Sarah Lewis, PharmD
What is coronary angioplasty?
Coronary angioplasty is a procedure to widen or open a blocked or narrowed coronary artery. Coronary arteries are blood vessels that supply blood to your heart muscle. Coronary angioplasty improves blood flow to your heart muscle. It is a treatment for coronary artery disease (coronary heart disease) caused by atherosclerosis.
Atherosclerosis is a buildup of fatty deposits on coronary artery walls. The deposits harden into a substance called plaque. As plaque builds on coronary artery walls, the artery narrows and hardens. Eventually, a serious blockage can occur. This stops blood from flowing freely through the coronary artery.
Atherosclerosis can also cause a blood clot to form. A blood clot can totally block the coronary artery. Atherosclerosis increases your risk of heart attack and other heart problems. Some problems are serious and even life threatening.
Coronary angioplasty is only one method of treating narrowed or blocked coronary arteries. Discuss all your treatment options with your doctor to understand which options are right for you.
Types of coronary angioplasty
The types of coronary angioplasty procedures include:
Atherectomy involves inserting a catheter into a vessel in your groin or arm. Your doctor will guide the catheter to the coronary artery that needs treatment. He or she will scrape or drill away the plaque to open the coronary artery.
Balloon coronary angioplasty is a similar procedure. It involves inserting a catheter into a vessel in your groin or arm. Your doctor will feed or guide the catheter to the coronary artery that needs treatment. Your doctor will expand a balloon on the tip of the catheter to open the coronary artery.
Laser coronary angioplasty also involves inserting a catheter into a vessel in your groin or arm. Your doctor will insert the catheter to the coronary artery that needs treatment using a guide wire. A laser on the catheter tip destroys the plaque and opens the coronary artery.
Your doctor will look at several factors to decide which type of procedure or combination of procedures to use. This includes the location, size, shape, and hardness or softness of the plaque.
Other procedures that may be performed
Your doctor may recommend one or more other procedures to diagnose or treat certain conditions. These include:
Coronary angiography makes images (called an angiogram) of your coronary arteries. It can be performed during a coronary angioplasty.
Minimally invasive bypass grafting makes a new route for blood to flow around narrowed coronary arteries. The new route is created from healthy vessels taken from other places in your body. You may have general anesthesia if your doctor combines this surgery with angioplasty.
Stenting involves inserting a metal tube (stent) inside your coronary artery and expanding it. The stent remains in place to keep the artery open after angioplasty.
Why is coronary angioplasty performed?
Coronary angioplasty treats coronary artery disease (CAD). CAD is a narrowing of the arteries that supply your heart with blood and can lead to heart attack. Coronary angioplasty can reduce the risk of death in some people with CAD.
You may be a candidate for coronary angioplasty if:
You have angina (chest pain) and shortness of breath with mild or moderate exertion. Angina and shortness of breath are symptoms of CAD.
You have had a heart attack.
You have had a previous coronary bypass graft that has closed or narrowed.
You have only one or two blocked or narrowed coronary arteries. If more coronary arteries are involved, your doctor may recommend coronary artery bypass grafting instead of angioplasty.
You have plaque that your doctor can reach with a catheter and treat with angioplasty.
Your symptoms do not respond to medications.
Your symptoms interfere with daily activities.
Who performs coronary angioplasty?
The following specialists perform coronary angioplasty:
Cardiologists specialize in diagnosing and treating conditions of the heart and its blood vessels.
Interventional cardiologists specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging.
Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.
How is coronary angioplasty performed?
Your coronary angioplasty will be performed in a cardiac catheterization laboratory (often abbreviated “cath lab”). A cath lab is a room in a hospital or clinic that has special X-ray machines and video screens. Your doctor uses this special equipment during your procedure. The procedure takes 30 minutes to a few hours, depending on your condition. It generally includes these steps:
You will dress in a patient gown and lie on a procedure table.
Your team will insert an intravenous (IV) line to provide fluids and medications.
Your team will attach devices to monitor your heart rate, blood pressure, and other functions.
You will have blood tests to test kidney function and blood clotting.
You will have medication (a light sedative) to make you drowsy and relaxed. Some patients have deeper sedation or anesthesia through the IV. In this case, you are more relaxed and unaware of the procedure and may not remember it. General anesthesia is generally used when angioplasty is combined with a larger procedure.
