Angioplasty, also called coronary angioplasty and percutaneous coronary intervention (PCI), is a nonsurgical procedure to open blocked arteries and increase blood flow to the heart. Over time, a fatty substance called plaque can build up in your arteries, causing them to harden and narrow; this is called atherosclerosis. Physicians who specialize in treating heart disease use the angioplasty procedure to help more than one million people in the United States every year.
The Ohio State University Wexner Medical Center performs one of the highest volumes of angioplasties in the country, even highly complex cases.
There are different types of coronary angioplasty procedures. Each one decreases blockage in a different way.
- Balloon angioplasty – A small balloon is inflated inside the artery to “crack” the blockage and push it against the wall of the artery
- Atherectomy – The blocked area inside the artery is “shaved” away by a tiny device on the end of a catheter
- Stent – A tiny coil made of metal is expanded inside the artery and is left in place to keep the artery open. This is the most common procedure when performing an angioplasty.
None of these procedures will cure coronary artery disease. There is a chance that the blockage could return.
A physician may schedule an angioplasty to help relieve symptoms of coronary artery disease, such as shortness of breath or the chest pain or discomfort known as angina. Angioplasty also is performed on an emergency basis to reduce damage to the heart muscle during a heart attack.
What to expect during an angioplasty procedure
Preparing for your procedure
Prior to angioplasty, you meet with your physician to discuss your medical history, medications you take and any questions you have. Your physician may also schedule tests before the angioplasty, including:
- Blood tests – Studies to detect enzymes that leak into the blood when the heart has been damaged and to detect infection and antibodies
- Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart
- Chest X-ray – A radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine
Your physician will first perform a CT angiogram to determine if you have blocked arteries that can be treated with angioplasty.
As is the case of most procedures, your physician will ask you to not eat or drink a certain number of hours beforehand, often nothing after midnight the night before.
During your procedure
Angioplasty is done in a part of the hospital called the cardiac catheterization laboratory (cath lab). There are special video screens and X-ray equipment in the cath lab that show enlarged pictures of coronary arteries so your physician can detect the blockages.
Prior to determining whether you’re a candidate for angioplasty, you’ll have a cardiac catheterization. You’ll receive a local anesthetic to numb the area where the catheter will be inserted, and you’ll remain awake but will be given medication to help you relax. A catheter is inserted into the leg or arm artery during this minimally invasive procedure.
The catheter is advanced to the artery of interest, and through the catheter, an angiogram can be performed to help determine a coronary angioplasty is appropriate for your condition. The angiogram involves imaging (X-rays) and dyes to precisely locate the narrowed artery. If a significant blockage is detected in the artery, a stent can be placed across the blockage to open the artery and re-establish normal blood flow.
The angioplasty takes one to two hours, and you may need to stay in the hospital overnight.
After you return to your room, the nurse checks your blood pressure, and your heart rate and rhythm often during the next six hours. The nurse also checks where the catheter was placed for signs of bleeding. The pulse in your arms, legs and feet are checked.
If the site for catheter insertion was the groin, you remain in bed with your leg straight for several hours after your procedure. The head of the bed may be raised slightly. You will be instructed to wiggle your toes and flex your ankles often, but not bend your leg. After several hours you may get out of bed with help from your nurse. If your arm was the site for catheter insertion, you must keep your arm straight for several hours after your procedure.
Most patients can start a regular diet anytime after this procedure. Drink large amounts of fluid to help clear the dye from your body.
If you have discomfort where the catheter was inserted, ask your nurse for pain medication. Tell your nurse immediately if you notice swelling or bleeding in this area or if you feel pain, numbness or tingling in your arm or leg. Your family may visit with you after you are settled in your room.
After you go home, drink plenty of fluids for the first 24 hours. The dressing on your groin may be removed after 24 hours. You may shower after the dressing has been removed.
Cardiac rehabilitation may be suggested by your physician.