Coronary angioplasty (AN-jee-oh-plas-tee) is a
medical procedure in which a balloon is used to open a blockage in a coronary
(heart) artery narrowed by
atherosclerosis
(ATH-er-o-skler-O-sis). This procedure improves blood flow to the heart.
Atherosclerosis is a condition in which a material
called plaque (plak) builds up on the inner walls of the arteries. This can
happen in any artery, including the coronary arteries, which carry oxygen-rich
blood to your heart. When atherosclerosis affects the coronary arteries, the
condition is called
coronary
artery disease (CAD).
Angioplasty is a common medical procedure. It may be
used to:
Improve symptoms of CAD, such as
angina
and shortness of breath.
Reduce damage to the heart muscle from a
heart
attack. A heart attack occurs when blood flow through a coronary artery is
completely blocked. Angioplasty is used during a heart attack to open the
blockage and restore blood flow through the artery.
Reduce the risk of death in some patients.
Angioplasty is done on more than 1 million people a
year in the United States. Serious complications don't occur often, but can
happen no matter how careful your doctor is, or how well he or she does the
procedure.
Research on angioplasty is ongoing to make it safer
and more effective, to prevent treated arteries from closing again, and to make
the procedure an option for more people.
Coronary angioplasty is used to restore blood flow
to the heart when the coronary arteries have become narrowed or blocked due to
coronary
artery disease (CAD).
When medicines and lifestyle changes, such as
following a healthy diet, quitting smoking, and getting more physical activity,
don't improve your CAD symptoms, your doctor will talk to you about other
treatment options. These options include angioplasty and
coronary
artery bypass grafting (CABG), a type of open-heart surgery.
Your doctor will take into account a number of
factors when recommending the best procedure for you. These factors include how
severe your blockages are, where they're located, and other diseases you may
have.
Angioplasty is often used when there is less severe
narrowing or blockage in your arteries, and when the blockage can be reached
during the procedure.
CABG might be chosen if you have severe heart
disease, multiple arteries that are blocked, or if you have diabetes or
heart
failure.
Compared with CABG, some advantages of angioplasty
are that it:
Has fewer risks than CABG.
Isn't surgery, so it won't require a large
cut.
Is done with medicines that numb you and help you
relax. Unlike CABG, you won't be put to sleep for a short time.
Has a shorter recovery time.
Angioplasty also is used as an emergency procedure
during a
heart
attack. As plaque builds up in the coronary arteries, it can burst, causing
a blood clot to form on its surface. If the clot becomes large enough, it can
mostly or completely block blood flow to part of the heart muscle.
Quickly opening a blockage lessens the damage to the
heart during a heart attack and restores blood flow to the heart muscle.
Angioplasty can quickly open the artery and is the best approach during a heart
attack.
A disadvantage of angioplasty as compared with CABG
is that the artery may narrow again over time. The chance of this happening is
lower when
stents
are used, especially medicine-coated stents. However, these stents aren't
without risk. In some cases, blood clots can form in the medicine-coated stents
and cause a heart attack. (See "What Are the
Risks of Coronary Angioplasty?" for more information.)
Your doctor will discuss with you the treatment
options and which procedure is best for you.
How Is Coronary Angioplasty Done?
Before coronary angioplasty is done, your doctor
will need to know whether your coronary arteries are blocked. If one or more of
your arteries are blocked, your doctor will need to know where and how severe
the blockages are.
To find out, your doctor will do an
angiogram
and take an x-ray picture of your arteries. During an angiogram, a small tube
called a catheter with a balloon at the end is put into a large blood vessel in
the groin (upper thigh) or arm. The catheter is then threaded to the coronary
arteries. A small amount of dye is injected into the coronary arteries and an
x-ray picture is taken.
This picture will show any blockages, how many, and
where they're located. Once your doctor has this information, the angioplasty
can proceed. Your doctor will blow up (inflate) the balloon in the blockage and
push the plaque outward against the artery wall. This opens the artery more and
improves blood flow.
Coronary Balloon Angioplasty
The illustration shows a
cross-section of a coronary artery with plaque buildup. The coronary artery is
located on the surface of the heart. Figure A shows the deflated balloon
catheter inserted into the narrowed coronary artery. In figure B, the balloon
is inflated, compressing the plaque and restoring the size of the artery.
Figure C shows the widened artery.
A small mesh tube called a
stent
is usually placed in the newly widened part of the artery. The stent holds up
the artery and lowers the risk of the artery renarrowing. Stents are made of
metal mesh and look like small springs.