You may have medication to prevent blood clots from forming in your arteries. You may also have medications to prevent spasms in your arteries during the procedure.
Your physician will determine the location to insert the catheter. The procedure team will shave and clean the area before your doctor numbs it and makes a small incision.
Your doctor will insert a catheter and guide wire through the incision. The catheter is fed into the coronary artery that needs angioplasty. X-rays help guide the wire to the exact location.
Your doctor will inject a contrast agent through the catheter. This improves the quality of the X-ray images.
Your doctor will open or widen your coronary artery using X-ray guidance. Your doctor may also place a stent in the artery to keep it open.
Your team will take additional X-rays to verify that blood is flowing as expected.
Your doctor will remove the catheter and close the small catheter site. You will need to lie with your leg or arm straight for six hours following the procedure. This decreases the risk of bleeding from the incision.
Will I feel pain?
Your comfort and relaxation are important to you and your care team. You may feel a pinch or pin prick pain during the IV placement and brief stinging during injection of the local anesthetic. You may also feel pressure as your doctor makes the incision and inserts the catheter. It is common to feel some discomfort when the balloon is inflated to open your artery.
You will have enough sedative or anesthetic medications keep you comfortable. Tell your doctor if you are uncomfortable in any way.
What are the risks and potential complications of coronary angioplasty?
Complications after coronary angioplasty are uncommon, but any procedure involves risks potential complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery.
Complications of coronary angioplasty include:
Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing
Blood clots within your arteries
Damage to an artery from the catheter or balloon
Exposure to ionizing radiation, which may be harmful in excessive doses
Kidney injury from the contrast agent, especially if you have kidney problems
Recurrence of artery narrowing or blockage
Sudden vessel occlusion. This is a total blockage of the artery at the site of the angioplasty. Sudden vessel occlusion is a rare complication. It typically occurs within 24 hours of angioplasty and requires immediate medical attention.
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor if you have kidney disease or diabetes
Notifying your doctor right away of any concerns, such as bleeding, fever, or increase in pain
Telling your doctor or radiologist if you are nursing or there is any possibility of pregnancy
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my coronary angioplasty?
You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome.
You can prepare for coronary angioplasty by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Following instructions about eating and drinking before angioplasty
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. With certain types of contrast dyes, you should not take metformin (Glucophage), an oral medication for diabetes, for 48 hours before and after your coronary angiography. You doctor will give you instructions about taking your medications.
Questions to ask your doctor
Preparing for coronary angioplasty can be stressful. It is common for patients to forget to some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before coronary angioplasty and between appointments.
It is also a good idea to bring a list of questions to your appointment. Common questions include:
Why do I need coronary angioplasty? Are there any other options for treating my condition?
What type of angioplasty will I have?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How do I take my medications?
How will you treat my pain?
What other tests or treatments might I need?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my coronary angioplasty?
Knowing what to expect after coronary angioplasty can help you get back to your everyday life as soon as possible.
How will I feel after coronary angioplasty?
You may have mild drowsiness from the sedative medications after coronary angioplasty. It is unlikely that you will have pain. It is common to experience mild tenderness and bruising at the catheter incision site. Tell your doctor if you are uncomfortable.
Your activities will be restricted following coronary angioplasty. You may need to lie down with your arm or leg straight for up to six hours following coronary angioplasty. You may also have new medications after angioplasty to help prevent blood clots and spasms in your arteries. Follow your doctor’s instructions for eating, drinking, resting, and taking medications after coronary angioplasty.
When can I go home?
You probably need to stay overnight in the hospital for observation after coronary angioplasty. This is true even if you did not have general anesthesia. You will go home when your doctor decides that your condition is stable.
You will need a ride home. You will need to rest for a few days. Your doctor will provide specific instructions about returning to your activities. Patients generally need to avoid heavy lifting and strenuous exercise for about 10 days after coronary angioplasty.
When should I call my doctor?
It is important to keep your follow-up appointments after coronary angioplasty. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Color change in the arm or leg that was used to insert the catheter
Numbness or a feeling of coolness in the arm or leg that was used to insert the catheter
Pain that is not controlled by your pain medication
Unusual swelling, redness or warmth around your incision
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