What is angioplasty?

Angioplasty is also called percutaneous transluminal coronary angioplasty (PTCA), coronary artery balloon dilation or balloon angioplasty. Angioplasty increases the flow of blood and oxygen through a clogged heart artery without surgery. A physician uses an instrument called a catheter equipped with a tiny balloon to widen the opening in a partially blocked artery.

Why would I need angioplasty?

Angioplasty may be used when blood flow in one or more of your coronary arteries is restricted because of the gradual accumulation of cholesterol and fibrous tissue within plaques inside the arteries. The thickening of the inside walls of your arteries, called atherosclerosis, can lead to chest pain and a heart attack.

Angioplasty is an alternative to coronary artery bypass, which requires open-heart surgery. Angioplasty can also be used to open blocked arteries in your brain, neck, kidney, hip, abdomen, thigh and knee.

How do I prepare for angioplasty?

Your doctor may have you take aspirin or other anti-clogging medication before the procedure to reduce the risk of blood clots. You’ll also be told not to eat or drink after midnight before the procedure. Check with your doctor to see if you should take your routine medications on the day of the procedure. An EKG (electrocardiogram), chest x-ray and blood tests are done before this procedure.

How is angioplasty performed?

The procedure is usually done in a hospital. An intravenous line is inserted in your arm before the procedure. You are awake but given a sedative, and your heart and vital signs are continuously monitored with special equipment attached to you beforehand.

After you receive a local numbing medication, a catheter is inserted into the femoral artery in your groin or, in some instances, in the brachial artery at the inside region of your elbow. The catheter is threaded through your blood vessels. Once the catheter is positioned, a contrast dye is injected, allowing the physician to get pictures of the inside of your arteries. The exact areas and amount of blockage can be determined. This is called an arteriogram (or angiogram) and serves as a road map for the physician when reducing the blockage.

The physician then inflates a tiny balloon (balloon angioplasty) to compress the plaque against the arterial walls. More and more physicians are choosing to insert a small wire mesh tube (a stent) into the artery after angioplasty, to help keep it open over the long term. Another technique, laser angioplasty, employs a laser that emits pulsating beams of light to vaporize the plaque.

Once the procedure is completed, the catheter is removed and pressure is applied to the groin for 15 to 20 minutes. You are observed in a recovery room for an additional 30 to 60 minutes.

What are the risks and complications?

You may feel some pressure and discomfort during the procedure. In about 20 percent of patients, the artery narrows again within six months and angioplasty may have to be repeated. Serious complications, such as a heart attack, sudden cardiac death or emergency bypass surgery are rare.

However, if the treated artery becomes blocked again shortly after the procedure (a condition called abrupt vessel closure), you may need emergency bypass surgery.

What can I expect after the procedure?

You’ll likely feel groggy from the sedative, and may have bruising and soreness at the site of insertion. Medical personnel continue monitoring your vital signs, and you lie still with your legs straight for six to eight hours. You are given fluids and food after returning to your room. Notify the nurse or doctor immediately if you develop any chest discomfort.

You’ll likely be discharged from the medical facility after 24 hours, and be scheduled for a follow-up visit with your cardiologist.

Typical post-procedure instructions include no lifting of heavy objects, strenuous exercise or sexual activity for several days, caring for the catheter incision, and taking medication. Most people can return to work and normal activities in one or two days. Contact your doctor if you have bleeding or pain at the site of the insertion.

What are the alternatives to angioplasty?

The decision on how to best treat clogged coronary arteries depends on many factors. A patient’s age, underlying medical problems, and area and extent of blockage are considered before a treatment plan is developed. In general, angioplasty is less risky than the more invasive coronary bypass surgery, and it is often attempted first when the areas of plaque can be reached with a balloon catheter.