Coronary Angioplasty and Stenting
Angioplasty, also called percutaneous coronary intervention (PCI), is a procedure used to open blocked coronary arteries (caused by coronary artery disease) and restore blood flow to the heart muscle without open-heart surgery.
For balloon angioplasty, a special catheter (a long, thin, hollow tube) is inserted into a blood vessel and guided to the blocked coronary artery. The catheter has a tiny balloon at its tip. Once the catheter is in place, the balloon is inflated at the narrowed area of the coronary artery. This presses the fatty tissue against the sides of the artery, making more room for blood flow.
Fluoroscopy helps the doctor find the blockages in the coronary arteries as a contrast dye moves through the arteries.
The doctor may determine that another type of procedure is necessary, such as an atherectomy (removal of plaque) at the site of the narrowing of the artery.
Stenting
Coronary stents are now used in nearly all coronary artery angioplasty procedures.
Where are the stents placed?
A stent is a tiny, expandable metal mesh coil that is put into the newly opened area of the artery to help keep the artery from narrowing or closing again.
What to Expect
Angioplasty may be done as part of a hospital stay. The patient receives a sedative medication through an IV to help relax, but stays awake during the procedure. A local anesthetic is injected into the skin where the catheter will be put in, typically in the groin area.
A sheath, or introducer, is put into the blood vessel. A catheter is threaded into the blood vessel and advanced through the aorta into the heart. Fluoroscopy is used to help guide the catheter into the heart.
Once the catheter is in place, contrast dye is injected through the catheter into the coronary arteries in order to see the narrowed area(s). After the contrast dye is injected, a series of rapid X-ray images of the heart and coronary arteries are made.
When the doctor locates the narrowed artery, the catheter is advanced to that location and the balloon is inflated to open the artery. The doctor may inflate and deflate the balloon several times. The decision may be made at this point to put in a stent to keep the artery open. In some cases, the stent may be put into the artery before the balloon is inflated. Then the inflation of the balloon will open the artery and fully expand the stent.
The doctor takes measurements, pictures or angiograms after the artery has been opened. Once it has been determined that the artery is opened sufficiently, the catheter will be removed. The introducer is taken out and the insertion site closed.
The patient is then taken to the recovery area, where their vitals are monitored closely. Bedrest will last anywhere from 2 to 6 hours, after which the patient can get out of bed with a nurse’s assistance. After the recovery period, the patient is discharged home unless their doctor decides otherwise.
Stenting procedure
Once the stent is placed, tissue begins to form over it within a few days after the procedure. The stent will be completely covered by scar tissue within a month or so. Medication must be taken to keep blood clots from forming inside the stent.
Some stents are coated with medication to prevent the formation of too much scar tissue inside the stent. These stents, called drug-eluting stents (DES), release medication within the blood vessel that inhibits the overgrowth of tissue within the stent and helps deter re-narrowing of the blood vessel.
If scar tissue does form inside the stent, a repeat procedure may be needed, either with balloon angioplasty or with a second stent. In some cases, radiation therapy may be given through a catheter placed near the scar tissue to stop the growth of scar tissue and open up the vessel.