Angioplasty

What is Angioplasty?

Angioplasty is a catheter-based procedure that reopens a heart artery narrowed by plaque. Plaque is the mix of cholesterol, calcium, and fibrous tissue that builds up inside artery walls. Doctors also call the procedure percutaneous coronary intervention, or PCI. There is no chest incision. A cardiologist numbs a spot at the wrist or the groin, then passes a thin flexible tube called a catheter into the artery. Live X-ray pictures guide it to the heart. Next the cardiologist steers a soft wire across the blockage. A tiny balloon travels over that wire and inflates for a few seconds. The balloon presses the plaque outward and stretches the artery open, so blood can flow freely again. In most cases the team then places a small metal mesh tube called a stent to hold the artery open. Angioplasty takes place in a hospital catheterization laboratory, not in the office. Many patients go home the same day.

Why Dr. Nanavati may recommend this

The goal of angioplasty is to restore blood flow to heart muscle that is not getting enough. That relieves symptoms, and during a heart attack it also saves muscle.

Dr. Nanavati is board certified in interventional cardiology. He may recommend angioplasty if you have:

• An active heart attack, where opening the artery quickly is the priority. The American Heart Association explains the warning signs of a heart attack. Calling 911 is always the right first step.
• Chest pain or pressure with exertion that has not settled with medication.
• A severe narrowing found on a coronary CT angiogram or a coronary angiogram.
• A large area of poor blood flow on advanced stress testing.
• Shortness of breath or reduced stamina traced to coronary artery disease.

Angioplasty is not right for every blockage. Some patients do better with medication alone, and others are better served by bypass surgery. That decision depends on how many arteries are involved, where the narrowings sit, and your overall health.

How to prepare

• Expect blood tests, an electrocardiogram, and often an echocardiogram beforehand. In an emergency these steps are compressed or skipped.
• Do not eat or drink after midnight, or as instructed. Small sips of water with essential pills are usually allowed.
• Ask specifically about blood thinners, diabetes medications, and metformin, which is often held around contrast dye. Do not stop anything on your own.
• Report any allergy to contrast dye, shellfish, latex, or medications, and tell the team about kidney disease.
• Arrange for an adult to drive you home and, ideally, stay with you the first night.
• Pack an overnight bag in case you stay, along with your medication list and insurance card.
• Leave jewelry and valuables at home, and wear something easy to change out of.
• Plan to be at the hospital for most of the day, even for a same-day discharge.

What happens during the procedure

You lie on a narrow padded table under a movable X-ray camera. Sticky electrodes monitor your heart, a cuff checks blood pressure, and a clip on your finger tracks oxygen. An intravenous line delivers fluids and medication.

You are awake but relaxed. Most patients receive a mild sedative, so the experience often feels hazy afterward. The team cleans the wrist or groin and covers it with sterile drapes, and local anesthetic numbs the skin. You may feel pressure at that spot, but not sharp pain.

The cardiologist threads the catheter through the artery to the heart. You will not feel it moving, because arteries have no sensory nerves inside. He injects contrast dye so the arteries show up on screen, and you may feel a brief warm flush.

The balloon is then inflated at the blockage, usually for several seconds at a time. Some people feel chest pressure during inflation, which passes as the balloon deflates. Tell the team what you feel. A stent is usually placed and expanded into the artery wall, where it stays permanently.

At the end, the catheter comes out, and a device or firm pressure closes the access site.

Recovery and results

If the wrist was used, a band applies pressure for a few hours. You can usually sit up right away. If the groin was used, you lie flat for several hours to prevent bleeding. Many stable patients go home the same day. After a heart attack, expect a hospital stay of several days.

The result is known immediately. Your cardiologist can see the artery open on the screen before the procedure ends. He will explain what was found and what was done.

At home, keep the access site clean and dry. Avoid heavy lifting, straining, and strenuous exercise for about a week. Most people return to desk work within a few days. Chest pain related to the blockage often improves quickly.

The most important part of recovery is medication. If you received a stent, you will take aspirin plus a second antiplatelet drug. Together they keep the stent from clotting. Do not stop these without talking to your cardiologist. Cardiac rehabilitation is strongly encouraged, and MedlinePlus describes how cardiac rehabilitation improves long term outcomes.

Risks and safety

Angioplasty is common and generally safe. It is still a procedure on the heart, and it carries real risks that deserve honest discussion.

More common problems include bruising, bleeding, or soreness at the access site. Contrast dye can also cause a temporary drop in kidney function. That is more likely when kidney disease or diabetes is already present. Allergic reactions to dye can occur and are usually treatable.

Less common risks include an abnormal heart rhythm, injury or tearing of the artery, and stroke. The procedure can also trigger a heart attack or create a need for emergency bypass surgery. Serious complications are uncommon in stable patients, and more likely in emergencies or in people who are already very ill.

Over time, an artery can narrow again inside or around the stent, a process called restenosis. Modern drug-coated stents have made this much less frequent. A stent can also clot suddenly, which is why the antiplatelet medications matter so much.

Call 911 for new severe chest pain. Call the office for bleeding, swelling, fever, or a spreading bruise at the access site.

Related services and conditions

• Coronary stenting, usually performed together with angioplasty.
• Coronary artery disease, the underlying cause.
• Cardiac rehabilitation after a heart procedure.
• Advanced stress testing to assess blood flow first.
• Our office locations in Bonita, San Diego, and Redding.