Coronary Angioplasty And Stenting

Percutaneous Coronary Interventions

Percutaneous coronary interventions (PCIs) are minimally invasive procedures used to open blocked or narrowed coronary arteries. PCI procedures use catheters (thin, flexible tubes) to deliver various treatments to affected areas of coronary arteries. The catheter is generally inserted through a small incision in the arm or groin area and threaded to the area of the blockage. Common PCI procedures include:

• Stent Placement: Stents are thin mesh tubes generally made of metal or plastic that are often used to open up clogged or blocked arteries.
• Rotational Atherectomy: A procedure to clear blocked arteries using a catheter with a diamond burr attached to the tip that scrapes away the plaque (hardened fatty deposits) to restore blood flow.
• Excimer Laser Procedures: In excimer procedures, a laser catheter (thin, flexible tube) is used to “vaporize” arterial blockages.
• Coronary Thrombectomy: A procedure used to remove a thrombus (blood clot) from a coronary artery. It is particularly useful in patients experiencing acute myocardial infarctions (heart attacks).
• Intravascular Lithotripsy: Most recent procedure which involves using Lithtripsy waves to break up the calcium in the coronary arteries to facilitate the passage of stents.

Do I need PCI?

Clearly it is necessary to demonstrate the presence of narrowing’s in the coronary arteries before performing angioplasty. This is usually done via angiography. Angioplasty is at its most effective in treating unstable angina and treating patients having a heart attack.

What is involved and what are the risks?

You’ll have an angiogram before your angioplasty to look inside your arteries and check where the blockages are and how much they are blocked. An angiogram often happens as part of the same procedure

The risks of Angioplasty are broadly similar to those of Coronary Angiography, however, there are more specific risks associated with the Angioplasty procedure itself. These tend to be damage to the coronary artery wall, the provocation of a heart rhythm disturbance or damage to the artery such that the patient may require a bypass operation. This tends to occur in less than 1:200 patients treated.

Coronary angioplasty and Stenting Procedure

An angioplasty normally takes between 30 minutes and two hours, although it can take longer depending on the complexity of the narrowings.

Angioplasty procedure is performed either through the wrist or groin

• At the start of the procedure you'll be given a local anaesthetic to numb the area. Then a catheter – a fine, flexible, hollow tube – with a small inflatable balloon at its tip is passed into an artery in either your groin or your arm.
• A special shape tube (catheter) is passed up the femoral or radial artery and sited at the mouth of the coronary artery that is narrowed.
• Through this tube, a very fine steel wire, 1/14,000 of an inch in diameter is navigated across the narrowing. When the steel wire tip is safely positioned at the far end of the artery, a tiny balloon is slid over the steel wire.
• Dye (contrast) is injected into the catheter and the arteries can be seen on an x-ray screen. It's normal to feel a hot flushing sensation when the dye is injected.
• The operator then directs the catheter up to the heart and into a coronary artery until its tip reaches a narrow or blocked section. When this balloon is in the position of the narrowing artery, it is gently inflated to high pressure using a special hydraulic inflation device. The pressure delivered to the balloon is transmitted to the arterial wall. The pressure cracks and stretches the plaque of cholesterol. This results in widening of the artery and allowing the blood to flow more easily. The catheter is then removed.
• Then, STENT - a small tube of stainless steel mesh - already mounted on the balloon is placed at the site of narrowing and once in correct position, the stent balloon is inflated and the stent expands so that it holds open the narrowed artery. The balloon is let down and removed, leaving the stent in place.
• Some people may feel a palpitation, and you might feel some angina. If you feel unwell, or have pain at any time during the procedure, tell the team.
• Once the coronary artery has been successfully treated, the catheter in the wrist or leg is removed and the hole closed by pressure devices or a plug.
• Sometimes there might be a small amount of bleeding when catheters are taken out. A nurse or doctor will press on the area for a short period.
• In the first few hours afterwards you might get some chest discomfort. If this happens, tell the doctor or nurse.
• After the procedure, you’ll need to stay in bed for a while. If there are no complications, you will be allowed home the same day or early next day

Leaving hospital after an angioplasty

Most people can go home the same day or the next day, but if you’ve had an emergency angioplasty particularly after you had a heart attack it’s likely you’ll need to stay in hospital for longer.

When you get home, check the area where the catheter was inserted. There is a possibility that you may develop some mild bruising and tenderness, but if you get any significant redness or swelling, or if the bruising worsens, contact your doctor.

Before you leave hospital, someone will have a chat with you about your recovery and what you can and can’t do. It’s normal to feel tired afterwards but most people find that they’re back to normal after a few days. However if you’ve also had Angioplasty after a heart attack it will take longer to recover.

• It’s best to avoid doing any demanding activities, such as heavy lifting, for a week or so.
• You shouldn’t drive for at least a week after having angioplasty – longer (6 weeks) if you also had a heart attack.
• If you’ve had a planned angioplasty with no complications you may be able to return to work within a few days, depending on the type of work you do.
• If you’ve had an emergency angioplasty or a heart attack you may need to take a few weeks off.

You should also be invited to go on a cardiac rehabilitation programm a course of exercise and information sessions that help you to recover as quickly as possible.

If you have a stent, you’ll need to take certain anti-platelet Professorugs (such as aspirin or clopidegrel, Prasugrel or Ticagrolor) to help reduce the risk of blood clots forming in and around the stent.

Stents are not affected by security systems at airports or MRI scans.

What should you do if you experience chest pain after discharge from the hospital?

If you get chest pain, stop and rest and take your GTN as prescribed. If the pain doesn't ease, call 999 immediately. You could be having a heart attack.

How would you know if coronary angioplasty is successful?

In most cases the blood flow through the artery is improved after angioplasty. Many people find that their symptoms get better and they’re able to do more activities.

Sometimes the artery can become narrowed again, causing angina to return. But advances in stent technology mean that the risk of this happening is getting lower. Many people are now symptom-free for a longer period of time.

A small number of people have complications. The risk varies depending on your overall health and your individual heart condition. Have a chat with your doctor about the benefits and possible risks of having an angioplasty and any concerns you may have.

Professor Javed Ahmed has considerable expertise in coronary stenting and performs all his Angioplasty procedures at the Freeman Hospital, Newcastle-upon-Tyne. Professor Ahmed provides Angioplasty and Stenting treatment to both insured and self-pay patients.