, more than one stent may be needed to open a blockage.
Once the stent is placed, the balloon catheter is detached and more images (angiograms) are taken to see how blood flows through your recently expanded artery.
Finally, the guide catheter is removed, and the procedure is completed.
After your stent placement, you may need prolonged treatment with medications, such as aspirin or clopidogrel to reduce the chance of blood clots forming on the stent.
The procedure time takes about 90 minutes to 150 minutes depending upon the number of vessels, the extent of block, age, calcified vessels etc.
At Apollo Hospitals, we have advanced imaging techniques such as Intra-vascular Ultrasound (IVUS), Optical Coherence Tomography (OCT) and Fractional Flow Reserve (FFR). Intracoronary imaging has the capability of accurately measuring the vessel and block dimensions, assessing vessel integrity, characterising lesion morphology and guiding optimal Percutaneous Coronary Intervention (PCI).
After the procedure
If you have been through a high-risk procedure, you are likely to stay in the hospital for 3 days; of which, you will be closely monitored for 1 or 2 days in the ICU and shifted to the ward for a day before discharge. In low-risk procedures, patients have been discharged the next day. You generally should be able to return to work or your normal routine the week after angioplasty.
When you return home, drink plenty of fluids to help flush your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for at least a day afterwards. Ask your doctor about other restrictions inactivity.
Life after Angioplasty
It’s important that you closely follow your doctor’s recommendations about your treatment with blood-thinning and other medications. Do not stop any medication without checking with your Cardiologist.
Changing to a heart-healthy lifestyle
Coronary Angioplasty significantly increases the blood flow through the formerly narrowed or blocked the coronary artery. Your chest pain generally should decrease, and you may be able to exercise better.
Having angioplasty and stenting doesn’t mean your heart disease goes away. You’ll need to continue healthy lifestyle habits and take medications as prescribed by your doctor.
To keep your heart healthy after angioplasty, you should:
- Quit smoking
- Lower your cholesterol levels
- Maintain a healthy weight
- Regulate other disorders, such as diabetes and high blood pressure
- Get regular exercise
Get in touch with the hospital and your medical team
- The site where your catheter was inserted starts bleeding or swelling
- You develop pain or discomfort at the site where your catheter was inserted
- You have signs of infection, such as redness, swelling, drainage or fever
- There’s a change in temperature or colour of the leg or arm that was used for the procedure
- You feel faint or weak
- If your symptoms return, such as chest pain or shortness of breath, or if other symptoms similar to those you had before your procedure recur