Who is a Good Candidate for Angioplasty and Stent Placement & How is the Procedure Done?

If your doctor recommended an angioplasty, here are the things you need to know before you go for the procedure.

The heart, as we know, is located on the center of the chest. Its job is to keep the blood continually circulating throughout the body. Arteries are blood vessels, which supply oxygen rich blood to the whole body. The heart muscles that supply blood to the heart itself are called coronary arteries. These vessels may be narrowed or blocked due to plaque deposits which restrict blood flow. Plaque is a material made of cholesterol, calcium, and fibrous tissue which can build up along the walls of your arteries with aging.

In simple words, angioplasty with stent placement is a procedure used to increase the amount of blood flowing to the coronary artery and as a result, to the heart.

Angioplasty is used to treat peripheral arterial disease (PAD), which is the hardening of the arteries caused by diabetes, smoking, high blood pressure, and elevated cholesterol. Often, angioplasty and stenting is performed as an alternative to bypass surgery, a more invasive surgery used to treat PAD. You are considered to be a good candidate for an angioplasty if you have severe narrowing of any of your peripheral arteries and the blockage is causing a problem. For example, a blockage can occur in your leg arteries producing pain in your legs when you walk, it could be in the arteries that supply blood to your brain making you at risk for stroke, or they could be in your kidney arteries causing severe hypertension.

Angioplasty is done to treat:

• Blockage in coronary artery during or after a blockage.
• Narrowing or blockage of coronary artery that may lead to heart failure.
• Narrowing of arteries which causes insufficient blood flow causing angina
• For people who have several blockages, a bypass surgery may be recommended instead of an angioplasty.

A stent is a small tube that acts as a platform or scaffold to support the inside of your artery. A balloon catheter, placed over a guide wire, puts the stent into your narrowed artery. Once in place, the balloon 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. Over several weeks, your artery heals around the stent.

These are often placed during angioplasty to help keep the artery open. The stent is usually made of metal and is permanent. It can also be made of a material that the body absorbs over time.

Some stents contain medicine and are designed to reduce the risk of the artery getting blocked again (your doctor may call that restenosis). The doctor will decide if this is the right stent for your blockage.

Most people will need a routine blood test and electrocardiogram. You will be given detailed instructions including a suggestion not to eat or drink after midnight the evening before. You need to discuss with the doctor whatever medications you are on. Reporting about your allergies is also necessary especially iodine, shellfish, x-ray die, latex or rubber products, and penicillin-type medications. You will be asked to take aspirin before the procedure. You will be awake during the procedure and will be given medications to relax.

A very small incision in the skin is made over a blood vessel in arm, leg, or wrist through which a small thin tube is inserted. The surgery can take several hours depending on the number of blockages and if any complications arise during the surgery.

Angioplasty is performed by a cardiologist and a team of specialized cardiovascular nurses and technicians, mostly in a special operating room called a cardiac catheterization laboratory. This room is often called the cath lab.

Most commonly an angioplasty is performed through an artery in the groin. Arms and wrists are less common sites. The area is prepared with an antiseptic solution. Local anesthesia is injected to the site of the catheter insertion. Your heart is carefully monitored throughout the procedure. You will receive fluids, medications, and anticoagulants. After all this, the procedure begins:

1. You will lie on a padded table. After anesthetizing the area, the doctor will make a small incision over the femoral artery in the upper part of the leg. A special needle is then inserted in the artery itself.
2. A guide wire is carefully passed through the needle and gently pushed into the artery and upwards towards your chest.
3. A catheter is threaded along the wire until it has reached the coronary artery.
4. The doctor injects a harmless dye with help of the catheter. The dye shows up on a TV monitor and helps to pinpoint the exact location of the blocked area. This dye breaks up later and leaves the body as a waste.
5. Once the blocked area is identified, a thin wire is inserted through the catheter and guided all the way to the blocked area and slightly beyond. This wire acts as a guide for the balloon catheter, which allows the doctor to insert the deflated balloon to position precisely in the middle of the narrow coronary artery.
6. The balloon is then inflated. As it expands, it squeezes the plaque deposits along the wall of the artery. It also stretches the artery wall and enlarges the channel through which blood flows.
7. After satisfactory blood flow is achieved the balloon catheter is withdrawn and another catheter is inserted. This balloon has a mesh stent wrapped around it.
8. Once this tube has been placed in the blockage area which has now widened, the balloon is inflated. The stent is expanded and gets attached to the wall of the artery.
9. Finally after a careful inspection of the site, the catheter is withdrawn. The stent remains in place and control the blood flow.

In general, people who have angioplasty are able to walk around within a few hours after the surgery depending on how well the surgery goes and where the catheter was placed. Complete recovery following angioplasty with stent placement takes about a week or less. You will be given detailed instruction on how to care for yourself after the surgery. You must let your doctor or nurse know immediately if you get fever, chest pain, swelling, pain or bleeding at your incision site.

The most common angioplasty risks include:

• Restenosis or re-narrowing of the artery.
• Blood clots can form within stent even after the procedure.
• Bleeding at the catheter insertion site.
• Although very rare, heart attack during the procedure is a risk for the surgery.
• Artery may be torn or ruptured during the procedure.
• The dye used may cause kidney damage especially in people who already have kidney problems.
• Abnormal heart rhythms and stroke.

For most of the people undergoing angioplasty with stent placement, the blood flow is greatly improved. It helps you to avoid the need for a bypass. There is always a chance that your arteries will become narrow again. Following a healthy diet, exercise, smoking restriction, and reducing stress lowers the chances of having another block. Cholesterol lowering medicines may be prescribed by your healthcare provider.