Coronary Angioplasty
all information

Coronary Angioplasty

(Balloon Angioplasty; Percutaneous Transluminal Coronary Angioplasty [PTCA]; Percutaneous Coronary Revascularization )

En Español (Spanish Version)

Click here to view an animated version of this procedure.

Definition

A coronary angioplasty is a procedure to open an artery and allow better blood flow. It is done with a balloon delivered through a special catheter.

Balloon Angioplasty

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Parts of the Body Involved

  • An artery in the groin or arm
  • Arteries leading to the heart
  • Coronary (heart) arteries

Reasons for Procedure

To open a blocked artery in the heart to allow more normal blood flow through that artery.

It has been used for many patients after a heart attack . The blocked artery that led to the heart attack can be opened even if it occurred days or weeks before.

Risk Factors for Complications During the Procedure

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Blood tests, especially if you are taking certain medications (high blood pressure pills, blood thinners, heart medications)
  • Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Chest x-ray

In the days leading up to your procedure:

  • The night before, eat a light meal and do not eat or drink anything after midnight
  • You may be asked to shower with a special antibacterial soap the morning of the procedure
  • Arrange for a ride to and from the procedure
  • Arrange for help at home after returning from the hospital

Anesthesia

Local anesthetic will be given to the area of the groin or arm where the catheter will be inserted.

Description of the Procedure

The area of the groin or arm where the catheter will be inserted is shaved, cleaned, and numbed. The doctor inserts a needle into the artery. A wire is passed through the needle. The wire is guided through the arterial system until it reaches the blocked artery in the heart. Next, a soft, flexible catheter tube is slipped over the wire and threaded up to the blockage.

This procedure is monitored using a continuous x-ray image called fluoroscopy. Dye can be injected through the catheter into the arteries of the heart to better see the arteries and the blockages. Once the blockage is reached, a small balloon at the tip of the catheter is rapidly inflated and deflated, stretching the artery open. The deflated balloon, catheter, and wire are then removed, and a bandage is placed over the groin or arm area. Depending on the size and location of the blockage, your doctor may insert a small mesh tube, called a stent (a metallic scaffold that is inserted into a vessel to prevent its narrowing). This will help to prevent the artery from narrowing in the future.

After Procedure

If the catheter was inserted through your groin, you will need to lie flat on your back, keeping your leg still for about six hours. You may have a sandbag placed over the area to put pressure on the artery and prevent bleeding. If the catheter was inserted in your arm, you will be required to keep your arm on an arm board.

How Long Will It Take?

30 minutes to three hours

Will It Hurt?

The local anesthetic should numb the area where the catheter is inserted. You may feel a burning sensation when the area is anesthetized. You may also feel pressure when the catheters are manipulated. Some people have a flushing feeling or nausea when the dye is injected. You may feel some chest pain during inflation of the balloon.

Possible Complications

  • Bleeding at the point of the catheter insertion
  • Perforation of the artery in the heart, requiring immediate emergency bypass surgery
  • Spasm of the artery
  • Heart arrhythmia (abnormal heart beats)
  • Heart attack
  • Stroke
  • Allergic reaction to x-ray dye
  • Blood clots may form and travel through your arteries, causing stroke, heart attack, kidney damage, breathing difficulties, damage to an arm or leg, or intestinal damage
  • Infection
  • Narrowing of an artery requiring additional procedure or surgery

Average Hospital Stay

0- 2 days

Postoperative Care

  • You may be sent home on blood thinning therapy, either aspirin or another medication, such as warfarin or agents that inhibit platelets clumping (eg, Plavix )
  • To minimize pain and soreness, you can place ice at the insertion area for 15-20 minutes each hour, for the first two days
    • After this time, switch to a heating pad or hot water bottle
  • To lower your risk of recurrent blockages in your coronary arteries and further heart disease make lifestyle changes including, eating a healthier diet, exercising regularly, and managing stress
  • You may need to undergo periodic stress tests to monitor for any early-on recurrent blockages

Outcome

Your artery should be more open. This will allow better blood flow to feed the heart muscle. It may mean that you'll no longer have the chest pain or that your tolerance for exercise will increase. Sometimes the procedure isn't successful or the artery narrows again. You may require repeat angioplasty or coronary artery bypass grafting (CABG).

Other techniques that do not use balloon for opening of the arteries have become more commonly used.

In a review of 23 studies, patients who received CABG had more angina relief and less need for another, similar procedure than those who received percutaneous coronary intervention (PCI). PCI involves techniques using balloon angioplasty or coronary stenting . *

Call Your Doctor If Any of the Following Occurs

  • Chest pain
  • Your arm or leg becomes painful, blue, cold, numb, tingly, swollen, or increasingly bruised
  • Cough, shortness of breath, chest pain, or severe nausea, or vomiting
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the insertion site in the groin or arm
  • Signs of infection, including fever and/or chills

RESOURCES:

American Heart Association
http://www.americanheart.org/

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/

Heart Healthy Kit: Public Health Agency of Canada
http://www.phac-aspc.gc.ca/

References:

Angioplasty. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Angioplasty/Angioplasty_WhatIs.html . Accessed July 21, 2008.

Baim D, Grossman W. Coronary Angioplasty, in Cardiac Catheterization, Angiography, and Intervention . 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2000.

Cardiac Procedures and Surgeries At-A-Glance. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3054086 . Accessed July 21, 2008.

Hochman J, Lamas GA, Buller CE, et al. Coronary intervention for persistent occlusion after myocardial infarction. N J Eng Med. 2006;355:2395-2407. Available at: http://content.nejm.org/cgi/content/abstract/NEJMoa066139 . Accessed November 14, 2006.

Kasper DL, et al. Harrison's Principles of Internal Medicine . 16th ed. New York, NY: McGraw-Hill Professional;2004.

Smith SC, Dove JT, Jacobs AK, et al. ACC/AHA guidelines of percutaneous coronary interventions. J Am Coll Cardiol . 2001;37:2215.

Weaver WD. Heart Disease: A Textbook of Cardiovascular Medicine . 5th ed. Philadelphia, PA:WB Saunders; 1997.

Updated Outcome section on 11/7/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Bravata DM, Gienger AL, McDonald KM, et al. Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007 Nov 20. [Epub ahead of print]



Last reviewed November 2007 by J. Peter Oettgen, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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