Coronary angioplasty is a procedure used to repair narrowed or blocked coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that caused by cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> plaques. This procedure typically follows a coronary angiography, an examination that visualizes the narrowings in the arteries.
It involves inserting a small balloon into the blocked artery, which is then inflated to dilate the vessel. In most cases, a stent (or endoprosthesis) is placed to keep the artery open, ensuring better bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow.
Historic First
The first coronary angioplasty on a human was performed in 1977 by Dr. Andreas Gruentzig, marking a major breakthrough in the treatment of coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that disease.
Today, it is commonly performed to treat symptoms like angina and prevent more serious events like heart attacks.
Angioplasty is usually recommended by a cardiologist after a comprehensive evaluation of the patient. The procedure often takes place immediately after the coronary angiography, but it may sometimes be postponed to a later date, for instance, when multiple blockages need to be treated or if an artery has been blocked for a long time.
In such cases, the cardiologist will discuss with the patient to determine the best therapeutic approach. This text addresses situations where a second hospitalization is necessary to proceed with the angioplasty.
Sometimes It’s Urgent
Certain circumstances require an urgent coronary angiography, such as a myocardial infarction.
Other situations, like hospitalization due to unstable angina or other cardiovascular conditions, may call for this examination on a semi-urgent basis.
Before the Procedure
It is possible, though not very common, that a pre-admission visit is required before the angioplasty.
During this visit, bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood tests and an electrocardiogram (ECG) are performed, and the procedure is explained to the patient.
Any questions the patient may have are also addressed at this time. This pre-admission typically takes place a few weeks before the procedure.
Consent Form
After being informed of the risks associated with this examination, the patient must sign a consent form. These risks are detailed further in this text.
At this point, the physician believes that the benefits of the examination outweigh the risks.
On the Day of the Procedure
Typically, a one-day hospital stay is planned for the angioplasty.
The patient is required to fast starting from midnight the night before, including medications, unless otherwise instructed during the pre-admission.
Upon arrival in the preparation room, the patient must remove their clothing and wear a hospital gown. A nurse will place one or two intravenous lines to administer fluids or medications during the procedure, if necessary.
The right wrist and both groin areas are shaved to prepare for catheter insertion into the artery selected by the cardiologist.
Preparation in the Examination Room
At the scheduled time, the patient is transported on a stretcher to the examination room. The medical team takes the same precautions as in an operating room to ensure a sterile environment and prevent infections. Doctors and nurses wear gowns, masks, and surgical caps.
The room is kept at a cool, sometimes cold, temperature to ensure the radiology equipment functions properly. A sterile drape is placed over the patient to minimize discomfort.
There are two main arteries that provide bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow to the hand: the radial artery and another adjacent artery. These arteries are interconnected, allowing one to compensate if the other becomes blocked. A test is performed to check this connection before using the radial artery for the procedure.
If the radial artery in the wrist is deemed unsuitable, the medical team may opt to use the femoral artery in the groin to access the heart. The advantage of using the wrist approach is that it reduces the risk of bleeding and allows the patient to get up more quickly after the procedure. However, this access point is not always feasible, and in certain circumstances, the femoral artery may be preferred.
Final Preparation
The access route used for the coronary angiography is generally reused for the angioplasty. However, other access points are also prepared in case they are needed.
Once all the equipment is ready, the nurse disinfects both the groin and the wrist used for the procedure. A sterile drape is then placed over the patient, and the final devices are connected for the examination. At this point, the patient is advised to minimize movement to ensure the smooth progression of the procedure.
During the Procedure
The doctor introduces themselves, and the procedure begins. Only local anesthesia is required.
To ensure the patient’s comfort, the nurse administers intravenous medication to help the patient relax and minimize any pain during the intervention.
The sting
The doctor administers local anesthesia at the site of the selected artery to minimize discomfort.
A small incision is made, and using a hollow needle, the artery is punctured to allow access.
Setting up the Entry Point
A plastic tube, known as an introducer, is inserted into the artery and keeps the entry point accessible throughout the procedure. The rest of the exam is painless. This process is the same when the groin artery is used.
Through this entry point, a long metal wire and a catheter (a long plastic tube) are passed to reach the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that.
Once in position, the wire is removed, and the catheter is manipulated to access the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that.
Not All Narrowings Require Repair
The images obtained during the coronary angiography are available for the doctor to assess the narrowing of the arteries. However, not all atherosclerotic plaques require intervention. Coronary angioplasty carries certain risks, and the benefits of the procedure must outweigh them. Therefore, it is performed only on cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> plaques that compromise the oxygen supply to the heart muscle.
In some cases, the narrowing is borderline in terms of needing intervention. In such situations, the doctor may use a special technique called FFR (Fractional Flow Reserve). This method measures the pressure difference across the narrowing using a very thin wire, allowing the doctor to determine whether a repair will be beneficial for the patient.
