Angioplasty for Coronary Artery Disease

Treatment Overview

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.

An 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.

View the slideshow on angioplasty for coronary artery disease to see how an angioplasty is done.

Stents

A small, 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.

Stenting should:

• 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 area.

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 these medicines.

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 artery.
• An artery that is likely to be treated successfully with angioplasty.
• 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 problems.
• 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

With angioplasty, 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 does.³

Risks

Risks of angioplasty may include:

• Bleeding at the puncture site.
• Damage to the blood vessel at the puncture site.
• Sudden closure of the coronary artery.
• Small 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 involved.

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?

Coronary 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.

References

Citations

1. 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.

2. 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.

3. 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.

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