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Coronary Angioplasty and Stenting

Often used in combination, coronary angioplasty and stenting are leading therapies for coronary artery disease (also called heart disease). In coronary artery disease, blood supply to the heart is obstructed by plaque — a waxy substance consisting of fats, cholesterol, calcium and fibrin, a blood-clotting protein. An oxygen-starved heart can lead to chest pain (called angina pectoris) or, in time, heart attack.

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Coronary angioplasty (also called balloon angioplasty, percutaneous coronary intervention [PCI] and percutaneous transluminal coronary angioplasty [PTCA]), is performed to re-open arteries narrowed by coronary artery disease with a small, catheter-guided balloon. To keep the artery open, a wire-mesh tube — called a stent — is inserted into the formerly blocked area.

At John C. Lincoln, coronary angioplasty is typically performed by an interventional cardiologist in a cardiac catheterization lab (the "Cardiac Cath Lab"). Interventional cardiology is a specialized branch of cardiology that relates specifically to catheter-based treatment; a catheter is essentially a tube that is inserted into the body.

This nonsurgical procedure can be performed during a diagnostic cardiac catheterization procedure — as blockage is identified, especially in emergency situations — or be scheduled for a future date.

How Coronary Angioplasty Is Performed

Traditionally, doctors have performed balloon angioplasty by guiding the catheter along the femoral artery, which runs from the groin to the heart. However, more recently, cardiologists have discovered the benefits of inserting the catheter into the radial artery in the wrist or arm, especially for female patients. Both approaches are virtually painless, and only local anesthesia is used. What's more, because small incision is required, scarring is minimal.

Before inserting the catheter, a thin tube (sheath) is inserted first. Next, a longer and thinner tube (catheter) is slid into the sheath. With the help of high-resolution imagery projected on a video monitor, the catheter is guided through the body to the site of the blockage.

The doctor may then perform a coronary angiogram, an imaging procedure that uses a harmless contrast dye to measure the size and location of the blockage.

A tiny balloon is then passed through the catheter and guided to the narrowed area. Finally, a needle penetrates the blockage and the balloon is expanded, pushing plaque out of the way and restoring blood flow.

Stent Placement and "Drug-Eluting" Stents

In most cases, angioplasty is followed by the insertion of a stent — a collapsed, wire-mesh tube that is expanded by the balloon. Much like reinforcement for a tunnel, the stent stays will keep the artery open, restoring blood flow to the heart.

Stent placements also are used commonly in other parts of the body, to open the carotid arteries of the neck and peripheral arteries in the legs.

Some stents gradually release medications over time, to prevent the growth of scar tissue around the stent. These drug-eluting stents maintain the smoothness of the artery, reducing risk of restenosis — when the artery becomes blocked again.

Risks

Serious complications of coronary angioplasty — which include bleeding from the blood vessel where the catheter is inserted, as well as blood vessel damaged caused by the catheter — are infrequent. Likewise, in rare cases, the blood vessel can close during the procedure, requiring emergency coronary artery bypass grafting (CABG). Further, some patients may have an allergy to the dye given during the balloon angioplasty.

Risks of complications are higher in persons aged 75 or older, persons who have kidney disease or diabetes, women, patients who have poor blood-pumping function in their hearts and patients with extensive heart disease.

While the success rate for coronary angioplasty is high, approximately 30% of patients will experience restenosis — re-closing of the artery, often due to scar tissue around the stent — and require another angioplasty procedure. Typically detected within six months following balloon angioplasty, restenosis is more common when a stent is not placed in the blocked artery.

Recovery

Patients are usually discharged from the hospital on the day following angioplasty. They may return to normal daily activities and work within one or two days of returning home. To allow the coronary artery, as well as the catheterized artery, time to heal, patients are advised against lifting heavy objects and over-exerting themselves for two weeks following the procedure.