Dr David Lipkin
Cardiac Heart Specialist
Coronary AngioplastyThe Technique
Coronary angioplasty is a technique for treating coronary artery disease. It was first developed in 1977. The technology has changed dramatically since then. The catheter (a fine, hollow tube) with a small inflatable balloon is passed into an artery in the heart from either your groin or your arm. An X-ray is used then to direct the catheter to a coronary artery until the narrowed segment is reached. The balloon is then gently inflated so that it squashes the fatty tissue. The balloon is removed and another balloon which is covered with a stainless steel mesh tube is inserted into the blocked artery. The balloon is then inflated to press the stent against the vessel wall. The balloon is removed.
Stenting is now a routine procedure and is almost invariable carried out during an angioplasty unless the artery is not large enough to accept one. Sometimes when the balloon is inflated in the coronary artery to deploy the stent mild angina occurs. If you let the doctor know then the balloon can be removed and the discomfort passes away.
Preparation for Angioplasty
Prior to having an angioplasty, you will be given 'anti-platelet drugs'. This includes Aspirin 300 mg daily for one month and then 75 mg daily and Clopidogrel 300 mg daily on day one and then 75 mg daily for 9 to 12 months.
Prior to having a coronary angioplasty you will have undergone a coronary angiogram/cardiac catheter test to see whether you are suitable. You may be unsuitable because you have too many narrowings in the arteries or you have a complete block in an artery which is too long to cross with the current technology.
Nowadays there are two main types of stents we can use. There is a so called 'bare metal stent' which is usually made out of stainless steel and the second type is a 'drug eluting stent' which is the bare metal stent but this time covered with a drug called Rapamycin or Paclitaxel.
The relative size of a coronary stent is shown. Notice that even though it is made of metal, the newer stents are still rather flexible, allowing them to conform to the natural curvature of the coronary arteries.
The drug eluting stents minimize the risk of the artery renarrowing after the procedure. The necessity usually for you to have another angioplasty to the same artery at the same place after a drug eluting stent is less than 3 or 4 in every hundred patients.
We can also carry out coronary angioplasty if you have had coronary artery by-pass graft surgery but your graft has become narrowed. If an artery is not completely blocked there is a 97% success rate. There is perhaps just over a 2% failure rate because the balloon or stent will not pass into the artery. Complications are extremely rare. There is a tiny chance that a small tear could occur in the artery in which case an operation would be required or there is a chance that the artery could block in the process of it being stretched in which case by-pass surgery would be required. The chance of that happening is probably less than 1 in 3-400.
Sometimes it is impossible to pass the balloon through the blocked artery because the artery has become 'calcified', that is the cholesterol in the artery has attracted calcium so much so that it makes the artery hard like bone. Under those circumstances we can use a drill to drill and open the artery. This is called rotablator.
If all goes well with your angioplasty the puncture site in your groin can be closed with a little 'collagen plug'. This allows us to close the little hole in the artery of your leg and the catheter can be removed immediately after the angioplasty.
After your angioplasty it is not unusual to have very mild discomfort in your chest for half and hour or so but just let the nurse know if this is the case. Most patients go home the next day after angioplasty. We advise you not to drive a car for a week which is the licensing authority regulations. It is normal to get some bruising in your groin after angioplasty but please let us know if the area becomes red or there is a swelling in the groin. It is best to avoid heavy lifting or very strenuous exertion for a week.