What Is Angioplasty?

The heart is an amazing muscle. It beats an average 100,000 times daily to pump almost 2,000 gallons of blood. To do this amount of work, the heart muscle needs a constant flow of oxygen and nutrients from the bloodstream. This is supplied by the coronary arteries, which supply the heart with the energy it needs to function. 

As we age, our coronary arteries become lined with fatty material, or plaque, that can interfere with blood flow. This process is called atherosclerosis. This can starve the heart of the oxygen-rich blood we need to survive. When the lack of blood flow to your heart reaches a critical stage, you could suffer a heart attack.

One symptom of a blocked artery is a type of chest pain called angina. You feel this pain when you exercise or otherwise exert yourself.

When you feel chest pain from blocked arteries, you might see an interventional cardiologist for treatment. This specialist might perform a balloon angioplasty to open the blocked artery. He or she may also place a device, called a stent, in your artery. The stent is a metal mesh tube that, when expanded, is about the size of a spring in a ballpoint pen. The stent will help keep your artery open with less chance of it becoming blocked again, than if you had a balloon angioplasty alone. This procedure helps to restore normal blood flow to your heart.

When you first see the cardiologist, he or she will order blood tests, take an electrocardiogram and other tests, and discuss the catheterization procedure with you.

During the procedure

For the procedure, you will be taken to a cardiac catheterization laboratory with special computers and X-ray equipment. A health care provider will sedate you, and the cardiologist will numb the skin at your groin or at your wrist, depending on the approach being used. He or she will insert a short, soft tube, called a catheter, into a blood vessel in your groin or at your wrist. The tip of the catheter will be moved up your artery and aorta to the opening of your coronary arteries, which average an eighth-inch in diameter.

Your cardiologist will inject dye through the catheter and into your coronary arteries (called an angiogram). The dye will help your doctor to see whether there are any blockages obstructing the blood flow. If a blockage is located, your cardiologist will insert a soft wire, carrying a balloon and a stent, into the catheter and pass them to the blockage. Once the balloon has reached the narrowed section of your coronary artery, the cardiologist will inflate the balloon at high pressure. This pressure will crush the blockage against the walls of your artery, much like pushing logs to the banks of a river. Once the narrowed area is pushed open, your doctor places the stent within the newly cleared area. The stent is expanded tightly against your artery wall to hold the artery open. You may feel chest discomfort or pain for a few seconds when the balloon is inflated. The entire procedure usually takes 45 minutes to an hour.

After the procedure

You will stay in the hospital for several hours or overnight. You will be asked to lie still while the blood vessel where the catheter was inserted begins to heal. During that time you will be checked for changes in your heart rate and blood pressure, and for any bleeding. You will be able to return to work about a week after leaving the hospital. You will need to make a follow-up appointment with your doctor.

Risks of the procedure

Serious complications are not common. Some that can occur include:

  • Bleeding or damage to the blood vessel where the catheter was inserted

  • Allergic reaction or kidney damage from the dye

  • An irregular heart rate

  • The need for emergency heart surgery

  • A heart attack, or a stroke 

Because the stent is a “foreign body,” your artery is at some increased risk of developing a blood clot and therefore closing. Some modern stents are coated with medication that reduces the likelihood of your coronary artery from becoming blocked again. Your doctor will instruct you to take aspirin and one of several anti-clotting medications, such as clopidogrel, prasugrel, or ticagrelor, to prevent clotting. You should take these medications for 6 to12 months. Your cardiologist will advise you about how long you will need to take these medications. During that time, a smooth layer of tissue that normally lines the inside of arteries and veins will grow to completely cover the inside surface of the stent. Once this process is finished, you will no longer need the anti-clotting drug. 

After the angioplasty, the artery may become blocked again. 

Lifestyle changes

Your doctor will talk with you about how to improve your lifestyle. Lifestyle changes can extend the benefits of angioplasty and improve your health in general. These changes include weight loss, eating a healthy diet with no more than 30% calories from fat, eating less saturated fat, avoiding fried foods, adding a balanced exercise program, practicing stress reduction, and quitting smoking. If you have diabetes, you should maintain a healthy blood sugar level through proper diet, exercise, and medication. If you have high blood pressure (also called hypertension) or high cholesterol, you should maintain a normal blood pressure or cholesterol level through proper diet, exercise, and medication.