Coronary Angioplasty and Stenting

What is Coronary Angioplasty?
Angioplasty is sometimes referred to as a PTCA (percutaneous tranluminal coronary angioplasty) or balloon angioplasty. It is a non-surgical way to treat artery buildup (atherosclerosis). Angioplasty is commonly performed with stenting in which a balloon is used to expand a metal sleeve inside the artery. Angioplasty is designed to open clogged arteries. This procedure is done after the doctor has seen the angiogram that shows where the arteries are blocked. Angioplasty, with or without stenting, opens the arteries to restore blood flow. 

Patient preparation
Prior to your angioplasty procedure, a number of blood tests are performed, and you will be asked about the medications you take, whether prescription or over-the-counter. You will be asked if you have any allergies. It is important to list all allergies to food and medicine, as well as hay fever or asthma. Existing allergies may indicate a possible reaction to the contrast agent that will be used during the examination. If you are a woman of childbearing age, you will be asked if there is any possibility that you are pregnant, because a fetus is sensitive to radiation. You will receive detailed instructions about how to prepare for your procedure. Including specific instructions about the food you may have. Generally, you will be allowed nothing to eat or drink six to eight hours before the procedure.

When you arrive for your angioplasty you will be prepared for the procedure. You will be asked to remove all clothing and jewelry and to put on a hospital gown. The nurse will need to start an intravenous (IV) line for fluids and medications. When it is time for your procedure the Cath Lab staff will explain the procedure to you and answer any questions you might have. Staff members present for the procedure are a radiology technologist, scrub technician or scrub nurse, and a nurse to monitor and care for your needs. The Cardiologist will perform the procedure.

Some suggestions to help you prepare:

  • Pack a small bag of overnight clothing and for the next day.
  • Do not bring any valuables.
  • Bring a list of your medications (with exact names and dosages).
  • Arrange for someone to drive you home the next day.
  • Empty your bladder for your own comfort.
  • You may wear your socks, dentures, hearing aids, or glasses.

During the Examination
The staff will position you on the exam table and connect you to a blood pressure cuff, heart monitor and oxygen monitor. The Cardiologist (a physician who specializes in the diagnostic interpretation of cardiac vessels) will administer a local anesthetic and then make a small nick in your skin so that a thin catheter can be inserted into the artery. The catheter is a flexible hallow tube about the size of a strand of spaghetti. It usually is inserted into an artery in your groin, although in some cases your arm or another site will be selected for the catheter.

The Cardiologist will ease the catheter into the artery and gently guide it to the area under investigation. The Cardiologist will be able to watch the movement of the catheter on a fluoroscope, which is an x-ray unit combined with a television monitor. When the catheter reaches the area under study, the contrast agent will be injected through the catheter. By watching the fluoroscope screen, the Cardiologist will be able to see the outline of your blood vessels and identify any blockages or other irregularities needing to be opened.

Angioplasty procedures can range in time from less than an hour to three hours or more. It is important that you relax and remain as still as possible during the examination. The staff and physician stay in the room with you throughout the procedure. If you experience any difficulty, let them know.

What do Angioplasty and Stenting do?
When the blockage is located, a balloon catheter is placed in the narrowed artery and slowly inflated to press the fatty deposits against the artery walls. This allows the blood to flow more freely to the heart muscle. In many cases, superior results can be obtained if the cardiologist inserts a stent into the area of the blockage and expands it with the balloon. A stent is an expandable wire mesh tube, sized to fit your artery. Once in place, a stent can provide a better channel for blood flow through the artery.

Post Examination Information
After the procedure is complete, you will be moved to a room where you can rest and recover. You will be admitted to the hospital for observation and recovery. Before you go home, you will be given instructions explaining how to care for the site where the catheter was inserted. Your physician also may recommend that you restrict your activities at home. Follow the physician's instructions carefully.

Your kidneys will excrete any contrast agent that remains in your system. You may be advised to drink lots of water to help flush the contrast from your system. The amount of contrast is very small, and it has no odor or color. You will not notice any discoloration of your urine. In addition, the radiation that you are exposed to during this examination, like the radiation produced during any other x-ray procedure, passes through you immediately.

Your doctor will talk to you about the amount of improvement in the artery opening and the possibility of your symptoms returning. Prior to discharge the following will be discussed: medications, restrictions, and changes in daily habits to reduce the risk of more arteries narrowing. You will also be told when to return for follow-up visits.

What can I do when I return home?
Avoid heavy lifting and do only light activities for a few days and call your doctor if:

  • The insertion site bleeds.
  • You feel chest pain or discomfort
  • Your arm or leg (at the insertion site) feels numb or cold.
  • The bruising or swelling gets worse or increases.
  • If you have a fever, or signs of infection (redness or oozing) appear at the insertion site. 
    Any other unusual symptoms.

What are the risks?
There can be some risk involved with certain diagnostic procedures. These risks will be discussed by your physician prior to the procedure.