A B C D E F G H I J K L M N O P R S T U V W

CORONARY ANGIOPLASTY

What is a Coronary Angioplasty?

Coronary angioplasty is a way of opening up narrowed coronary arteries from the inside. In some instances it is an alternative to coronary artery bypass surgery (CABG). Both techniques can be used for treating angina which is interfering with lifestyle or has not responded to medical treatment. Surgery can also be used after a heart attack, especially in younger patients, to reduce the likelihood of a further heart attack. The evidence that angioplasty can be used to reduce this risk is limited. It is therefore used mostly as an alternative to medication for treating angina. However, angioplasty avoids an anaesthetic, opening the chest, and prolonged recovery involved in by-pass surgery. It also avoids the prolonged healing and convalescence needed after such major surgery.

What preparations should be made for a Coronary Angioplasty?

The treatment requires about 2 days in hospital and a few days for convalescence. No special preparation is required and all your usual medications should be continued unless advised otherwise. If living alone, a period of one week’s convalescence may be advised, especially if elderly.

What happens during a Coronary Angioplasty?

The procedure is carried out by a) heart specialist in a special cardiac catheterization room. The skin of the groin (or occasionally the elbow) may need to be shaved first. Cardiac catheterization and coronary arteriography are carried out under the effect of a mild sedative. A catheter (a thin tube) is usually inserted through an artery in the groin. It is passed into the heart (cardiac catheterization), and advanced into the start of the coronary artery where moving pictures of the arteries are recorded (cardiac catheterisation). A thin wire, called a guide wire, is then threaded through the catheter into the coronary artery and on through the narrowed section. A second catheter with a deflated balloon on the tip is then passed through the first catheter over the guide wire. It too passes through the narrowed section of the coronary artery. The balloon is then inflated for several seconds and the narrowed segment of artery then opens up. This is repeated several times until the opening is adequate. You may feel short episodes of anginal pain during the inflations of the balloon. Short tubes, called a " stents", are often inserted permanently into the coronary artery and positioned at the point where the artery has been opened up by balloon. It is designed to prevent the opened section of artery from narrowing again. They have been shown to reduce the need for a second angioplasty in many instances and are now used quite commonly. Mechanical devices to core out the narrowings (atherectomy) and lasers have been used but they have not been very successful and not now used very often.

When is angioplasty performed?

Although angioplasty is an alternative to CABG, some patients are not suitable. It may sometimes be possible to pass a balloon catheter through a very recent total blockage but it cannot pass through old blockages. Because the technique is time-consuming and demanding, it is difficult to deal with a large number of narrowed arteries or very long narrowings. It is used mainly when only one or two arteries are narrowed and when the narrowings can be easily reached. Patients with many narrowings or with blockages are usually advised to have bypass surgery Following a bypass operation, the grafts themselves can become narrowed. Angioplasty can then be used to open up the grafts and so avoid a second operation. Angioplasty may also be used immediately after a heart attack to open up an artery that has just blocked. This is called ‘primary angioplasty’. This can be particularly useful if clot-dissolving drugs (thrombolytics) cannot be used, if they are not successful or if the patient is especially ill. However, it may be quite difficult in many hospitals to undertake angioplasty as an emergency.

Possible complications during a Coronary Angioplasty?

One might expect that inflating a balloon in an artery might cause it to burst. In fact this does not happen. The artery may sometimes block instead of opening, and this may lead to a myocardial infarction (heart attack). If this happens, the major problems of a heart attack can be avoided by carrying out bypass surgery immediately. For this reason, angioplasty is usually undertaken in hospitals where cardiac surgeons are available to carry out surgery quickly. When surgery is not possible for other reasons or if there is a nearby hospital with cardiac surgeons, some angioplasties can be carried out in other hospitals. After the procedure, you will need to be treated with medication which reduces blood clotting to avoid blood clots in the recently opened coronary arteries. This can sometimes lead to bleeding around the artery in the groin. In about 25-30% of patients, the artery narrows again (restenosis) and causes a recurrence of angina. With the use of stents the rate of restenosis may be lowered to about 15% However, unlike bypass surgery angioplasty is easy to repeat.

If a Coronary Angioplasty is not performed?

There is always some degree of risk involved in carrying out angioplasty, but there is also a risk in not carrying it out. Angioplasty is usually undertaken to treat pain and is usually only done when the pain is interfering with life. If it is advised to reduce the risk of a heart attack, the risks of not doing it will be greater.

After a Coronary Angioplasty

You will be left with a sore groin for a few days and possibly a bruise. You may need painkillers. This may limit your activity for a while but is unlikely to be a problem. You will need to remain on various medications for a few weeks or months. Some will help avoid angina and spasm of the coronary arteries by relaxing the arteries. Other drugs, such as aspirin or newer aspirin-like drugs, reduce the risk of blood clots obstructing the arteries. You can expect to return to work after about a week. Arrangements will be made for further check-ups. The results of the angioplasty will be judged after a month or two, with tests which may include electrocardiograms and an exercise test.