DR. JAYARAM LINGAMANAICKER

MBBS, LRCP (Edin), LRCS (Edin),
LRCP&S (Glas), MRCP (UK),
FRCP (London), FACA (USA),
FAMS (Cardiology), FACC (USA)

Lifeline Heart Centre
#11-10 Mount Elizabeth
Medical Centre
3 Mount Elizabeth
Singapore 228510

Tel: (65) 6836 2611 /
  (65) 6836 9038 /
  (65) 6836 1990

Fax: (65) 6836 9037

E-mail:    

lifelineheart@gmail.com /
lifelineheart@singnet.com.sg



Patient Guide > Angioplasty
Patient Guide > Angioplasty


Coronary angioplasty and stenting:

Angioplasty can reopen blocked coronary arteries during a heart attack or when build-up of plaque is causing angina, shortness of breath or other symptoms. The tight narrowing of the blood vessel can be opened and stented.

Angioplasty is also referred to as percutaneous coronary intervention (PCI) - a procedure used to open clogged heart arteries. It improves some of the symptoms associated with blocked arteries, such as chest pain and shortness of breath, or can be used during a heart attack to quickly open a blocked artery and minimize heart damage. Angioplasty is usually combined with implantation of a small metal coil called a stent in the blocked artery to help prop it open. Coronary angioplasty has become a common medical procedure worldwide.


Angioplasty Indications

When medications or lifestyle changes aren't enough to reduce symptoms of blocked or narrowed arteries or if you have a heart attack, your doctor might suggest angioplasty.

You may be a candidate for an angioplasty if coronary angiogram shows:
  • Your blockage is tight

  • Your blockage is amenable for angioplasty

  • The artery involved is not the main vessel supplying blood to the left side of your heart
If the main artery supplying the left side of your heart is narrowed then coronary artery bypass surgery (CABG) may be a better option. In addition, if you have diabetes and multiple blockages, your doctor may suggest coronary artery bypass surgery. The decision of angioplasty versus bypass surgery will depend on your heart problem and overall medical condition.

Preparation for angioplasty

Initially your doctor will review your medical history and perform a physical exam. You'll receive instructions to stop eating or drinking by midnight the night before. Your preparation may vary if you're already hospitalized.

You will undergo routine tests first, including a chest X-ray, electrocardiogram (EKG or ECG) and blood tests.

Tips:
  • Follow your doctor's instructions about adjusting your current medications before angioplasty. You may be instructed to stop taking certain medications before angioplasty, particularly if you take diabetes medications or blood thinners.

  • Bring all of your medications to the hospital.

  • Take approved medications with small sips of water.

  • Inform if you're allergic to any medications.
The Team

The Team

Angioplasty is performed by a heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians. Usually, an angioplasty will be done only at a medical institution with backup cardiac surgical facilities or access to rapid emergency transport services because of a small risk of complications that could require emergency heart surgery.

Angioplasty Procedure

Coronary angioplasty is not considered surgery because it's less invasive the body isn't cut open except for a very small puncture in a blood vessel in the groin or wrist through which a small, thin tube (called a catheter) is threaded and the procedure performed. The entire procedure can take 30 minutes to a couple of hours.
  • For the procedure, the area is prepared with antiseptic solution and a sterile drape is used to cover your body.

  • A local anaesthetic is injection is given in the groin to numb the area.

  • Electrode pads are placed on the chest to monitor your heart rate and rhythm during the procedure.
You will be awake during the procedure. You may receive IV fluids and medications for relaxation. You'll get blood-thinning medications to reduce blood clotting, and then the procedure begins:
  • After numbing the incision area, a small puncture is made, to access the artery. The doctor will then insert a thin guide wire into the artery and thread it through the artery from the incision area up to your blockage.

  • Once the guide wire reaches the blockage, a small, thin tube (catheter) is passed over the wire until it reaches the blockage. You won't feel the catheter in your body and hence it is painless.

  • A small amount of contrast agent is injected through the catheter. This helps to see the blockage on X-ray images called angiograms.

  • There is a small balloon at the end of the introduced catheter which is inflated, widening the blocked artery. The balloon stays inflated for up to a minute at the site of the blockage, stretching out the artery before it's deflated and removed. This may be done several times before it's removed, stretching the artery a bit more each time to widen it.
As the balloon temporarily blocks blood flow, it's common to experience chest pain while it's inflated. If you have several blockages, the procedure may be repeated at each site.

Stenting

Stenting

After the artery is widened, a device called a stent is placed in the artery to act as scaffolding to help prevent it from re-narrowing after the angioplasty. The stent looks like a very tiny coil or spring. Stents can be coated with medication that's slowly released to help prevent arteries from re-clogging. These coated stents are called drug-eluting stents, in contrast to noncoated versions, which are called "bare-metal" stents.
  • The stent is collapsed and wrapped around a balloon at the end of the catheter and guided through the artery to the blockage.

  • At the blockage, the balloon is inflated and the spring-like stent expands inside the artery keeping it wide open.

  • The stent remains in the artery permanently and becomes part of the artery wall.

  • After the stent is deployed, the balloon catheter is removed and more images (angiograms) are taken to see how well blood flows through the newly widened artery.
After stent placement you need to continue taking medications to reduce the chance of blood clots forming on the stent material. Aspirin is usually taken for life.

Recovery

Normally you will remain in hospital for a day occasionally two or more days. When you return home, drink plenty of fluids to help rid your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects. You should be back to normal after a few days rest.

Call your hospital immediately if:
  • The catheter insertion site starts bleeding or swelling

  • Increasing pain or discomfort at the insertion site

  • Signs of infection, such as redness at the site or fever

  • You develop chest pain or shortness of breath

  • There is change of colour of the leg or arm that was used for the procedure
You should be able to return to work or your normal routine the week after angioplasty.

Lifestyle modifications

Lifestyle modifications will help you maintain your good results. You must lead a healthy lifestyle by doing the following:
  • Stopping smoking

  • Lowering your cholesterol levels

  • Good Diabetic control

  • Good blood pressure control

  • Regular exercise

  • Maintaining a healthy weight
Risks of coronary angioplasty
  • Restenosis
    A major drawback of coronary angioplasty is the potential for your artery to re-narrow (restenosis) within months of the procedure. With balloon angioplasty alone without stent placement restenosis happens in as many as 40 percent of cases. The bare-metal stents reduce the chance of restenosis to less than 20 percent. However the use of drug-eluting stents has reduced the risk to less than 10 percent!

  • Stent thrombosis
    Recent studies have raised concern about the risk of blood clots forming within stents long term meaning weeks or months after angioplasty. These clots may cause a heart attack or sudden death. Some studies have suggested that drug-eluting stents increase this clotting risk, compared with bare-metal stents. Regardless of the type of stent placed, it is absolutely necessary to take aspirin, clopidogrel (Plavix) and other medications as prescribed. Presently the advice is to take double blood thinner for at least a year if you have a drug coated stent.

  • Other risks of angioplasty include:

    • Bleeding
      You may experience heavy bleeding, requiring a transfusion or other medical procedures.

    • Damage
      Your artery may be damaged during the procedure, requiring emergency bypass surgery.

    • Heart attack
      You may have a heart attack during the procedure, though large heart attacks are rare.