Angioplasty

• Procedure
• Complications

Angioplasty is used in the treatment for coronary artery disease (CAD). In coronary heart disease, there is hardening of the artery supplying the heart muscle (also known as atherosclerosis). In these arteries there is a biochemical substance that gets deposited in the hardened arteries (these are known as fibrofatty plaques). With a hardened artery partially blocked, there will be restriction of blood flow to the heart muscle, hence leading to symptoms such as angina or heart-related chest pain. The aim of angioplasty is to push the plaque (see above) against the artery wall. With such, the artery is dilated and bigger – giving more room for the blood to flow through the previously narrowed artery. This improved flow of blood reduces the risk of heart attack and sudden death due to heart diseases.

Procedure:

Generally, this procedure lasts 1 to 2 hours in the respective cardiac centres in hospitals or other medical centres. The patient will be taken to a room that resembles an operating theatre (i.e. with all the monitoring systems along with healthcare providers dressed in surgical gowns). Before the procedure, the doctor will speak to the patient first to ensure everything is fine before the procedure. After that, the patient will be given a mild sedative to reduce anxiety and for calming effect. The patient will be conscious but usually will not remember the details of the entire event. The procedure itself involves inserting a balloon-tipped pipe (a catheter) into the femoral artery in the groin or upper thigh. Aside of femoral artery, other arteries that may be used include the ulnar artery (on the forearm), the radial artery (also on the forearm) and brachial artery (on the upper arm). The area chosen will be cleaned, draped and numbed with local anaesthetic.

The catheter is then passed into the artery all the way towards the heart. There may be some minor discomfort during the process. A video monitor is used to guide the process. Once the catheter reached the designated area, a coronary angiogram will be done. This means an x-ray of the coronary arteries will be taken to locate and measure the narrowing of arteries. The catheter will be inserted further into the exact location of the narrowing, and then the balloon at the tip of the catheter will be inflated. The time period for inflation can last for seconds to several minutes. During this period because there is no blood flow to the heart muscle, the patient may feel the same type of chest pain as they feel in angina. Multiple inflations of the balloon may be needed in the same area. After the inflation, further coronary angiograms will be done to assess the narrowing of the artery.

Following angioplasty, usually a stent will be implanted at the site of narrowing. A stent is a small wire-mesh tube. It acts as a scaffolding tube that supports the weakened artery. This is important to reduce the chances where the dilated artery may become narrow again (known as restenosis) after angioplasty. Then, the catheter will be taken out. After the procedure, the patient may feel sleepy and drowsy from the sedative being used before the procedure. Also the catheter insertion site may be bruised. Depending on the patient’s condition, the stay in hospital after the procedure is variable. Most patients will be able to go home once they are stable after several hours of observation in heart centres. If not overnight stay is required, and typically the patient will be discharged home the next day.

Complications:

Like all medical procedures, there are risks associated with angioplasty. One of the complications are sudden closure of the affected vessel. Sudden closure of the artery can lead to a heart attack and also sudden death. If this occurs, emergency heart surgery may be needed. However, the risk is rare, and it is reduced further by inserting a stent during angioplasty. Other risk include blood clots forming after the procedure. However by giving medications such as aspirin and clopidogrel (a drug used to prevent clotting) in combination, the risk is significantly redced. Another risk of the procedure would be narrowing of the artery on the same site after angioplasty (known as restenosis). However the insertion of stents during angioplasty has reduced this risk, yet this is still a relatively common occurrence. Some minor complications include local collection of blood at the catheter insertion site (haematoma) or local infection. These are usually benign but can be dangerous if they are widespread.

References

1. Up to Date: Periprocedural complications of percutaneous transluminal coronary angioplasty [online]. 2005. [Cited 2005 September 24th]. Available from: URL: http://www.utdol.com/application/topic.asp?file=chd/14877&type=A&selectedTitle=3~57
2. Up to Date: Restenosis after percutaneous transluminal coronary angioplasty [online]. 2005. [Cited 2005 September 24th]. Available from: URL: http://www.utdol.com/application/topic.asp?file=chd/36907&type=A&selectedTitle=4~57