For a person suffering from coronary artery disease, the arteries in the heart may completely or partially be blocked by a sticky material called plaque, and this blocks the blood flow.
Coronary Angioplasty is a non-surgical procedure to unblock the coronary arteries that are narrowed by plaque buildup, and restore the blood flow to the heart muscles.Typically, a catheter placed on a guide wire is inserted inside the blocked artery to help widen it.
Angioplasty is also called Percutaneous Coronary Intervention (PCI) and Percutaneous Transluminal Coronary Angioplasty (PTCA).
Based on the type of instrument used, the procedure can be categorized into
Angioplasty is generally combined with stent placement to support the walls of the artery and prevent it closing again.
This procedure is recommended by the doctor to treat coronary artery disease called atherosclerosis. This condition leads to building up of a sticky material in the coronary arteries, leading to reduction in blood flow to heart muscles.
If multiple arteries are clogged with plaque, then the doctor might suggest Coronary Artery Bypass Grafting (CABG), commonly called Bypass Surgery.
Angioplasty is a step-by-step process. There are quite a few preparations that are required to be done.
First step is Angiography, a diagnostic test to precisely determine the narrowed areas and the severity of the plaque formation. The test result acts as a “road map” for the doctor to plan the best treatment strategy. Besides, the result also suggests how soon angioplasty needs to be done on the patient.
In the procedure a catheter is directed to the heart by threading it through the blood vessels. A special contrast dye is injected into the coronary artery that shows up in the X-ray images.
After angiograpy, the doctor will
Instruct the patient to fast for 8 to 10 hours prior to angioplasty
Conduct chest X-ray, blood test and ECG on the day of the procedure
Angioplasty is performed by an experienced cardiologist, and depending on the severity of the condition can last upto 90 minutes.
During the procedure
Firstly, the patient is sedated and in some cases, a local anaesthesia is injected near the femoral artery, the one that leads to the coronary arteries.
A narrow incision is made in the skin in groin or arm area to access the femoral artery, catheter is inserted and directed towards the blocked coronary artery. The doctor follows the catheter movement on a TV monitor through X-ray photography.
In Balloon Angioplasty, the tip of the catheter expands and pushes against the plaque to flatten it thereby widening and unblocking the artery. The balloon might be inflated and deflated a few times before it is removed. This is most widely used technique.
In Laser Angioplasty, the catheter has a laser instead of a balloon on its tip. The laser tip gradually directs to the blocked artery and destroys the plaque layer wise. The laser basically vaporizes the plaque into gaseous particles. It is often used in combination with balloon angioplasty. Laser angioplasty is not generally used by the doctors.
In Atherectomy, a special instrument is pressed against the fatty deposits of the walls of the arteries instead of a balloon. The instrument basically cuts away the plaque. This procedure is mainly used to treat more calcified (hardened) blockages.
The stent is guided along with catheter, and expanded at the location from where the plaque is removed. The stent is a permanent structure that supports the artery and prevents it from narrowing again.
The patient has to stay atleast for a day in the hospital, during which the heart condition is closely monitored. Complete recovery generally takes about 6 to 8 weeks.
After the procedure, the doctor will recommend
Drinking plenty of water to flush out the dye used during the procedure
Avoid extreme physical activity for atleast a few weeks
Taking blood thinning medications, regularly, for life
Maintain healthy weight
Control diabetes and blood pressure
Risk and Complications
Angioplasty does not have any serious complications as such. However, in certain cases complications may occur. Known complication include,
Discomfort in the catheter insertion site. Often bleeding also occurs.
Damage to blood vessels.
Cardiac arrhythmia, in some cases
In rare cases (less than 3% of the total patients undergoing angioplasty) the artery instead of opening up closes down leading to heart attack
Kidney damage, due to the dye used
Risk of complications is higher among older people (above 65 years old), or among people who have chronic kidney diseases, heart diseases, or coronary artery blockages.
The cost of angioplasty mostly depends on the type of stent used. The cost of the stent almost covers 50% of the total cost.
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