Coronary Angioplasty
CORONARY ANGIOPLASTY
Your heart is the chief primary pump of your body, its main function being to pump and circulate oxygenated blood all through your body and deoxygenated blood back to the lungs for removal. The heart can be affected by blockage of either the incoming or outgoing vessels of the heart. A blockage of these vessels and impaired blood supply to the cardiac muscle is a possible indication for coronary angioplasty.
What is coronary angioplasty ?
Many patients undergo coronary angioplasty to recover the impaired blood supply to the cardiac muscle. A balloon (initially deflated) is used to increase the width of the artery in the blocked area by inflation, and a stent is used to make it stay wide. This is done in relatively fewer, initial and early blockages- say just one or two arteries. A coronary angioplasty is still a relatively minor surgical procedure as compared to the other cardiac procedures like bypass graft surgery/ open heart surgery or heart transplantation which are major surgical procedures. Angioplasties are to be done by interventional cardiologists. Angioplasty procedure is performed under the influence of general anesthesia mostly and requires a dedicated change in lifestyle and rehabilitative exercises to help recover full heart function. Your cardiologist will choose the best procedure to treat you.
Angioplasty is a non-surgical heart procedure used to treat coronary artery disease by opening up the blocked coronary arteries so that the blood flows smoothly. There are certain factors like hardening of blood vessels, cholesterol and minerals that may form a plaque in the inner walls of the arteries (blood vessels that carry blood rich in oxygen throughout your body) over a period time. A raised plaque may clog the arteries and hence restrict the blood flow through the coronary artery. A raised plaque may also change the surface of the artery from smooth to rough, and these rough surfaces may stimulate the formation of a blood clot, which may lead to narrowed artery. A blood clot can also build up quickly and abruptly close the artery. Clogged or closed arteries greatly increase the likelihood of heart attack, stroke, and even death.
Angioplasty or coronary angioplasty or coronary stenting procedure is one of the most common heart procedures performed at our network heart hospitals in India. Every year a large number of heart patients from different parts of the world come here to avail high quality angioplasty procedure at most affordable cost.
How is coronary artery disease diagnosed ?
After the initial physical examination and history taking, if the doctor feels that you have an increased risk of coronary artery disease or certain symptoms of the disease then he/she may recommend an electrocardiogram (ECG). If at all there are variations in the ECG then the doctor may recommend a stress test or stress TMT. A stress test measures changes in the electrical activity of your heart as you perform controlled exercise. If the results of the stress test indicate a need for further testing, your doctor may arrange for you to have a coronary angiogram.
The coronary angiogram is the most useful test for diagnosing Coronary Artery Disease because it allows the doctor to see exactly where the coronary arteries are narrowed or blocked. At first you will receive a local anesthetic or pain medicine. The doctor then inserts an introducer sheath into an artery in your groin or forearm. Then the doctor inserts a long thin tube called catheter, into the artery and advances it into the blocked artery. By injecting a contrast dye that can be seen on an X – ray screen, the doctor can observe the arteries in your heart. You may be asked to take a deep breath and hold it while the doctor is taking the angiogram. Any narrowing or blockage that exists can then be identified.
An angiogram test will tell the doctor the extent of blockage in the arteries, the number of blockages and the nature of blockages that are obstructing the blood flow. Based on the result of the angiogram test, your doctor may advise medical therapy, angioplasty (PTCA) or coronary by pass graft surgery (CABG).
How is angioplasty performed ?
Likewise an angiography test, an angioplasty is also performed in a cardiac catheterization laboratory (Cath lab). An angioplasty is Patients usually receive medication before and during angioplasty procedure to help relax. You are awake and alert throughout the procedure.
Angioplasty begins by inserting a sheath for the catheter into a blood vessel, usually the upper leg or groin area, but sometimes in the arm. A hollow tube termed catheter is placed through the sheath in to the mouth of the coronary artery.A very small balloon catheter is passed through the guiding catheter in to the coronary arteries. Once the balloon is at the narrowing of the artery, the balloon is inflated to widen the narrowed position of the artery.Every situation is unique, but in most cases the inflation will last from 30 seconds, up to several minutes, depending on the nature of the blockage. While the balloon is inflated, some people feel a chest pain that is similar to the angina they have experienced. This happens because the balloon is temporarily blocking off the flow of blood and the oxygen that it carries to the heart. Patients should describe to the doctor any pain they feel during the procedure.After the block has been opened the balloon is deflated and retracted back through the blood vessel.
What is a stent ?
A stent is an expandable metallic tube which is crimped on to a thin balloon. A stent is implanted to support the artery and keep the vessel open like a structural framework. It is introduced into your artery just after balloon angioplasty and is positioned at
the site of the obstruction. Inflation of the balloon deploys the stent at the site thus widening the narrowed part of the artery.The stent is implanted permanently in the artery. Stent implantation helps in two ways,
- After balloon dilatation of the narrowed artery, artery may suddenly occlude termed acute vessel closure. This is prevented by stents.
- After balloon angioplasty many patients can develop recurrence of the block by a process known as restenosis. Stents reduce the risk of restenosis.
Drug-eluting stent is a metal stent that has been coated with a pharmacologic agent (drug] that is known to reduce the chance of restenosis (reblocking). With the metal stents, the risk of restenosis is reduced to 15— 25%, where as drug eluting stents reduce this risk to 6— 8%.
What happens after the angioplasty procedure?
After the angioplasty procedure, patients are monitored overnight in intensive care unit. Blood pressure, pulse monitoring and ECGs are performed routinely after angioplasty procedures and does not signify any special problems. If a patient experiences any chest discomfort or pressure, the nurse and the doctor should be notified immediately.Angioplasty is not a cure, but a treatment to reduce the effects of coronary artery disease. Following angioplasty, diet and medications have to be strictly followed to reduce the risk of recurrences.There are some situations or cases where the doctor may perform an angioplasty procedure, immediately following the angiogram test.
What can you do to help yourself ?
There is also a lot you can do, both before and after your procedure, to help yourself
- Stop smoking
- Maintain ideal bodyweight
- Control cholesterol level
- Exercise regularly
- Take medication regularly
- Have regular follow ups and monitor the progress with appropriate tests as recommended by doctor
Most patients are required to hold their leg or arm straight and still for the first six to eight hours. After the angioplasty, you are required to stay in the hospital for 2-3 days. You can resume full activity within a few days of returning home.
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