Talking With Your Doctor About Coronary Angioplasty


Hedy Marks, MPH

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Coronary angioplasty is a minimally invasive procedure to widen or open a blocked or narrowed heart artery. Angioplasty can improve your symptoms and reduce your risk of heart attack due to coronary artery disease (CAD). 

CAD occurs when fatty deposits called plaque clog the arteries that supply blood to your heart muscle. You may have chest pain (angina) with little exertion, and trouble breathing. 

Angioplasty may be an emergency treatment during a heart attack, or it may be a planned procedure to prevent a heart attack. Here are topics to bring up with your doctor to help you understand why angioplasty may be right for you.

How Do You Know I Need Coronary Angioplasty?

Angioplasty works to increase blood flow through an artery that has become narrowed or blocked from atherosclerosis. Atherosclerosis occurs when fatty deposits grow and harden on artery walls. It develops over many years. Left untreated, the plaque can fill up the artery or break apart to form blood clots. A block can reduce blood flow to the heart and lead to a heart attack. 

Signs that you may need angioplasty include:

  • You have symptoms of CAD, such as angina (chest pain) or shortness of breath.

  • You have significant narrowing or blocking of only 1 or 2 coronary arteries. Your doctor may recommend heart bypass surgery (coronary artery bypass graft surgery) instead of angioplasty.

  • You’re having a heart attack.

Your doctor will perform a number of tests to diagnose your condition and determine the best course of treatment for you:

  • EKG: An electrocardiogram records the heart’s electrical activity to see how the heart is beating and if the rhythm is steady or abnormal. An EKG can tell if you have heart damage from coronary artery disease or from a previous heart attack. In some cases, it can tell the doctor you are currently having a heart attack.

  • Stress test: A stress test monitors your heart rate as you exercise on a stationary bike or treadmill. If you have poor endurance for a typical person of your age, you may not be getting enough oxygenated blood to your heart. This is a sign of coronary artery disease.

  • Coronary angiography: This test a minimally invasive way of looking at how blood is flowing through your heart arteries. The test uses a dye in your bloodstream and X-rays to follow the flow of blood. Your doctor may perform angioplasty at the time as angiography if they find a block.

The results of these and other tests, including blood tests and X-rays, will help your doctor decide if angioplasty is a good treatment option for you. Your doctor may recommend other treatments to prevent further blockage, such as taking medicine to reduce the amount of fat in your blood, and making changes to your lifestyle, such as eating less fatty food and exercising more.  

Types of Angioplasty 

Your doctor has a few options during angioplasty:

Atherectomy scrapes or drills the plaque away with special tools.

Balloon angioplasty expands a very small balloon to open the artery.

Laser angioplasty destroys the plaque with heat and opens the artery.

Your doctor may also place a stent in your artery to help keep it open after angioplasty. A stent is mesh-like metal tube. It stays in place to prevent the artery from closing. Many stents are coated with a drug to prevent scar tissue from forming around the stent, which helps prevent the artery from narrowing again. 

Your doctor will consider the location, size, shape, and softness or hardness of the plaque to decide which type of procedure to use for you. 

Ask your doctor why he or she thinks a certain treatment is right for you. Ask about the side effects, risks, and how long it may take for you to recover. 

Weighing the Benefits vs. the Risks

The benefits of coronary angioplasty are clear—it can prevent and treat a heart attack and long-term heart failure. But as with all procedures, angioplasty involves risks and potential complications. Complications of angioplasty are not common but can occur during the procedure or recovery. 

Risks and potential complications of angioplasty include: 

  • Adverse reaction or problems related to sedation or medications, such as an allergic reaction or problems with breathing

  • Severe bleeding

  • Blood clots within your arteries

  • Damage to an artery from the catheter or balloon

  • Heart attack or stroke

  • Kidney injury from the contrast agent, especially if you already have kidney problems

  • Recurrence of artery narrowing or blockage. Placing a stent reduces the chance of this happening.

  • Sudden vessel occlusion. This is a total blockage of the artery at the site of the angioplasty. Sudden vessel occlusion is a rare complication that typically occurs within 24 hours of angioplasty. It requires immediate medical attention.

Talk to your doctor about all of your treatment options. You may have less invasive treatment options like medications and lifestyle changes. It’s also possible you may need more advanced procedures to treat your heart disease. Heart bypass surgery (coronary artery bypass graft surgery) is a more invasive surgery that bypasses your narrowed heart arteries.