Coronary Angioplasty Overview

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A coronary angioplasty is a procedure to open an artery in the heart that has become narrowed. This allows better blood flow through the artery and to the heart muscle. It is often done with a balloon that is passed through a special catheter (tube).

Balloon Angioplasty © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor will likely do the following:

• Blood tests—especially if you are taking certain medicines (high blood pressure pills, blood thinners, heart medicines)
• 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:

• Talk to your doctor about your current medicines. Certain medicines may need to be stopped before the procedure, such as:

• Anti-inflammatory drugs (eg, ibuprofen ) for up to one week before surgery
• Blood-thinning medicines such as warfarin (Coumadin)
• Metformin (Glucophage) or glyburide and metformin (Glucovance)
• You should take aspirin before and during the procedure. Your doctor may also prescribe clopidogrel (Plavix) before the procedure.
• The night before, eat a light meal. Do not eat or drink anything after midnight.
• 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. It will numb the area of the groin or arm where the catheter will be inserted. You will also be given sedation and pain medicine through an IV. This will help to keep you comfortable during the procedure.

Description of Procedure

The area of the groin or arm where the catheter will be inserted will be shaved, cleaned, and numbed. A needle will be inserted into the artery. You will receive blood thinning medicines during the procedure. A wire will be passed through the needle and into the artery. The wire will be guided through until it reaches the blocked artery in the heart. A soft, flexible catheter tube will then be slipped over the wire and threaded up to the blockage.

The doctor will be taking x-ray pictures during the procedure to know where the wire and catheter are. Dye will be injected into the arteries of the heart. This will make a better view of the arteries and blockages

Once the blockage is reached, a small balloon at the tip of the catheter will be rapidly inflated and deflated. This will stretch the artery open. The deflated balloon, catheter, and wire will be removed.

Your doctor may also insert a small mesh tube called a stent into the artery where there was a narrowing. A stent acts to keep the artery open by providing support inside the artery.

After the procedure is done and the blood thinning medicines have worn off, the catheter will be removed. Pressure will be applied for 20-30 minutes to control bleeding.

A bandage will be placed over the groin or arm area.

How Long Will It Take?

30 minutes to three hours

Will It Hurt?

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

Average Hospital Stay

The usual length of stay is overnight. Speak to your doctor to see if this is an option in your case.

Post-procedure Care

At the Hospital

You will likely need to lie still and flat on your back for a period of time. A pressure dressing may be placed over the area where the catheter was inserted to help prevent bleeding. Or, a vascular closure device may be used to seal the arterial puncture site. This will allow earlier movement and hospital discharge. It is important to follow the nurses' directions.

At Home

• You may be sent home on blood-thinning therapy. This may include one or more of the following:

• Aspirin
• Warfarin
• Clopidogrel
• Prasugrel (Effient)

• Ice may help decrease discomfort at the insertion site. You may apply ice for 15-20 minutes each hour, for the first few days.

• To lower your risk for further complications of heart disease, you can make lifestyle changes. This includes eating a healthier diet, exercising regularly, and managing stress.

• Be sure to follow your doctor’s instructions .

Sometimes the procedure is not successful or the artery narrows again. You may require repeat angioplasty or coronary artery bypass grafting (CABG).

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:

American College of Cardiology Task Force. American College of Cardiology/Society for Cardiac Angiography and Interventions clinical expert consensus document on cardiac catheterization laboratory standards: a report of the American College of Cardiology Task Force on clinical expert consensus documents. J Am Coll Cardiol. 2001 Jun 15;37(8):2170-2214.

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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 January 12, 2009.

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

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