Some stents, called drug-eluting stents, are coated
with medicines that are slowly and continuously released into the artery. These
medicines help prevent the artery from becoming blocked again from scar tissue
that grows around the stent.
Stent Placement
The illustration shows
the placement of a stent in a coronary artery with plaque buildup. Figure A
shows the deflated balloon catheter and closed stent inserted into the narrowed
coronary artery. The inset image on figure A shows a cross-section of the
artery with the inserted balloon catheter and closed stent. In figure B, the
balloon is inflated, expanding the stent and compressing the plaque to restore
the size of the artery. Figure C shows the stent-widened artery. The inset
image on figure C shows a cross-section of the compressed plaque and
stent-widened artery.
In some cases, plaque is removed during
angioplasty. In a procedure called atherectomy (ath-er-EK-toe-me), a catheter
with a rotating shaver on its tip is inserted into the artery to cut away
plaque. Lasers also are used to dissolve or break up the plaque. These
procedures are now rarely done because angioplasty gives better results for
most patients.
What To Expect Before Coronary Angioplasty
Meeting With Your Doctor
A cardiologist (a doctor who treats people with
heart conditions) performs coronary angioplasty at a hospital. If your
angioplasty isn't done as emergency treatment, you'll meet with your
cardiologist before the procedure. Your doctor will go over your medical
history (including the medicines you take), do a physical exam, and talk about
the procedure with you. Your doctor also will order some routine tests,
including:
When the procedure is scheduled, you will be
advised:
When to begin fasting (not eating or drinking)
before the procedure. Often you have to stop eating or drinking by midnight the
night before the procedure.
What medicines you should and shouldn't take on
the day of the angioplasty.
When to arrive at the hospital and where to
go.
Even though angioplasty takes 1 to 2 hours, you will
likely need to stay in the hospital overnight. In some cases, you will need to
stay in the hospital longer. Your doctor may advise you not to drive for a
certain amount of time after the procedure, so you may have to arrange for a
ride home.
What To Expect During Coronary Angioplasty
Coronary angioplasty is performed in a special part
of the hospital called the cardiac catheterization (kath-eh-ter-ih-ZA-shun)
laboratory. The "cath lab" has special video screens and x-ray machines. Your
doctor uses this equipment to see enlarged pictures of the blocked areas in
your coronary arteries.
Preparation
In the cath lab, you will lie on a table. An
intravenous (IV) line will be placed in your arm to give you fluids and
medicines. The medicines will relax you and prevent blood clots from forming.
These medicines may make you feel sleepy or as though you're floating or
numb.
To prepare for the procedure:
The area where the catheter will be inserted,
usually the arm or groin (upper thigh), will be shaved.
The shaved area will be cleaned to make it germ
free and then numbed. The numbing medicine may sting as it's going in.
Steps in Angioplasty
When you're comfortable, the doctor will begin the
procedure. You will be awake but sleepy.
A small cut is made in your arm or groin into which
a tube called a sheath is put. The doctor then threads a very thin guide wire
through the artery in your arm or groin toward the area of the coronary artery
that's blocked.
Your doctor puts a long, thin, flexible tube called
a catheter through the sheath and slides it over the guide wire and up to the
heart. Your doctor moves the catheter into the coronary artery to the blockage.
He or she takes out the guide wire once the catheter is in the right spot.
A small amount of dye may be injected through the
catheter into the bloodstream to help show the blockage on x ray. This x-ray
picture of the heart is called an
angiogram.
Next, your doctor slides a tube with a small
deflated balloon inside it through the catheter and into the coronary artery
where the blockage is.
When the tube reaches the blockage, the balloon is
inflated. The balloon pushes the plaque against the wall of the artery and
widens it. This helps to increase the flow of blood to the heart.
The balloon is then deflated. Sometimes the balloon
is inflated and deflated more than once to widen the artery. Afterward, the
balloon and tube are removed.
In some cases, plaque is removed during angioplasty.
A catheter with a rotating shaver on its tip is inserted into the artery to cut
away hard plaque. Lasers also may be used to dissolve or break up the
plaque.
The animation below shows the process of coronary
angioplasty. Click the "start" button to play the animation. Written and spoken
explanations are provided with each frame. Use the buttons in the lower right
corner to pause, restart, or replay the animation, or use the scroll bar below
the buttons to move through the frames.
The animation shows how a doctor
inserts a tube called a balloon catheter into a coronary artery narrowed by
plaque. The balloon catheter compresses the plaque and widens the artery to
restore blood flow.
If your doctor needs to put a
stent
(small mesh tube) in your artery, another tube with a balloon will be threaded
through your artery. A stent is wrapped around the balloon. Your doctor will
inflate the balloon, which will cause the stent to expand against the wall of
the artery. The balloon is then deflated and pulled out of the artery with the
tube. The stent stays in the artery.
