Coronary angioplasty helps to treat blocks in arteries supplying blood to the heart muscles. Coronary arteries supply blood to the heart muscles. Blocks or narrowing of these arteries can restrict the blood flow to the heart muscles.  

What is a coronary angioplasty?

During the procedure, your surgeon will screw a thin wire to your blocked coronary artery through an artery in your arm or groin. This procedure is called cardiac catheterization. The end of the wire will have a small inflatable balloon. When the wire reaches the area with blocks, the surgeon will inflate the balloon. It increases the width of the artery. 

Your surgeon will then place a wire mesh called a stent in the areas with blockages. The stent prevents it from getting narrow again. Some stents release drugs that prevent the formation of blood clots. These are called drug-eluting stents. 

It is a minimally invasive procedure with a very high rate of success. The risks and associated complications are very low. Your recovery from an angioplasty will be quick.

When to do a coronary angioplasty?

Common symptoms of coronary artery disease

• Chest pain often described as a tightness or heaviness
• Pain in the upper abdomen
• Pain in the back, neck, jaw, or arm
• Shortness of breath
• Sweating
• Nausea
• Loss of consciousness

You may also have an angioplasty

• As an emergency procedure after a heart attack 
• If you have severe coronary artery occlusion (not involving proximal LAD and left main arteries) which is not manageable with medications
• If your health does not permit an open-heart bypass surgery for severe coronary artery disease

Your doctor may suggest coronary artery bypass surgery for severe coronary artery disease involving proximal LAD and left main arteries and triple vessel disease. 

An angioplasty is not for you if the chest pain that you have with exertion is not due to coronary artery disease. Very rarely, the blocks will be in a region that is not accessible to a catheter. In such situations, it will be hard to perform an angioplasty. 

Coronary angioplasty procedure

Before the procedure

You will have a few medical tests to see whether you are fit enough to have an angioplasty. The cardiologist will have a look at the way your heart functions by a test called an echocardiogram.

You will then have a test called a coronary angiogram. This test will help to map the flow of blood through your coronary arteries. During this chest, your doctor will inject a small quantity of a dye through an artery in your arm, wrist, or groin. The dye will travel very fast to the coronary arteries. The doctor will take repeated X-rays of your heart to see the spread of the dye.

In areas of blockages, the dye will not move forward. It helps your doctor to identify the precise location of your blocks. Also, the test will help to assess the severity and number of blocks as well. Your doctor will be able to show these to you as well.

The next step is to fix the date for coronary angioplasty. You will have to tell your doctor about the medicines that you are regularly having. Medicines like blood thinners and some herbal supplements can cause bleeding during surgery. You will have to stop these medicines for a few days till you recover. 

You will report to the hospital on the day of surgery.

During the procedure

You may not need general anesthesia during an angioplasty. All that you will have is a local anesthetic in the area of the artery for catheterization. The anesthetist will give you a mild sedative to help you relax. But you will be fully awake during the procedure. 

The procedure will happen in a catheterization laboratory or a ‘cath lab’ in short.

The doctor will start by applying a local anesthetic over the artery through which he will insert the catheter. It will make the area numb. So, you will not feel any pain or discomfort during the procedure.

Your doctor will then puncture your artery with a needle. He or she will then insert a plastic sheath into it to keep it open. A very long and thin hollow tube called a catheter inside the sheath.

Your cardiologist will then slowly screw this tube through the artery towards the blocked coronary artery.

The doctor will then insert a thin wire through the catheter to the area of blockage. The tip of the wire will have a small sausage-shaped inflatable balloon. It will also have a wire mesh called a stent over the balloon.

Once the wire reaches the blockage area, the doctor will slowly inflate it and keep it for some time. Then he or she will deflate the balloon. While deflating the expandable metal stent remains in its position. The stent prevents the artery from getting narrow again

If the artery is narrow, the doctor will repeat this procedure a few times.

As the balloon inflates fully, there will be an obstruction to the blood flow through the artery. You may feel some chest pain at this moment.

After the procedure 

Once the stent is in position, the doctor will remove the wire, the catheter, and the sheath. Pressure will be applied over the cut to prevent bleeding. The doctor will place a pressure pack over the wound to arrest bleeding.

You will go back to your room an hour after the procedure. The doctor will usually allow you to go home the same day. In some, an overnight hospital stay will be necessary. In that case, you will go back the next day. 

Recovery from angioplasty

Once back home, you may feel exhausted. It is natural, and the tiredness will go off soon. You will need to take rest for a day or two.

You will be able to do mild activities for two days. Walking around the house is good as it promotes better blood circulation. It helps you recover faster and better.

You will not lift heavy objects for a few days after the procedure. There is no restriction for on climbing stairs, but it will be better to keep it to a minimum

If your job is not strenuous, you can join back in three to four days. Driving will have to wait for a week or so.

There will be medicines which you need to take at regular intervals.

Avoiding mental and emotional stress is very important for faster recovery. So, it will better for you not to get worked up or excited for any reason.

After angioplasty, You will have to start following a heart-healthy lifestyle to prevent any heart problems in the future. If blocks develop in other coronary arteries as well, you will need a Heart bypass surgery.

To keep your heart in good health, you will need to 

• Eat a healthy diet with less fat and salts
• Do physical exercises regularly
• Avoid too much of mental and emotional stress
• Practice relaxation techniques like yoga, meditation, etc. 
• Avoid habits like smoking and drinking too much alcohol.

Risks and complications if angioplasty

An angioplasty is a very safe procedure with a success rate of more than 99 %. But a few may have some difficulties as well. The common ones are

• Bleeding under the skin at the site of catheterization
• Allergic reactions to the dye
• Damage to the artery due to the insertion of the catheter   
• Infrequent complications include heart attack, stroke, kidney problems, etc.

A coronary angioplasty is a non-surgical alternative to coronary artery disease. Proper lifestyle changes and medications can help to prevent any more damage to the arteries