Angioplasty

Overview

Angioplasty, also known as balloon angioplasty or percutaneous coronary intervention (PCI), a process that enlarges the lumen of an artery with accumulated plaque buildup, thus increasing its internal space to make it easier for blood to flow through them.

In order to push plaque against the artery walls and allow blood to flow through, the healthcare provider utilizes a small balloon. Frequently, a stent or tube is also inserted into the recently expanded area to maintain its patency.

Angioplasty is a medical procedure that can be performed in response to an emergency situation, such as a heart attack. Additionally, when a healthcare provider has a strong suspicion that a patient may have heart disease, they may choose to perform angioplasty as an elective surgery.

Reasons for undergoing the procedure

Coronary angioplasty may be required for individuals diagnosed with heart attack or coronary artery disease. The neck, arms, legs, kidneys, and pelvis are just a few of the body areas that can benefit from an angioplasty if they have narrow or clogged arteries.

Angioplasty enables improved blood flow through a narrowed or plaque-blocked artery, resulting in enhanced blood supply to the organ served by that artery following the procedure.

Angioplasty is used to treat atherosclerosis, which is a buildup of plaque consisting of fat and cholesterol in the arteries throughout the body.

• Coronary artery disease: If they experience chest pain and/or a heart attack due to a narrowed or blocked coronary artery preventing their heart from receiving the oxygen it needs, coronary angioplasty, also known as percutaneous coronary intervention, may be able to help.
• Peripheral artery disease: Angioplasty is a procedure used to treat atherosclerosis in the main arteries of your arms, legs, and pelvis.
• Carotid artery disease: Angioplasty can help clear blocked arteries in the neck. If they are not treated, the brain might not get enough oxygen, which could result in a stroke.
• Chronic kidney disease: The amount of oxygen that can reach their kidneys is impacted when plaque builds up in the arteries in their kidneys. A renal artery angioplasty may occasionally be helpful.

Risk

Serious complications following an angioplasty are uncommon, yet like any invasive procedure, there are occasional risks involved. In some cases, emergency coronary artery bypass graft surgery may be necessary during or shortly after angioplasty. The incidence of complications occurs in approximately one out of every 100 procedures, although this rate can vary depending on the individual patient’s circumstances.

The following risks of angioplasty:

• Negative reaction to the dye.
• Heart attack.
• Stroke.
• Abnormal heart rhythm.
• Blood vessel or kidney damage.
• Blood clots.
• Chest pain.
• Bleeding at the site of the catheter.
• If a stent is not placed into the artery, a recurrent blockage may happen.
• The requirement for open cardiac surgery due to a ruptured or completely closed coronary artery.

For older people or those with several blocked arteries, kidney disease, or heart failure, the risk of angioplasty consequences is increased. Depending on their particular health state, there can be additional dangers. Before the surgery, the patient should discuss any worries with their healthcare provider.

Procedure

A long, thin tube (catheter) is inserted into a blood vessel and directed to the blocked coronary artery during angioplasty. At the end of the catheter is a small balloon. The balloon is inflated at the heart artery’s constricted portion once the catheter has been inserted. This increases the space available for blood flow by pressing the plaque or blood clot up against the artery’s walls.

During the procedure, the healthcare provider use fluoroscopy. A unique kind of X-ray called fluoroscopy is like an X-ray. As a contrast dye travels through the arteries, it assists the healthcare provider in locating the blockages in the heart arteries (coronary angiography).

Before the procedure

The patient can ask questions as the healthcare provider guides them through the process. The patient will be required to sign a consent document authorizing the surgery. Carefully read the paperwork, and if anything is unclear, they are encourage to ask questions.

The patient will typically be asked to refrain from eating or drinking for a few hours prior to their angioplasty operation by their healthcare provider. Depending on their situation, they might anticipate that their angioplasty operation will last anywhere between a half-hour and a few hours.

The patient should disclose to the healthcare provider any allergies they may have as well as the medications they are taking. The healthcare provider will insert an IV in their arm to administer a medication that will make patients feel more relaxed. A medication that prevents the body from producing blood clots will also be injected into their IV.

Inform the healthcare provider if the patient ever experienced bleeding disorders or if they take any blood-thinning medications (anticoagulants or antiplatelet), aspirin, or other medications that alter blood clotting. Before the surgery, the patient might need to cease taking some of these medications. Ask the healthcare provider if the patient should continue taking aspirin and antiplatelet medications before the planned angioplasty procedure.