Equipment Similar to That Used for Coronary Angiography
Just like coronary angiography, coronary angioplasty requires the use of catheters, a contrast dye, and X-rays to visualize the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that.
However, specific instruments are also used to repair the narrowed sections within the arteries.
Angioplasty can be performed immediately following the coronary angiography.
Angioplasty compresses the atheroma plaque
The main goal of coronary angioplasty is to compress the atheroma (cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >>) plaque that narrows or blocks the artery. This compression causes the plaque to rupture, triggering the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood clotting process.
To prevent the formation of a clot that could partially or completely block the artery, intravenous medication is administered to thin the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood during the procedure.
A thin metal wire creates the "railroad track"
A very fine metal wire is threaded through the plaque in the coronary artery that needs to be treated. This wire serves as a “railroad track” to guide all the necessary equipment for the repair.
A balloon is used to compress the plaque
A balloon catheter is then inserted to the site of the blockage. Once in place, it is inflated, compressing the atheroma plaque responsible for the narrowing, and widening the artery. After the balloon is deflated, the artery remains more open.
Some patients may feel angina discomfort during this phase, as bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow is temporarily interrupted in the artery. Once the balloon is deflated, circulation resumes, and the discomfort disappears.
However, not all patients experience this type of discomfort.
A metal stent to keep the artery open
To ensure better long-term success, a vascular stent, commonly known as a stent, is placed at the site of the stenosis.
The stent is a small metal spiral resembling a spring that helps keep the artery open. It is delivered into the artery via a balloon catheter. As the balloon inflates, it deploys the stent and presses it against the artery wall.
Once the balloon is deflated and removed, the stent stays in place permanently.
Most stents are coated with medication to reduce the risk of restenosis (narrowing) at the treated site.
Some patients may experience angina discomfort when the stent expands the artery due to the stretching of the artery walls. The stent, once deployed, helps maintain the opening over the long term.
The stent does not cause rejection
Vascular stents do not trigger rejection by the body.
However, since they are foreign objects, they can activate plateletsPlatelets, also known as thrombocytes, are small cell fragments produced by the bone marrow. They play a crucial role in blood clotting by forming aggregates and clots to stop bleeding when blood vessels are damaged. >> and initiate blood clotting, which can lead to the formation of clots (stent thrombosis). This condition occurs when the stent becomes completely blocked, a potentially life-threatening complication.
To prevent this risk, certain precautions are essential.
Precautions against thrombosis
To avoid stent thrombosis, doctors prescribe a combination of antiplatelet medications to be taken daily.
Aspirin is usually prescribed for life, while a second antiplatelet medication, such as clopidogrel or ticagrelor, is prescribed for at least one month, often extended to one year or even for life in some cases.
These medications significantly reduce the risk of clot formation in the stent.
Never stop taking anticoagulants without a cardiologist’s advice, even for minor surgery
Any concerns related to this therapy should be discussed with a physician who has strong expertise in cardiology, preferably a cardiologist.
It is important to note that the body’s cells will regenerate around the stent in the months following implantation, aiding in the stent’s integration into the arterial wall.
Home Recommendations
After a coronary angiography, only a few precautions are necessary, but it’s important to follow these recommendations for the first 4 days:
- Avoid soaking the small wound at the entry site (either the groin or wrist) in water. Swimming pools and open water should be avoided, though showering is permitted.
- If the procedure was done via the wrist, avoid repetitive and strenuous movements with that hand.
- For those with a groin entry, it’s recommended to move the leg every hour if sitting for prolonged periods.
Returning to Work
After a coronary angioplasty, returning to work is generally possible within 7 to 14 days, depending on the nature of the job.
The physical demands of the work and the patient’s recovery status will influence the recommended rest period.
Follow Up
Patients who have undergone coronary angioplasty must continue regular follow-up with a healthcare professional. Angina may reoccur, either due to restenosis (narrowing at the site of the repair) or because of a new atherosclerotic plaque.
Angioplasty does not cure coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that disease. Therefore, it is crucial for the patient to remain vigilant about symptoms of angina, such as discomfort occurring during exertion, relieved by rest, and reappearing after similar efforts. If such symptoms are present, it is recommended to consult a doctor promptly.
Risks During the Procedure
Coronary angioplasty is generally a very safe procedure, but like any medical intervention, it carries certain risks. These risks depend on the patient’s overall health and the complexity of the necessary repairs.
In general, the risk of death associated with this procedure is estimated at less than 1 in 1,000. Other major complications, such as a stroke, heart attack, kidney problems, or the need for emergency surgery, occur in less than 4 cases per 1,000.
Minor complications, such as bleeding, bruising, or hematomas, occur in about 1% of patients.
Results Sent to Your Doctor
The results will be communicated later to the physician who requested the examination.
Requesting a Copy for Another Doctor
You can request that a copy of the results be sent to another doctor by simply providing their name and contact information to the staff.
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