After the angioplasty is done, your doctor pulls
back the catheter and removes it and the sheath. The hole in the artery is
either sealed with a special device, or pressure is put on it until the blood
vessel seals.
The animation below shows the process of coronary
angioplasty and stent placement. Click the "start" button to play the
animation. Written and spoken explanations are provided with each frame. Use
the buttons in the lower right corner to pause, restart, or replay the
animation, or use the scroll bar below the buttons to move through the
frames.
The animation shows how a doctor
inserts a tube called a balloon catheter into a coronary artery narrowed by
plaque. The balloon catheter compresses the plaque, widens the artery, and
restores blood flow. Through the catheter, a stent is placed in the artery to
help maintain the restored blood flow.
During angioplasty, strong antiplatelet medicines
are given through the IV to prevent blood clots from forming in the artery or
on the stent. These medicines help thin your blood. They're usually started
just before the angioplasty and may continue for 1224 hours
afterward.
What To Expect After Coronary Angioplasty
After coronary angioplasty, you will be moved to a
special care unit, where you will stay for a few hours or overnight. While you
recover in this area, you must lie still for a few hours to allow the blood
vessels in your arm or groin (upper thigh) to seal completely.
While you recover, nurses will check your heart rate
and blood pressure. They also will check your arm or groin for bleeding. After
a few hours, you will be able to walk with help.
The place where the tube was inserted may feel sore
or tender for about a week.
Going Home
Most people go home 1 to 2 days after the procedure.
When your doctor thinks you're ready to leave the hospital, you will get
instructions to follow at home, including:
How much activity or exercise you can do.
When you should follow up with your doctor.
What medicines you should take.
What you should look for daily when checking for
signs of infection around the area where the tube was inserted. Signs of
infection may include redness, swelling, or drainage.
When you should call your doctor. For example,
you may need to call if you have a fever or signs of infection, pain or
bleeding where the catheter was inserted, or shortness of breath.
When you should call 911 (for
example, if you have any chest pain).
Your doctor will prescribe medicine to prevent blood
clots from forming. Taking your medicine as directed is very important. If a
stent
was inserted, the medicine reduces the risk that blood clots will form in the
stent. Blood clots in the stent can block blood flow and cause a
heart
attack.
Recovery and Recuperation
Most people recover from angioplasty and return to
work about 1 week after being sent home. Your doctor will want to check your
progress after you leave the hospital. During the followup visit, your doctor
will examine you, make changes to your medicines if needed, do any necessary
tests, and check your overall recovery. Use this time to ask questions you may
have about activities, medicines, or lifestyle changes, or to talk about any
other issues that concern you.
Lifestyle Changes
Although angioplasty can reduce the symptoms of
coronary
artery disease (CAD), it isn't a cure for CAD or the risk factors that led
to it. Making healthy lifestyle changes can help treat CAD and maintain the
good results from angioplasty.
Talk with your doctor about your risk factors for
CAD and the lifestyle changes you'll need to make. For some people, these
changes may be the only treatment needed.
Your doctor may want you to take part in a cardiac
rehabilitation (rehab) program. Cardiac rehab helps people with heart disease
recover faster and return to work or daily activities.
Cardiac rehab includes supervised physical activity,
education on heart healthy living, and counseling to cut down on stress and
help you return to an active life. Your doctor can tell you where to find a
cardiac rehab program near your home. "Your Guide to Living Well With Heart
Disease," will give you more information on cardiac rehab.
What Are the Risks of Coronary Angioplasty?
Coronary angioplasty is a common medical procedure.
Although angioplasty is normally safe, there is a small risk of serious
complications, such as:
Bleeding from the blood vessel where the catheter
was placed.
Damage to blood vessels from the catheter.
An allergic reaction to the dye given during the
angioplasty.
The need for emergency
coronary
artery bypass grafting during the procedure (24 percent of people).
This may occur when an artery closes down, instead of opening up.
As with any procedure involving the heart,
complications can sometimes, though rarely, cause death. Less than 2 percent of
people die during angioplasty.
Sometimes chest pain can occur during angioplasty
because the balloon briefly blocks off the blood supply to the heart.
The risk of complications is higher in:
People aged 75 and older
People who have kidney disease or diabetes
Women
People who have poor pumping function in their
hearts
People who have extensive heart disease and
blockages
Research on angioplasty is ongoing to make it safer
and more effective, to prevent treated arteries from closing again, and to make
the procedure an option for more people.
