What is Angioplasty, and how is it done?

What is Angioplasty?

Percutaneous Coronary Intervention (PCI) known by its more common name ‘Angioplasty’ is an interventional procedure done to remove a blockage in coronary arteries of the heart and restore healthy blood flow to the heart. A catheter with a balloon and a stent sometimes is inserted into the arm or leg in one of the arteries leading to the heart, and guided in place slowly, to undertake this procedure.

Why is Angioplasty done?

Like any other organ or part of the body, the heart too requires a healthy supply of oxygen-rich blood to function correctly. The coronary arteries supply this. Over time, due to underlying disease cholesterol deposition happens on the walls of the artery, thereby narrowing the arteries and restricting the blood flow in them. This condition is called Coronary Artery Disease.

In some patients with CAD, the fat deposits along with cellular waste and other substances accumulate and harden over time to form a plaque. This condition is called Atherosclerosis. Angioplasty treats both these conditions. However, if there are multiple blockages or other medical reasons, the doctor may undertake a Coronary Arterial Bypass Grafting (CABG) or ‘bypass surgery.’

Other medical conditions that will require an Angioplasty are:

You have repeated and severe bouts of angina or chest pain
You have just had a heart attack. In such a case, Angioplasty is done as an emergency procedure to quickly open the blocked artery and reduce damage to your heart
Peripheral artery disease (PAD) in which arteries in the legs or arms get narrowed
Carotid artery stenosis where neck arteries supplying blood to the brain get narrowed
Narrowing or blockage in the veins in the chest, abdomen, pelvis, arms or legs

Renal vascular hypertension or high BP caused by narrowing of the kidney arteries

Screening

Not all patients are suited for Angioplasty, so the doctor will first check your eligibility. Angioplasty will be ruled out in any of the below conditions:

Some health problems like terminally ill patients or severe renal failure, which will negate the benefit of angioplasty
Only small areas of the heart are at risk, and the risk of a heart attack is low
There is not enough evidence of reduced blood flow to the heart

The doctor has ruled out blood thinners, aspirin or any anti-platelet medication due to some other medical conditions

Preparing for the procedure

To begin with, the doctor will take stock of all the medicines you are taking presently
Six to eight hours before the procedure, you must not eat or drink anything
On the morning of your procedure, take the approved medication with small sips of water
Prepare for hospital stay as Angioplasty usually requires two to three days of hospitalization to monitor for any complications after the procedure.

During the procedure

Angioplasty is undertaken with the use of local anesthesia; The procedure may take 30 to 60 minutes, depending on how many blockages are there and if there is any difficulty while doing the procedure.

A catheter, which is a fine, thin tube is inserted into your arm or leg in an artery leading to the heart and guided all the way to the heart using a Teflon or terumo wire. The blocked area in the artery is crossed using a thin guide wire under fluoro guidance. The balloon catheter has a deflated balloon attached to the tip, which was passed over the guide wise. Once the catheter tube reaches the spot of the blockage, a dye is injected into the catheter. This helps the doctor view the artery on a large X-ray screen, and this image is called an Angiogram.

The balloon is positioned precisely at the spot of the blockage and then inflated. This pushes the deposits against the walls of the artery and clears the blockage. Then the balloon is deflated and pulled back, after which the catheter is pulled out of the body.

Also Read: what is an angiogram and why have I been asked to have one done?

Vascular Stenting

Depending on the extent of the blockage and the risk of new blockage, the doctor may choose to implant a stent there. The stent is a metallic wire-mesh which may or may not be covered by a drug coating. The stent is wrapped around the balloon, and when the balloon is inflated, the stent is pushed against the walls of the artery and stays locked in place, even after the balloon is deflated. The stent is coated with medication that releases slowly and prevents any blockage from forming again at that spot.

After the procedure

Depending on your case, the doctors may advise you to stay at the hospital for one or more days. In this duration, your heart rate is monitored, and your medications adjusted. Up to a week, lifting heavy objects or strenuous work is restricted. After a week or so, you can resume your regular routine and life.

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Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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