Alternative Names: Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Cardiac angioplasty; PTCA; Percutaneous transluminal coronary angioplasty; Heart artery dilatation

Description:

Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis.

If the blockage is not too severe, an angioplasty procedure can be used to open the artery. Traditional angioplasty involves the use of�a balloon catheter�--�a small, hollow, flexible tube that has a balloon near the end of it.

Before the balloon angioplasty procedure begins, you will be given some pain medicine. Occasionally, blood thinning medicines are also given to prevent formation of a blood clot.�

You will lay down on�a padded�table. The health care provider will make a small cut on your body, usually near the groin,�and insert the catheter�into an artery.�You will be awake during the procedure.

The health care provider will use x-rays to look at your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps reveal any blockages in the vessels leading to the heart. The balloon catheter is moved�into or near the blockage, and the balloon on the end is blown up (inflated). This�opens the blocked vessel and restores proper blood flow to the heart.��

In almost all cases, a device called a stent is also placed at the site of narrowing or blockage in order to keep the artery open. A common type of stent is made of self-expanding, stainless steel mesh.

In a small number of�cases, a special catheter with a small, diamond tip is used to drill thru hard plaque and calcium that is causeing the blockage. This is called rotational atherectomy.

Indications:

Angioplasty may be performed to treat:

• Persistent chest pain (angina)
• Blockage of one or more coronary arteries
• Residual obstruction in a coronary artery during or after a heart attack

Risks:

The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

The risks for any surgery are:

• Bleeding
• Infection

Additional risks include:

• Complete obstruction of blood flow to an area of the heart (risk�is less than 1%)
• Damage to a valve or blood vessel
• Stroke (less than 1%)
• Arrhythmia
• Bleeding in area where the catheter was inserted
• Kidney failure (1% risk;�those who have kidney functioning problems before the procedure are at highest risk)
• Allergic reaction to the x-ray dye
• Death

Expectations after surgery:

This procedure greatly improves blood flow through the coronary arteries and the heart�in about 90% of patients. It�may eliminate the need for coronary artery bypass surgery (CABG).

The result is relief from chest pain, and improved exercise capacity. In 2 out of 3 cases, the procedure is considered successful with complete elimination of the narrowing or blockage.

This procedure treats the condition, but does not cure the cause. Re-narrowing may occur, which may or may not require another procedure. However, the introduction of stents �coated with medicines to prevent narrowing (drug-eluting stents) has helped reduce the rates of repeated angioplasty.

You should diet, exercise, stop smoking (if you smoke), and reduce stress to help lower�your chances of re-narrowing. The health care provider may prescribe a medication, such as a statin drug, to help lower your cholesterol.

Aspirin and the anti-platelet medicine clopidogrel (Plavix) are usually given after coronary angioplasty and stenting. It is very important to take the medicines exactly as recommended by the health care provider. Failure to do so can result in�blood clotting in the�stent (stent thrombosis) and a heart attack.�

If the arteries are not sufficiently widened by angioplasty or the blockages are too severe to be treated by angioplasty,�CABG may be recommended.

Convalescence:

Usually, the average hospital stay is less than 2 days. Often times,�an overnight hospital stay is not required at all.

In general, persons who have angioplasty are�able to�walk around within 6 hours after the procedure. Complete recovery takes a week or less. You should keep the area where the catheter was inserted dry for 24 to 48 hours.