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 12–24 hours afterward.