Angioplasty and stents
A coronary angioplasty is a procedure to treat heart disease by widening narrowed or blocked arteries, then keeping them open with a special tube of wire mesh called a stent.
The procedure is also known as percutaneous transluminal coronary angioplasty, PTCA, or percutaneous coronary intervention or PCI.
Coronary angioplasty is one of the most common heart treatment operations, with around 75,000 procedures performed in England every year.
What happens during angioplasty?
First, a cardiac catheterisation is performed. You will receive medication for relaxation, and then the doctor will numb the skin over an artery in the arm or groin with a local anaesthestic.
Next, a sheath (a thin plastic tube) is inserted into an artery - usually in your groin, but sometimes in the arm. A long, narrow, hollow tube, called a catheter, is passed through the sheath and guided, under x-ray control, to the blood vessel to the arteries supplying the heart muscle.
A small amount of contrast material (a special dye that shows up on X-rays) is injected through the catheter and is photographed as it moves through the heart's chambers, valves, and major vessels, to create a set of images known as an angiogram. This may be performed ahead of time or immediately before the angioplasty. From the digital pictures of the contrast material, the doctors can tell whether the coronary arteries are narrowed and/or whether the heart valves are working correctly.
Once the catheter engages the artery with the blockage, the doctor will perform one of the interventional procedures described below.
The procedure lasts 30 minutes or longer, but the preparation and recovery time add several hours. You may stay in the hospital overnight - or for longer - to be observed by the medical staff.
What types of interventional procedures are used in angioplasty?
Here are several types of interventional procedures which your doctor may use when performing angioplasty. They include:
- Balloon angioplasty. During this procedure, a specially designed catheter with a small balloon tip is guided to the point of narrowing in the artery. Once in place, the balloon is inflated to compress the fatty matter into the artery wall and stretch the artery open to increase blood flow to the heart.
- Stent. A stent is a small metal mesh tube that acts as a scaffold to provide support inside your coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed coronary artery. Once in place, the balloon tip is inflated and the stent expands to the size of the artery and holds it open. The balloon is then deflated and removed while the stent stays in place permanently. Over a several-week period, your artery heals around the stent. Stents are commonly placed during interventional procedures such as angioplasty to help keep the coronary artery open. Some stents are coated with drugs (known as drug-eluting stents) designed to reduce the risk of reblockage (restenosis). The interventional doctor will determine if this type of stent is appropriate for your type of blockage.
- Rotablation angioplasty. A special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of narrowing in your coronary artery. The tip spins around at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed safely away in your blood stream and filtered out by your liver and spleen. This process is repeated as needed to allow for better blood flow. This procedure is occasionally used in patients unsuitable for balloon angioplasty and stenting.
- Percutaneous laser coronary angioplasty. A thin, flexible fibre-optic catheter connected to a laser-generating source outside the body is introduced via the femoral artery. The catheter is advanced over a guidewire through the artery to the blockage in the coronary artery, under fluoroscopic guidance. The tip of the catheter system emits pulses of laser light to vaporise the plaque while being slowly advanced across the lesion. The procedure aims to penetrate plaque within coronary arteries where standard techniques, such as balloon angioplasty or stenting, are not effective.