Complications From Stents
Restenosis
There is a chance that the artery will become
narrowed or blocked again in time, often within 6 months of angioplasty. This
is called restenosis.
Stent Restenosis
The illustration shows the
restenosis of a stent-widened coronary artery. The coronary artery is located
on the surface of the heart. In figure A, the expanded stent compresses plaque,
allowing normal blood flow. The inset image on figure A shows a cross-section
of the compressed plaque and stent-widened artery. In figure B, the plaque
grows (over time) through and around the stent, causing a partial blockage and
abnormal blood flow. The inset image on figure B shows a cross-section of the
growth of the plaque around the stent.
When a
stent
isn't used, 4 out of 10 people have restenosis. When a nonmedicine-coated stent
is used, 2 out of 10 people have restenosis.
The growth of scar tissue in and around the stent
also can cause restenosis. Medicine-coated stents reduce the growth of scar
tissue around the stent and lower the chance of restenosis. When
medicine-coated stents are used, the chance of restenosis is lowered even more,
to around 1 in 10 people.
Other treatments, such as radiation, can help
prevent tissue growth within a stent. For this procedure, the doctor puts a
wire through a catheter to where the stent is placed. The wire releases
radiation to stop any tissue growth that may block the artery.
Blood Clots
Recent studies suggest that there is a higher risk
of blood clots forming in medicine-coated stents compared to bare metal stents
(nonmedicine-coated). The Food and Drug Administration (FDA) reports that
medicine-coated stents usually don't cause complications due to blood clots
when used as recommended.
When medicine-coated stents are used in people with
advanced CAD, there is a higher risk of blood clots, heart attack, and death.
The FDA is working with researchers to study medicine-coated stents, including
their use in people with advanced CAD.
Taking medicine as prescribed by your doctor can
lower the risk of blood clots. People with medicine-coated stents are usually
advised to take an anticlotting drug, such as clopidogrel and aspirin, for
months to years to lower the risk of blood clots.
As with all procedures, it's important to talk to
your doctor about your treatment options, including the risks and benefits to
you.
Key Points
Coronary angioplasty is a medical procedure in
which a balloon is used to open a blockage in a coronary (heart) artery
narrowed by
atherosclerosis.
This procedure improves blood flow to the heart.
Atherosclerosis is a condition in which a
material called plaque builds up on the inner walls of the arteries. When
atherosclerosis affects the coronary arteries, the condition is called
coronary
artery disease (CAD).
Angioplasty can improve some of the symptoms of
CAD, such as
angina
(chest pain) and shortness of breath. It also can reduce damage to the heart
muscle from a
heart
attack and reduce the risk of death in some patients.
You may need angioplasty if medicines and
lifestyle changes haven't improved your symptoms of CAD. You also may need
angioplasty as emergency treatment during a heart attack.
Angioplasty is less invasive than surgery.
General anesthesia isn't needed. You will be given medicines to help you relax,
but you will be awake during the procedure.
Angioplasty is performed in a special part of the
hospital called the cardiac catheterization laboratory.
Before angioplasty is done, your doctor will need
to know whether your coronary arteries are blocked. To find out, he or she will
do an angiogram
and take an x-ray picture of your arteries to show any blockages and where
they're located. Once your doctor has this information, the angioplasty can
proceed.
During angioplasty, your doctor will use a small
tube called a catheter with a balloon at the end. He or she will thread the
balloon through an artery to the blockage. The balloon is blown up (inflated),
pushing the plaque outward against the artery wall. This opens the artery more
and improves blood flow through it.
During angioplasty, a
stent
(mesh tube) is often placed in the artery that has been opened. The stent
reduces the chance that the artery will become blocked again in the future. The
stent remains in place after the procedure.
Most people go home 1 to 2 days after having
angioplasty. Full recovery from the procedure is usually 1 week or less.
Lifestyles changes are recommended after
angioplasty to improve CAD and to prevent the arteries from becoming narrowed
or blocked again. Lifestyle changes include a healthy diet, weight control,
medicines to lower
high
blood pressure and
high
blood cholesterol, regular physical activity, and quitting smoking.
Angioplasty is a common medical procedure and is
generally safe, but there is a small risk of serious complications.
Renarrowing of the treated artery and growth of
scar tissue within a stent can occur. The use of medicine-coated stents can
lower the chance of this happening, but these stents aren't without risk. In
some cases, blood clots can form in the medicine-coated stents.
Research on angioplasty is ongoing to make it
safer and more effective, to prevent treated arteries from closing again, and
to make the procedure an option for more people.
Links to Other Information About Coronary
Angioplasty