Angioplasty for Coronary Artery Disease
Angioplasty and related techniques are known
as percutaneous coronary intervention (PCI). Angioplasty is a procedure in
which a narrowed section of the coronary artery is widened. Angioplasty is less
invasive and has a shorter recovery time than
bypass surgery, which is also done to increase blood
flow to the heart muscle but requires open-chest surgery. Most of the time
stents are placed during angioplasty.
angioplasty is done using a thin, soft tube called a catheter. A doctor inserts
the catheter into a blood vessel in the groin or wrist. The doctor
carefully guides the catheter through blood vessels until it reaches the
blocked portion of the coronary artery.
Cardiac catheterization, also called coronary angiography, is done first to
identify any blockages.
slideshow on angioplasty for coronary artery disease to see how an angioplasty is
expandable tube called a stent is often permanently inserted into the
artery during angioplasty. A very thin guide wire is inside the catheter. The
guide wire is used to move a balloon and the stent into the coronary artery. A
balloon is placed inside the stent and inflated, which opens the stent and
pushes it into place against the artery wall. The balloon is then deflated and
removed, leaving the stent in place. Because the stent is meshlike, the cells lining the blood
vessel grow through and around the stent to help secure it.
- Open up the artery and press the plaque against
the artery walls, thereby improving blood flow.
- Keep the artery
open after the balloon is deflated and removed.
- Seal any tears in
the artery wall.
- Prevent the artery wall from collapsing or
closing off again (restenosis).
- Prevent small pieces of plaque from
breaking off, which might cause a heart attack.
Stent placement is
standard during most angioplasty procedures.
Your doctor may use a bare metal stent or a drug-eluting stent. Drug-eluting stents are coated with medicine that helps keep the artery open after angioplasty.
What To Expect After Treatment
The procedure may take 30 to 90 minutes. But you need time to get ready for it and time to recover. It can take several hours total.
After angioplasty, you will be moved
to a recovery room or to the coronary care unit. Your heart rate, pulse, and
blood pressure will be closely monitored and the catheter insertion site
checked for bleeding. You may have a large bandage or a compression device on
your groin or arm at the catheter insertion site to prevent bleeding. You will be
instructed to keep your leg straight if the insertion site is near your groin
You can mostly likely start walking within 12 to 24 hours
after angioplasty. You will likely stay one night in the hospital. You may resume exercise and driving after several days.
You will take antiplatelet medicines to help prevent another heart
attack or a stroke. If you get a stent, you will probably take aspirin plus
another antiplatelet such as clopidogrel (Plavix). If you get a drug-eluting
stent, you will probably take both of these medicines for at least one year. If
you get a bare metal stent, you will take both medicines for at least one month
but maybe up to one year. Then, you will likely take daily aspirin long-term.
If you have a high risk of bleeding, your doctor may shorten the time you take
After your procedure, you might attend a
cardiac rehabilitation program. In cardiac rehab, a
team of health professionals provides education and support to help you
recover and build new, healthy habits,
such as eating right and getting more exercise. For keeping your heart healthy and your arteries
open, making these changes is just as
important as getting treatment.
Why It Is Done
Although many things are involved,
angioplasty might be done if you have:1
- Frequent or severe angina that is
not responding to medicine and lifestyle changes.
- Evidence of severely reduced blood flow
(ischemia) to an area of heart muscle caused by one narrowed coronary
- An artery that is likely to be treated successfully with
- You are in good
enough health to undergo the procedure.
Angioplasty may not be a reasonable
treatment option when:
- There is no evidence of reduced blood flow to
the heart muscle.
- Only small areas of the heart are at risk, and
you do not have disabling angina symptoms.
- You are at risk of
complications or dying during angioplasty due to other health
- You cannot take blood thinner medicines (aspirin and another antiplatelet medicine) after getting a stent.
- The anatomy of the artery makes angioplasty or stenting
too risky or will interfere with the success of the procedure.
How Well It Works
Angioplasty relieves angina and
improves blood flow to the heart. Stents lower the risk of the artery narrowing again (restenosis). If restenosis occurs, another angioplasty or
bypass surgery may be needed.1
you'll feel relief from angina sooner than with medicines and lifestyle changes. But over time, both treatments work
about the same to ease angina and improve quality of life.2
Angioplasty can ease angina, but it has not been
proved to help you live any longer than medical therapy does. Also, angioplasty
does not lower the risk of having a heart attack any more than medical therapy
Risks of angioplasty may include:
- Bleeding at the puncture
- Damage to the blood vessel at the puncture
- Sudden closure of the coronary artery.
tear in the inner lining of the artery.
- Heart attack.
- Need for additional procedures. Angioplasty may increase the risk
of needing urgent bypass surgery. In addition, the repaired artery can renarrow
(restenosis) and a repeat angioplasty may need to be performed.
- Reclosure of the dilated blood vessel (restenosis).
- Death. The risk of death is higher when more than one artery is
What To Think About
Medical therapy and lifestyle changes may be a better option than angioplasty for some people. To help you decide if angioplasty is right for you, see the topic:
- Heart Disease: Should I Have Angioplasty for Stable Angina?
artery bypass surgery may be a better option than angioplasty for some people. To help you decide if bypass surgery is right for you, see the topic:
- Heart Disease: Should I Have Bypass Surgery?
Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.
Levine GN, et al. (2011). 2011 ACC/AHA/SCAI Guideline for percutaneous coronary intervention: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation, 124(23): e574–e651.
Weintraub W, et al. (2008). Effect of PCI on quality
of life in patients with stable coronary artery disease. New England Journal of Medicine, 359(7): 677-687.
Boden WE, et al. (2007). Optimal medical therapy with
or without PCI for stable coronary disease. New England Journal of Medicine, 356(15): 1503–1516.
Other Works Consulted
Douglas JS, King SB (2011). Percutaneous coronary intervention. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1430–1457. New York: McGraw-Hill.
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Robert A. Kloner, MD, PhD - Cardiology
April 5, 2012