What is angioplasty?

Indications and Procedures

Angioplasty, particularly balloon angioplasty, may be performed on any blocked or narrowed blood vessel, such as in the legs, but it is most commonly used to open heart vessels blocked by coronary artery disease.

Worldwide, an estimated seventeen million people die each year from cardiovascular disease, a condition often signaled by chest pain known as angina pectoris. Other symptoms include shortness of breath, heart palpitations, or an actual heart attack. Probable causes of heart disease can be diagnosed by stress tests and angiography
. If the cause is blockage of the coronary arteries, the cardiologist may order angioplasty to open the blocked vessels and restore a better blood flow to the heart.

The patient cannot eat or drink anything after midnight the day before the procedure is to be performed. A mild sedative may be given. The site for insertion of the catheter, often the inside of the elbow or the groin, is shaved and is cleaned with an antiseptic solution. A local anesthetic is injected at the insertion site, but the patient remains awake during the procedure. The surgeon makes a small opening in the skin at the insertion site, inserts the catheter into an artery, watches the progress of the catheter on an x-ray monitor, and guides the tip into the blocked arteries.

In balloon angioplasty, the most common type, the tube is equipped with a balloon. Once the tip is in place in the blocked area, the balloon is inflated and deflated several times in order to compress the fatty material (plaque) and increase blood flow through the artery. The catheter then is slowly withdrawn.

If the arm site was used, the small incision is stitched closed. If the groin site was used, the puncture opening is closed with pressure. A dressing is applied to the insertion site. Barring any complications, the patient may return home later the same day or the next day.

Uses and Complications

The cardiac catheters used in angioplasty can also remove plaque with special cutting or laser tips. The balloon tip may be used to place a stent, a metal mesh tube that is placed permanently in the coronary artery to keep it open. Blood thinning medication may be prescribed to keep blood from clotting on the stent and closing it.

About 80 percent of the angioplasty treatments are successful, with the patient being able to resume a reasonably normal lifestyle and enjoy a good quality of life. Complications of coronary artery angioplasty seldom occur, but they may include bleeding or clotting, an abnormal heartbeat, perforation of the heart muscle or artery, and, rarely, a heart attack, stroke, or even death.

Bibliography

American Heart Association. AHA Focus Series: Arteriosclerosis. Washington, D.C.: American Heart Association, 1988.

"Angioplasty and Stent Placement—Heart." Medline Plus, August 24, 2012.

"Coronary Angioplasty." Health Library, February 7, 2013.

McGoon, M. The Mayo Clinic Heart Book. 2d ed. New York: William Morrow, 2000.

Ohman, Magnus, Gail Folger Cox, and Victoria K. Folger. So You’re Having a Heart Cath and Angioplasty. Hoboken, N.J.: John Wiley & Sons, 2003.

Rutherford, Robert B., ed. Vascular Surgery. 7th ed. Philadelphia: Saunders/Elsevier, 2010.

Tcheng, James E. Primary Angioplasty in Acute Myocardial Infarction. Totowa, N.J.: Humana Press, 2002.

"What Is Coronary Angioplasty?" National Heart, Lung, and Blood Institute, February 1, 2012.