Coronary Angioplasty
Coronary angioplasty is a technique used to widen coronary arteries (the arteries supplying blood to the heart) that have been narrowed by coronary heart disease. These narrowings occur as a result of the build up of fatty deposits (plaques) inside the artery walls.
Coronary angioplasty is also referred to as percutaneous coronary intervention (PCI) and was previously referred to as percutaneous coronary angioplasty (PTCA). The procedure is performed in a cardiac catheter laboratory by a specialist cardiologist.
A catheter (a thin flexible tube) with a small inflatable balloon at its tip is inserted though an introducer sheath positioned in an artery in the groin (femoral approach) or the arm (brachial approach). Less commonly, the artery in the wrist (the radial artery) is used. The balloon is positioned inside the narrowed section of the coronary artery. Inflation of the balloon causes it to push against the artery wall thus opening up the narrowing.
The coronary angioplasty procedure was first developed in the late 1970s and was first performed in New Zealand in 1981 at Auckland’s GreenLaneHospital.
Coronary angioplasty can be performed as a day stay procedure or may require an overnight stay in hospital. On admission the doctor will take a full medical history and perform a physical examination.
The following tests will also be required:
- Electrocardiogram (a tracing of the heart’s electrical activity)
- Chest x-ray
- Blood tests.
Baseline measurement of the blood pressure, heart rate and temperature will be recorded. It is also necessary for the area through which the catheter is to be inserted to be shaved.
The patient cannot eat or drink anything for a few hours before the procedure.
Just prior to the procedure the patient will be asked to shower and dress in a special gown. A mild sedative may be given immediately prior to the procedure.
The patient will be taken to the cardiac catheter laboratory on a bed and moved onto a specialised procedure table. The patient will be awake during the procedure and staff in the catheter laboratory will monitor heart rhythm and rate, blood pressure and blood oxygen levels.
A specialised x-ray camera moves over the chest during the procedure, enabling the heart to be seen on an x-ray screen.
The area where the catheter is to be inserted will be cleaned with a sterile solution, before large drapes are positioned to maintain sterility. A local anaesthetic is used to numb the catheter insertion site.
A small incision is made in the catheter insertion site and an introducer sheath is positioned in the artery. The cardiologist injects x-ray dye into the coronary arteries through a guiding catheter enabling the narrowed arteries to be seen on the x-ray screen. While x-rays are being taken, the patient may be required to hold their breath for a few seconds. Sometimes the patient may also be asked to cough following dye insertion, as this helps to increase the rate at which the dye leaves the coronary arteries.
A balloon-tipped catheter is then passed through the introducer sheath and is threaded up into the coronary arteries. Its position within the narrowed portion of the artery is checked on the x-ray screen.
Once correctly positioned, the balloon is inflated. The inflated balloon opens up the narrowed artery by compressing the plaque and slightly stretching the artery wall. Inflation and deflation of the balloon may be done several times. Each balloon catheter is selected to be approximately the same size as the artery and the balloon is made to only inflate to a specific size.
When the cardiologist is satisfied that the artery has been opened sufficiently, the deflated balloon catheter will be removed. More x-ray pictures of the artery will be taken to see how blood flow through the artery has improved. The guiding catheter is then removed.
Coronary Angioplasty
Graphic courtesy of A. Bonsall and MedicineNet.com
If the angioplasty is performed via the femoral approach the introducer sheath will be removed on the ward two to four hours after the procedure. With a brachial or radial approach, the introducer sheath will be removed at the conclusion of the procedure.
Following the procedure, the patient is returned to the ward and blood pressure, heart rate and heart rhythm will be monitored. A nurse will check the catheter insertion site frequently and also check the pulses in the foot (for femoral approach) or the hand (for a brachial or radial approach).
Fluids will be given intravenously through a small needle (drip) inserted in the hand or arm. This fluid will help to flush the x-ray dye from the kidneys.
Prior to discharge a further ECG and blood tests may be taken. A doctor or nurse will advise about recovery and activity guidelines following discharge from hospital. Some activities, such as heavy lifting, should be avoided for at least a week. Land Transport Safety Authority (LTSA) guidelines prohibit driving for at least two days after a coronary angioplasty. The patient will therefore need someone to drive them home after the procedure.
Medications will be prescribed before are discharged. These may or may not be the same medications that the patient was taking before admission to hospital.
A follow up appointment with the cardiologist is usually made in order to assess recovery and progress.
The risks associated with coronary angioplasty are very small. It is important to discuss these with the cardiologist prior to signing the consent form for the procedure. Risks of coronary angioplasty include:
- Abrupt closure of the coronary artery
- An allergic reaction to the x-ray dye
- Heart attack or stroke
- Damage to the coronary artery
- Damage to the catheter insertion site.
In approximately 30% of cases the coronary artery narrows again soon after the angioplasty. This is called re-stenosis and usually occurs within the first six months after the angioplasty is performed. In these cases a repeat angioplasty or coronary artery bypass surgery may be recommended.
In a small number of cases (about one to two percent) emergency coronary bypass surgery is necessary as a result of complications of the coronary angioplasty procedure.
Often a stent is inserted into the narrowed section of the coronary artery during the angioplasty procedure. A stent is a small metal scaffold, cylindrical in shape, that is left in the artery permanently to help keep the narrowed artery open. It is estimated that the use of coronary artery stents can reduce the incidence of restenosis by up to 50%. If a stent is inserted, a course of blood thinning medications is given to prevent blood clots forming on the stent.
A type of stent known as a “drug eluting stent” may be used in some cases. These stents emit a medication that studies have indicated may be more effective in reducing restenosis rates than non-drug eluting stents.
MedicineNet (2002) Coronary balloon angioplasty (PTCA). Foothill Ranch: MedicineNet.Inc
http://www.medicinenet.com/Script/Main/Art.asp?li=MNI&ArticleKey=271
National Heart Foundation of New Zealand (2007) Coronary Angioplasty and Stenting. Pamphlet. The National Heart Foundation of New Zealand. Wellington.
Proseus E. R. (2006) Angioplasty. Gale Encyclopaedia of Medicine, Third Edition. Jacqueline L. Longe. Editor. Infotrac Health and WellnessResourceCenter. Farmington Mills, MI. Gale
Last Reviewed – 27/03/07
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