Coronary angioplasty, also called Percutaneous Coronary Intervention, is a procedure used to open blocked arteries.
In angioplasty, a tiny balloon catheter is inserted into a blocked blood vessel to help open that blocked vessel and improve blood flow in the heart. Angioplasty is often performed with a small wire tube called a stent.
The stent helps open the artery and reduces the likelihood of it being re-narrowed. Most stents are coated with medication to help your blood flow. Bare metal stents may rarely be used.
Angioplasty can improve symptoms of blockage of the veins, such as chest pain and shortness of breath. Angioplasty is also often used during heart attack to quickly open a blocked artery and reduce the extent of damage to the heart.
Angioplasty is also used to treat the accumulation of fat plaques in the blood vessels of the heart. This accumulation of fat plaques is a heart condition known as “atherosclerosis”.
Effectivity of Angioplasty in the Treatment of the Disease
Angioplasty may be a solution to the following problems:
- You have tried different medications or changed your lifestyle but your heart health has not improved.
2- You have chest pain (angina) that becomes more severe.
- You have had a heart attack. Angioplasty can quickly open a blocked artery and reduce damage to the heart.
Angioplasty is not suitable for everyone. Depending on the gravity of heart disease and overall health, the doctor determines which option is better between coronary artery bypass surgery and angioplasty.
Requirements for Coronary Artery Bypass Surgery
In the following cases, you may need coronary artery bypass surgery:
- The main artery that carries blood to the left side of the heart is narrow.
2- The heart muscle is weak.
3- You have diabetes and multiple severe blockages in your arteries.
Possible Risks of Angioplasty
Angioplasty is a less risky way to open blocked arteries compared to coronary artery bypass surgery. But this method still carries many risks. The most common risks of angioplasty include:
1- Re-narrowing of the vessel:
When angioplasty is combined with stent insertion, the possibility of re- occlusion of the arteries is very low (less than 5%). The risk of re-narrowing of the vessel when using bare metal stents is about 10% to 20%.
2- Blood clots:
Blood clots can develop inside stents even after surgery. These clots can clog arteries and cause heart attacks.
It is important to take aspirin in combination with clopidogrel (Plavix), prasugrel (Effient), or another drug that helps reduce the risk of blood clots. Most doctors prescribe these drugs.
Talk to your doctor about how long to take these medications. Never stop taking these medicines without your doctor’s approval.
3- Bleeding:
You may have bleeding from the foot or arm at the catheter site. This usually leads to bruising. But sometimes serious bleeding occurs and may require a blood transfusion or surgery.
Other Rare Risks of Angioplasty
In the following, we will list other possible risks of angioplasty.
1- Heart attack: Although heart attack is rare, you may have a heart attack during an angioplasty.
2- Coronary artery damage: During surgery, the coronary artery may rupture. This condition may require emergency bypass surgery.
3- Your kidneys may be damaged during angioplasty and stent placement, especially if you already have kidney disease.
If you are at risk, your doctor may take the necessary measures to protect your kidneys, such as limiting the amount of contrast agent and ensuring that the body is hydrated during surgery.
4- Stroke: During angioplasty, plaques are destroyed if the catheters are released through the aorta. Blood clots can also form in catheters and go to the brain if loosened. Stroke is a very rare complication of coronary angioplasty. Therefore, blood thinners are used during angioplasty to reduce the risk of stroke.
5- Abnormal heart rate: During this operation, the heart may beat too fast or too slowly. These heart rate complications are usually short-lived.
Preoperative Angioplasty Procedures
Before the scheduled angioplasty, your doctor will check your medical records and examine you. You may need to take blood tests before undergoing screening tests for angiography, including chest x-rays and electrocardiograms,
Your doctor will also perform another test called angiography to see if your heart arteries are blocked and whether they can be treated with angioplasty. If your doctor notices a vascular occlusion during angiography, he or she may perform an angioplasty immediately after the angiography.
Your doctor will give the necessary instructions. They may recommend discontinuing certain medications, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAID) or blood-thinning medications before angioplasty.
Make sure to tell your doctor about all medications, including herbal supplements. You should usually fast for six to eight hours before angiography. In the morning before the operation, you can drink a few sips of water as prescribed by your doctor. Angioplasty usually requires one night and one day in the hospital, and you will not be able to return home the day after surgery.
During Angioplasty
Angioplasty is performed by a cardiologist and a team of nurses and specialized cardiovascular technicians in a special operating room called the Heart Catheterization Laboratory. Angioplasty is performed via the vein in your thigh, arm or wrist.
General anesthesia is not required for angioplasty. You will receive fluids, medications to sedate you, and blood thinners (anticoagulants) through a catheter (IV) in your hand or arm.
Your heart rate, pulse, blood pressure and oxygen level are monitored during the procedure. Your doctor will prepare various parts of your body, including your legs, arms, or wrists, with a disinfectant solution and place a sterile sheet over your body.
Your doctor will use local anesthesia to numb the location of the incision. Then a small, thin wire is inserted into the blood vessel.
With the help of X-rays, the doctor passes a thin tube (catheter) through your artery. A special dye is injected after the catheter is inserted. This allows the doctor to look inside the blood vessels and detect the blockage.
A small balloon or stent at the tip of the catheter is inflated at the site of the blockage, dilating blocked vessels. Once the vessel is pulled, the balloon is drained and the catheter is removed. If you have multiple blockages, this method may be repeated in each blockage.
