Coronary Angioplasty and Stenting

The information on this pages for patients who are having treatment for narrowed or blocked coronary arteries (blood vessels that supply the heart muscle), known as a 'coronary angioplasty'; this may also include the insertion of a 'stent'. It explains what is involved and any risks there may be. If you agree with your specialist doctor to having a coronary angioplasy, it may follow on directly after the cardiac catheterization, in which case you will not need to go through any of the preparation again.

What is a coronary angioplasty?
It is a treatment, where a fine tube (a catheter) is passed into your coronary artery. The catheter has a small flat balloon at the tip, which can be inflated to stretch the narrowed or blocked artery, avoiding the need for a major operation.


What preparation do you need?
The prepatation is the same as for a cardiac catheterisation. If your take warfarin tablets, they must be stopped two days before the treatment. You will usually come into hospital the day before treatment and stay one or two night for observation, so please come prepared with an overnight case. Please remember to bring your regular medicines with you in their containers.

Preparation in hospital
Before the angioplasty you may have some of the following tests: a chest x-ray, blood test and a heart tracing (an ECG ). A doctor will see you and explain the coronary angioplasty and ask you to sign a consent form that you understand the procedure and agree to go ahead with it. You will be given a gown to wear, and you will need a small area of your groin shaved, and then you will be taken to the cardiac suite for the procedure.

What does it involve?
This procedure is very similar to cardiac catheterization. First of all you will need to be given an injection of local anaesthetic into the top of your leg to numb it. Then a small plastic tube is inserted into the blood vessel to keep it open. The 'guide catheter' is first placed into the artery and then a balloon catheter is guided into the narrowed or blocked artery. When it reaches the narrow part, the balloon is inflated (for about 1 minute) to stretch and widen the artery. When the balloon catheter is removed, normal blood flow can resume. This may need to be done several times to be successful in widening the artery. When the balloon is blown up you may feel a brief chest pain like angina. Do not worry but do tell the doctor. Finally when the catheter is removed pressure is put over the site to stop the bleeding and a dressing is applied.

What is a stent?
A stent is a small mesh tube that’s used to treat narrowed or weakened arteries in the body
You may have a stent placed in an artery as part of your angioplasty procedure. Angioplasty can restore blood flow through narrowed or blocked arteries. Stents help prevent arteries from becoming narrowed or blocked again in the months or years after treatment with angioplasty. You may also have a stent placed in a weakened artery to improve blood flow and to help prevent the artery from bursting.

                                    
Stents are usually made of metal mesh, but sometimes they’re made of fabric. Fabric stents, also called stent grafts, are used in larger arteries. Some stents are coated with medicines that are slowly and continuously released into the artery. These medicines help prevent the artery from becoming blocked again.

How are stents used?
With age and some health conditions, the inside openings of the coronary arteries (arteries of the heart) tend to narrow due to deposits of a fatty substance called plaque. High cholesterol, diabetes, and smoking can cause the arteries to narrow. This narrowing of the coronary arteries can cause angina (chest pain) or lead to heart attack.
During angioplasty, doctors use an expanding balloon inside the artery to compress the plaque and widen the passageway. The result is improved blood flow to the heart and a decreased chance of heart attack.
Unless an artery is too small, doctors usually place a stent in the treated portion of the artery during angioplasty. The stent supports the inner artery wall and reduces the chance of the artery closing up again. A stent also can keep an artery open that was torn or injured during angioplasty.
When stents are placed in coronary arteries, there’s a 1 in 5 chance that the arteries will close in the first 6 months after angioplasty. When stents aren’t used, the risk of the arteries closing can be twice as high.

How are stents placed?
Once the tube is in the area of the artery that needs treatment your doctor uses a special dye to help see narrowed areas of the blood vessel.
Your doctor inflates the balloon. It pushes against the plaque and compresses it against the artery wall. The fully extended balloon also expands the surrounding stent, pushing it into place in the artery.
The balloon is deflated and taken out along with the catheter. The stent remains in your artery. Cells in your artery eventually grow to cover the mesh of the stent and create an inner layer that resembles what is normally seen inside a blood vessel.

                   
           Narrowed artery pre-stenting               Normal artery post-stenting

Recovery
After the stent procedure , once the stent has been placed and the balloon and catheter have been removed, the tube insertion site will be bandaged. A small sandbag or other type of weight may be put on top of the bandage to apply pressure to help prevent bleeding. You will recover in a special care area where your movement will be limited.

While you’re in recovery, a nurse will check your heart rate and blood pressure regularly. The nurse also will see if there’s any bleeding from the insertion site. Eventually, a small bruise and sometimes a small, hard “knot” will appear at the insertion site. This area may feel sore or tender for about a week.

You should let your doctor know if:

• You have a constant or large amount of bleeding at the site that can’t be stopped with a small bandage.
• You have any unusual pain, swelling, redness, or other signs of infection at or near the insertion site