Coronary angioplasty, also called percutaneous coronary intervention, is a procedure used to open clogged and/or narrowed heart vessels. Angioplasty is the process of widening the vessel by inflating a small balloon in the area where the heart artery is clogged. Angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent to help open the artery and reduce the chance of re-narrowing. The first stents used were bare metal stents. Due to the re-contraction of bare metal stents, drug-eluting stents have been developed and the risk of re-contraction has been greatly reduced.
Angioplasty procedure improves symptoms of clogged vessel such as chest pain and shortness of breath. At the same time, angioplasty to the occluded vessel during a heart attack reduces the damage caused by the infarction to the heart. Angioplasty is used to treat a type of heart disease known as anterosclerosis. Atherosclerosis is the gradual accumulation of fatty plaques in the arteries. Your doctor may recommend angioplasty when your anginal (chest pain, shortness of breath) symptoms do not improve with lifestyle changes and medication, or if you have a heart attack.
Angioplasty may not be suitable for every patient. In some patients, the surgical option is more appropriate. The age of the patient, the structure of the heart vessels, additional diseases (diabetes, kidney failure, heart valve disease, stroke) are taken into account in the decision of surgery or angioplasty. If there is multi-vessel disease and diabetes, surgery is a more suitable option. Again, if there is valvular disease that requires surgery along with occlusion in the heart vessel, bypass is a more suitable option.
Risks of angioplasty procedure
Although angioplasty is a less invasive way to open a clogged artery than bypass surgery, the procedure still carries some risks. These risks are:
-Re-narrowing: Re-narrowing is seen in 30% of cases in balloon angioplasty alone. Stents were developed to reduce reconstriction. Re-narrowing is around 15% for bare stents and 8-10% for drug-eluting stents.
-Blood clot: During and after the procedure, a blood clot may form in the vein and cause a heart attack.
– Bleeding: There may be bleeding at the catheter insertion site in your leg or arm. This is usually in the form of a mild bruise, sometimes bleeding that requires blood transfusion and surgery.
-Heart attack: It can be seen, albeit very rarely.
-Coronary artery damage: There may be rupture of the vessel, dissection (stripping inside the vessel) during the procedure, and this may require emergency surgery.
Pastry failure: The drug used during the procedure may cause kidney failure, especially in diabetics and people with previous kidney damage. Kidney failure can be temporary or permanent. In order to prevent kidney failure, it is important to give enough fluids and give some medications.
Stroke: It is a very rare complication of angioplasty. Blood thinners are used during the procedure to reduce the risk.
-Rhythm disturbance: Serious rhythm disturbances may occur, especially during a heart attack. If low heart rate impairs hemodynamics, a temporary pacemaker may be required. Life-threatening rhythm disturbances (ventricular tachycardia, ventricular fibrillation) are terminated with electroshock.
After the procedure
After the angioplasty procedure, patients are usually discharged one day after the medications are adjusted. They can return to work after a week. If a stent was performed during a heart attack, the length of stay in the hospital is prolonged.
When returning home, it is necessary to take plenty of fluids so that the contrast material does not damage the kidney. Strenuous exercise and heavy lifting should be avoided for 2-3 days.
Inform your doctor if you have chest pain, shortness of breath, bruising, swelling, pain and coldness in the arm and leg related to the entrance area.