Angioplasty may take several hours, depending on the difficulty and the number of obstructions and complications during the operation. You may feel pain in the area where the catheter is inserted. You may also experience mild pain when the balloon is inflated and the vessel is stretched. But you should not normally feel severe pain during the operation.
Stent Placement in Angioplasty
Most doctors who diagnose and perform angioplasty for a patient place a stent in a blocked vein during the procedure. A stent, which looks like a small coil, protects the walls of the arteries and helps keep the arteries from narrowing again after angioplasty.
The stent is inserted around the balloon at the tip of the catheter and is guided through the vein to the site of the blockage. During occlusion, the balloon is inflated and the stent expands into a spring and is placed inside the artery.
The stent stays permanently in the artery to keep it open and improve blood flow in the heart. In some cases, more than one stent may be needed to open the artery blockage. Once the stent is in place, the balloon catheter is drained and removed.
More x-rays (angiography) are taken so that the doctor can see how much blood is flowing in the opened arteries. After the stent is inserted, your doctor will prescribe medications such as aspirin, clopidogrel (Plavix), ticagreler (Brilinta) or prasugrel (Effient) to reduce the chance of blood clots forming on the stent.
Angioplasty Postoperative Instructions
If you have already planned for angiography, you will most likely only need one day to stay in the hospital, during which time your heart will be checked and you will be explained how to take the medication.
In most cases, people return to their normal life one week after angiography and can take care of their daily activities. When you get home, drink plenty of fluids to clear your body of the color of the contrast agent. Avoid intense exercise and heavy lifting at least one day after angiography. Ask your doctor or nurse about other activity restrictions.
Important Symptoms after Angioplasty
If you notice any of the following symptoms, talk to hospital staff immediately:
- The area where your catheter is placed begins to bleed or swell.
- You feel severe pain or discomfort in the place where your catheter is placed.
- Symptoms of infection such as redness, swelling or fever.
- Change in temperature or color of the foot or arm due to angiography
- Weakness
- Chest pain or shortness of breath
Blood Thinners
It is important to follow your doctor’s advice on taking blood-thinning medications such as aspirin and clopidogrel (plavix), Effient or similar medications regularly. Most people who have undergone angioplasty with or without stent placement should take aspirin for the rest of their life. Those who have had a stent need a blood-thinning drug such as clopidogrel for six months to a year.
Angioplasty Results
Coronary angioplasty increases blood flow through a vessel that is already narrowed or blocked. In general, your chest pain should decrease and you may be able to exercise better. Angioplasty and stenting do not mean that your heart disease is gone. You need to maintain a healthy lifestyle and take medication as prescribed by your doctor. Contact your doctor if you have symptoms similar to preoperative symptoms, such as chest pain or shortness of breath. Call the emergency room if chest pain becomes uncontrollable.
Measures to protect your heart after angioplasty
To protect your heart after angioplasty, you should:
1- Quit smoking.
- Lower your blood cholesterol levels.
- Follow a healthy, lean diet.
4- Have a healthy weight.
5-Control other conditions such as diabetes and blood pressure.
6- Exercise regularly.
7- Use medications as prescribed by your doctor.
Successful angioplasty also means you will no longer need coronary artery bypass surgery.
Benefits of Angioplasty
Angioplasty and stenting are used as less risky options for coronary artery bypass graft (CABG) surgery. Possible complications are less common in angioplasty because most patients do not require general anesthesia. In addition, in the angioplasty procedure, the recovery period is easier and patients return home after a night and a day in the hospital and resume their activities. Some of the most important benefits of angioplasty and stenting are:
- Angioplasty is performed after a heart attack, thereby it helps improve blood flow in your arteries and saves your life from death.
- Angioplasty can relieve and alleviate the symptoms of heart disease.
3- May reduce the risk of future stroke.
- Angioplasty can improve your overall performance.
Disadvantages of Angioplasty
While complications from angioplasty and stenting are far less common than coronary artery bypass graft surgery, patients should still be informed of the potential risks. The best thing you can do is make sure you follow all of your doctor’s instructions. It is better to know the following points to avoid possible complications.
1- Some patients may have an allergic reaction to their stent.
- Blood vessels may be damaged wherever the catheter is inserted.
- A vessel may be damaged or blocked.
- Blood clots can develop inside the stents.
- The more the main arteries are involved, the greater the risk of fatal heart attack or stroke during surgery.
- In case of failure of angioplasty, coronary artery bypass surgery may be required.
- Some patients may experience side effects from medications they take after angioplasty.
Angioplasty in Iran
More than 35,000 Iranian and foreign patients undergo coronary angioplasty in Iran every year. Iran is one of the best countries in the Middle East for cardiovascular angioplasty because it benefits from the presence of the best Iranian cardiologists. More than 70,000 cardiac surgeries are performed in Iran every year. Expert Iranian physicians with great experience perform these operations. Many patients from all over the world travel to Iran for coronary angioplasty. One of the reasons for this is Iranian specialists and surgeons who have performed successful operations.
Reasons for Choosing Iran for Angioplasty
The most important reasons for choosing Iran for angioplasty are:
1- Low cost of coronary angioplasty in Iran
2- Low cost of accommodation in Iran
3- Experienced specialists
4- High number of coronary angioplasty performed in Iran