During the procedure

Angioplasty might be performed during the hospital stay. The specific procedures can differ based on your medical condition and the practices of your healthcare provider. Most patients who undergo an angioplasty and stent placement spend the night in the hospital under observation.

• A catheter or tube is inserted through the patient’s skin and into a blood vessel in the wrist or groin by the healthcare provider. They take medication to prevent them from sensing the tube’s insertion into their bodies.
• A healthcare provider guides the catheter (tube) through the patient’s blood arteries to reach the blocked or restricted coronary artery with the use of X-rays. When a dye is released through the catheter to make it easier to observe their blood vessels, they may experience a brief warm sensation.
• The healthcare provider will insert a wire and a second catheter (a balloon catheter) with a little balloon at the end after they have reached the troublesome location.
• When the balloon is inflated, the plaque is moved to the side of the artery wall and out of the way. This makes it possible for blood to pass through.
• A stent, a small hollow metal scaffold, is often placed by the healthcare provider next. The stent keeps the artery open following balloon removal because it is more durable than a balloon.

The stent, once expanded and securely positioned within your artery by your healthcare provider, remains in place for a long period following the completion of the angioplasty procedure.

A drug coating found on many stents assists in preventing the artery from once again becoming too narrow.

The healthcare provider may utilize a balloon that transfers its medication coating to the arterial wall if the patient has peripheral artery disease. After the balloon is taken out, the medication is left behind.

When the healthcare provider inflates the balloon, the patient could experience some discomfort, but this goes away when they deflate it. After the balloon has served its purpose, the healthcare provider deflates it. The balloon can be inflated multiple times at the same location or within another blocked artery elsewhere in your body.

The healthcare provider can assess the effectiveness of an angioplasty by comparing the blood flow before and after the procedure using an angiogram (X-ray images of the blood vessels).

After the procedure

The patient may be transferred to the recovery room for observation following the procedure or may be brought back to your hospital room. After the procedure, the patient will spend many hours in a flat position in bed. A nurse will keep an eye on their vital signs, the insertion site, as well as the affected arm or leg’s circulation and sensation.

A bandage will be applied to the area where the catheters were inserted into the patient’s skin after the healthcare provider removes the catheters. They might sense pressure being applied on the wound to stop the bleeding. Patient may later experience a bruising or soreness on the incision site.

As soon as the patient get home, they need to keep an eye out for any changes in temperature, edema, unusual pain, or bleeding at the insertion site. Small bruises are typical. Inform the healthcare provider if the patient notices a steady or significant quantity of bleeding at the site that cannot be stopped by a small dressing.

In case your physician employed a closure device at the insertion site, you will receive detailed instructions concerning the type of closure device used and how to manage the site’s care. The area will have a tiny knot or lump under the skin. Over a few weeks, the knot ought to gradually go away. The insertion site needs to be kept dry and clean. The patient will receive detailed bathing instructions from the medical staff. In general, wait until the skin has healed before using a bathtub, hot tub, or swimming.

Outcome

Patients recovering from angioplasty may require an overnight stay at the hospital or spend several hours there. Their healthcare provider will provide guidance on prescribed medications and advise on the recommended level of activity post-angioplasty. To leave the hospital after undergoing anesthesia, patients will need transportation arranged for them.

Patient are instructed to drink water and rest at home. Within the next 24 hours, the patient shouldn’t exert themselves. Following the angioplasty treatment, the patient might need to take blood thinners or aspirin. It’s crucial to take blood thinners exactly as suggested by the healthcare provider. A dose shouldn’t be missed. Patients should speak with their doctor before stopping their blood thinners if they feel they need to.

The patient should be able to drive and go back to work in about a week following the coronary angioplasty. The duration might vary for different types of angioplasty. Consult your healthcare provider for specific information.

After returning home, the patient has a follow-up appointment, but they should get in touch with their healthcare provider if:

• The area where the catheters were inserted into the patient’s skin is bleeding or infected.
• The area where the catheters were hurts or feels warmed up.
• They have a change in leg color.

Furthermore, it is essential for the patient to promptly notify their healthcare provider of any concerns or problems related to the anticoagulant medication they are required to take for a duration of three to twelve months following the placement of a stent.