Coronary Angioplasty: 8 Things Doctors Want You to Know

The arteries of the heart are critical to keeping blood pumping through the body, so when they’re blocked, it’s cause for concern. Depending on whether they’ve narrowed or have become entirely obstructed, symptoms can range in severity from chest discomfort to a heart attack (although some people do not notice symptoms at all). How do you open an artery that’s run out of room? One way is with a coronary angioplasty, a procedure involving a tube, a tiny balloon, and sometimes a wire mesh known as a stent. We asked cardiologists what they want all their patients to understand about angioplasty, stenting and stenosis.

The term ‘coronary angioplasty’ is a little dated because it refers mainly to the balloon part of the procedure. “We don’t generally do just balloons anymore, we do angioplasty and stenting,” says Paul Pagley, MD, a cardiologist who practices at Heart Hospital of Austin. “Almost everybody ends up with a stent,” he says. “Today we use the term PCI, or percutaneous coronary intervention,” says Armin Zadeh, MD, director of the Cardiac CT Program at The Johns Hopkins Hospital. “It refers to a procedure where we advance a catheter, or long tube, usually through the arm and into the arteries of the heart, threading the wire through and inflating a balloon to open the artery. Then we place the stent, essentially a wire mesh that acts as a cage to keep the artery open after we remove the balloon.”

“Stents are small, metal, mesh tubes we use to treat blockages in the coronary arteries,” says Robert J. Timmermans, MD, director of interventional cardiology at Westchester Medical Center. “You can think of a stent as similar to the spring inside of a ballpoint pen. Now, we almost exclusively use stents that are coated with a medication (known as drug-eluting stents) that reduce scar tissue formation within the stent. These stents have been proven superior to stents without the drug coating (called bare-metal stents).”

Drug-eluting stents may have decreased the incidence of scar tissue forming around the stent, but there is still a risk of blood clots after PCI. “Stenting is a simple procedure, and patients are usually back to their full activities in 48 to 72 hours,” says Dr. Pagley. “But after a stent is placed, it is extremely important to take the blood thinning medications that are prescribed. That’s the number one thing to know.” “What we call blood thinners don’t actually thin the blood, but they do make it less ‘sticky,’ which reduces the risk of clots and sudden closure of the arteries,” explains Dr. Zadeh.

“For patients who have stable chest pain [chest pain with activity or stress] and are considering an elective [PCI] procedure, I lean on the conservative side [and recommend lifestyle modification and medication],” says Dr. Zadeh. “The evidence for this procedure is most consistent for relieving symptoms. It doesn’t change the risk of heart attack or overall mortality. If your symptoms are not bothersome, there is no overwhelming benefit to balance the risks and cost. Medication itself can be quite effective in controlling symptoms.” And, for patients with more serious coronary artery issues, coronary angioplasty may not be appropriate. “Some patients, particularly diabetics, may have multiple blockages in several of the major heart arteries, and in this case, the patient may benefit more from [coronary artery] bypass graft surgery,” says Dr. Timmermans.

PCI isn’t right for every patient with cardiovascular disease, but in an acute setting, it’s often the procedure of choice. “Stents have been proven to be the best treatment for a patient having a heart attack in which one of the coronary arteries is usually totally blocked,” says Dr. Timmermans. Patients with severe blockages or symptoms that negatively affect their quality of life may be interested in elective PCI. “In a majority of situations, the goal of treatment of coronary artery stenosis with stents is to improve a patient’s symptoms and quality of life,” says Luke C. Kohan, MD, of Sentara Cardiology Specialists. “Elective angioplasty and PCI doesn’t reduce a person’s risk of heart attack or death, but it certainly can help people feel better and enjoy life.”

“The reality is that a stent can treat an area of stenosis in the artery, but the underlying process of atherosclerosis continues,” says Dr. Kohan. “This isn’t a cure for blocked arteries or cardiovascular disease,” says Dr. Pagley. “It does take care of the problem of a bad blockage or narrowed artery, but it’s not a cure and it’s very important that people know that. You still have cardiovascular disease and need to do risk factor modification.” Adds Dr. Zadeh, “Medications are a very powerful, important part of treatment. Cholesterol-lowering medications, typically statins, are an important part of stopping the disease.”

“Patients have much more control over their disease than we do,” says Dr. Zadeh. “Controlling risk factors is largely what determines what is going to happen.” Managing diabetes, high cholesterol, and high blood pressure; quitting smoking; losing weight; eating a healthy diet; and exercising are all within a patient’s power. But that’s easier said than done, of course. “What I recommend is if you need to modify risk factors, pick the one you’re most likely to be successful with and stick with that one. If you’re trying to do 4 to 5 things, you’re just going to end up throwing your hands up in frustration. It’s a long-term process; you’re not going to change all your habits in six weeks. Go one at a time and stick to it,” says Dr. Pagley.

“Out of everything patients can do to modify their risk factors—changing diet, losing weight, reducing stress—the most important lifestyle modification to reduce the risk of current and future cardiovascular events is regular aerobic exercise,” says Dr. Pagley. “Patients always ask, ‘What kind of exercise is best?’ and I say, ‘Whichever one you’ll actually do.’ Walk, swim, do chair aerobics, yoga to some extent, a stationary bicycle. Four to five times a week, 30 to 45 minutes. Whatever you will do is the best exercise for you.”