Coronary angioplasty and stenting
What is the heart and how does it work?
The heart is a muscle inside your chest, which has valves and four chambers inside. The heart pumps blood around your body to your vital organs. It’s important that your organs receive blood filled with oxygen to keep them alive and working well. Your heart is wrapped in vessels called the coronary arteries, which provide your heart with the oxygen it needs to work properly.
What is coronary angioplasty and stenting?
The coronary arteries around your heart can become clogged and hardened with cholesterol (fat) over time. This can narrow or even block the arteries.
Coronary angioplasty is a procedure to open these vessels back up with a small inflatable balloon. Often, angioplasty is followed by stenting. This is when a small, metal tube is inserted into the vessel to keep it propped open. Stents are left in place for years to make sure the artery stays open, to make sure your heart gets a healthy supply of blood.
Why do I need a coronary angioplasty and stenting?
Angioplasty is the best test doctors have to look at the build-up of cholesterol in your coronary arteries, and it is commonly used to identify blockages and find out whether they need a stent.
Angioplasty and stenting can be performed when someone has symptoms of coronary artery disease, but isn’t acutely unwell. These are symptoms like chest pain and shortness of breath.
Coronary angioplasty and stenting is an excellent way to quickly treat a heart attack. When someone has a heart attack, one or more of their coronary arteries is blocked by a build-up of cholesterol. Angioplasty pushes this build-up out of the way, and stenting ensures the artery remains open.
What happens during the procedure?
This procedure happens in hospital. After cleaning and numbing the area, a special needle catheter (tube) is inserted into an artery in either your wrist or groin. The catheter is guided through your arteries towards your heart. Once the catheter is in the right place, contrast (dye) is injected through the tube and the doctor will look at X-ray scans of your heart to assess whether any of the vessels have narrowed or clogged shut.
If there is a significant build-up of cholesterol, a special balloon on the end of the catheter is inflated with air to expand inside your coronary artery. It compresses this cholesterol to the sides of the artery and increases the width of the artery, so blood can flow through more easily.
If your doctor thinks it’s necessary, a metal stent is inserted into your artery with the catheter. It’s expanded with a balloon to prop the artery open and stays in place for years. Most stents are coated with certain drugs to make sure blood doesn’t stick to it and form clots or other blockages. Once the stent has been placed, the catheter is removed from your wrist or groin and the area is covered with a clean dressing.
What are the alternatives?
The most common alternative to coronary angioplasty and stenting is a coronary artery bypass graft (CABG). This is when vessels are taken from elsewhere in your body and connected to your coronary arteries to provide better blood flow and oxygen supply to your heart. This is open heart surgery, and takes much longer, requires you to go on bypass, and has higher risks. Like angioplasty and stenting, open heart surgery is an excellent treatment for a heart attack, and treats coronary artery disease effectively.
Non-operative management is an option for relief of symptoms, however it will not cure your coronary artery disease. A combination of medications and lifestyle changes can be helpful if you choose not to have any procedure, and your doctor can discuss these with you.
What are the risks of angioplasty and stenting?
- Bruising and soreness at the injection site
- Reaction to the contrast used
- Blood clots inside the stent
- Re-narrowing of the coronary arties
- Infection where the needle is inserted into your wrist or groin
- Bleeding or damage to your blood vessels
- Abnormal rhythms of the heart, which may require pacemaker insertion
- Kidney injury
- Blocked coronary artery
What do I need to do after the procedure?
You might be asked to stay in hospital overnight after your angioplasty and stenting so the doctors and nurses can keep an eye on your recovery. You won’t be able to drive for two days so should arrange to have someone drive you home.
You will likely have bruising and pain where the needle was inserted into your wrist or groin and this can last up to two weeks. Try to avoid bathing or swimming for five days. You can resume normal activities within two days but avoid heavy lifting for a week. Visit your doctor straight away if you notice pain, oozing, numbness, coldness or persistent bleeding from the injection site.
If you had a stent inserted, you will need to take a blood thinning medication. Most often, it will be a combination of Aspirin and another anti-platelet medication like clopidogrel (Plavix). You will need to take this medication long-term.
Whilst coronary angiography and stenting is an excellent way to treat coronary artery disease, lifestyle changes are an essential part of your treatment. Your doctor will prescribe medications that suit your needs. It’s important to continue gently exercising as much as you can tolerate – walks are a great daily activity. You are also strongly encouraged to get involved with cardiac rehabilitation after your procedure as it has been shown to significantly improve survival.