Angioplasty

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Alternative names

Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Cardiac angioplasty; PTCA; Percutaneous transluminal coronary angioplasty; Heart artery dilatation
Definition

Angioplasty is a medical procedure to open narrowed or blocked blood vessels of the heart. These blood vessels are called the coronary arteries.

Angioplasty is not considered to be a type of surgery. It is called a percutaneous coronary intervention (PCI).

See also:

Angiogram
Cardiac catheterization
Description

Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis.

If the blockage is not too severe, an angioplasty procedure can be used to open the artery. Traditional angioplasty involves the use of a balloon catheter -- a small, hollow, flexible tube that has a balloon near the end of it.

Before the balloon angioplasty procedure begins, you will be given some pain medicine. Occasionally, blood thinning medicines are also given to prevent formation of a blood clot.

You will lie down on a padded table. The health care provider will make a small cut on your body, usually near the groin, and insert the catheter into an artery. You will be awake during the procedure.

The health care provider will use x-rays to look at your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps reveal any blockages in the vessels leading to the heart. The balloon catheter is moved into or near the blockage, and the balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart.

In some cases, a device called a stent is also placed at the site of narrowing or blockage in order to keep the artery open. A common type of stent is made of self-expanding, stainless steel mesh.

Rarely, a special device with a small, diamond tip is used to drill through the hard plaque and calcium that are causing the blockage. This is called rotational atherectomy.

Indications

Angioplasty may be used to treat:

Persistent chest pain (angina)
Blockage of one or more coronary arteries
Blockage in a coronary artery during or after a heart attack
Note: Recent studies show that medicine and angioplasty with stenting have equal benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of coronary artery disease. Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack

Risks

Risks of angioplasty include:

Allergic reaction to the x-ray dye
Bleeding in area where the catheter was inserted
Blockage of blood flow to an area of the heart (very rare)
Damage to a heart valve or blood vessel
Death
Kidney failure (higher risk in those with existing kidney problems)
Irregular heart beats (arrhythmias)
Stroke (rare)
The risks for any anesthesia are:

Breathing problems
Reactions to medications
The risks for any surgery are:

Bleeding
Infection
Expectations after surgery

Angioplasty greatly improves blood flow through the coronary arteries and the heart in most patients. It may eliminate the need for coronary artery bypass surgery (CABG). However, CABG may be recommended for persons whose arteries can not be widened enough with angioplasty or who have severe blockages.

Angioplasty does not cure the cause of the blockage. The arteries may become narrow again, which may or may not require another procedure. Stents coated with medicines (drug-eluting stents) may help prevent future narrowing (drug-eluting stents) and reduce the rates of repeated angioplasty.

You should diet, exercise, stop smoking (if you smoke), and reduce stress to help lower your chances of re-narrowing. Your health care provider may prescribe medicine to help lower your cholesterol.

Most patients receive aspirin and another medicine called clopidogrel (Plavix) after this procedure. It is very important to take the medicines exactly as your doctor tells you. Failure to do so can result in blood clotting in the stent (stent thrombosis) and a heart attack.

Convalescence

Usually, the average hospital stay is less than 2 days. Some people may not have to stay overnight in the hospital at all.

In general, persons who have angioplasty are able to walk around within 6 hours after the procedure. Complete recovery takes a week or less. Keep the area where the catheter was inserted dry for 24 to 48 hours.

Summary: Adding a stent or a balloon procedure to open up the arteries that feed blood to the heart to the best medical treatment provided no more protection against death, heart attack, stroke and hospitalization than the best medical treatment alone in patients who had stable heart disease. Best medical treatment involves many drugs along with changes in the patients’ activities and eating habits.

Why it’s important: An increasing number of people with symptoms of heart disease such as chest pain undergo angioplasty (balloon procedure to open up the arteries) and stenting. This involves inserting a tube through a blood vessel in the leg and feeding it into the arteries that provide blood to the heart. Doctors then inflate a balloon in the artery to increase its diameter and usually insert a metal cage or coil called a stent to keep the artery open. This procedure is called percutaneous intervention or PCI. This increases the risk to the patient as well as the cost.While this procedure has been shown to reduce death and heart attacks in patients with unstable heart disease, it has not been shown to have benefit to patients with stable heart disease in the long term.

What’s already known: Current guidelines recommend that as a first step, doctors use intensive medical treatment and a reduction of risk factors to treat patients with signs and symptoms of heart or coronary artery disease. Yet, in 2004, more than 1 million balloon stent procedures took place in the United States. Data from a registry of such procedures indicate that 85 percent of these were done in patients who had not had a heart attack and who had heart disease believed to be stable. Using balloons and stents in patients with acutely active disease that could lead to a heart attack can reduce that risk along with the threat of dying. Previous studies show that using balloons and stents can reduce chest pain called angina. However, studies do not show that it reduces heart attack or death in patients with stable heart disease.

How this study was done: The doctors who took part in the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial sought to determine over time whether using angioplasty and stents along with the best possible medical treatment reduced deaths and heart attacks in these patients. To do this, they assigned 1,149 patients who chose to take part to receive the best medical treatment and angioplasty/stenting. They also assigned 1,138 patients to a control or comparison group that received the best possible medical treatment. They monitored these patients for 2.5 to 7 years to determine how many in each group had a heart attack or died.

What was found: In the group that received both stents and the best medical treatment, there were 211 heart attacks or deaths. There were 202 such events in the group that received only medication. Over 4.6 years, 19 percent of those in the stent plus medicine group either died or had a heart attack compared to 18.5 percent in the medicine alone group. The study found no difference in rates of stroke or need to go into the hospital among the groups.

The study conducted by the Cooperative Studies Program of the U.S. Department of Veterans Affairs and the Canadian Institutes of Health Research (CIHR) involved 15 VA medical centers as well 35 other medical centers in both the United States and Canada.

"People assume that once you have PCI (angioplasty and stent), it's curative," said the study’s lead author, William E. Boden, M.D., who is a consultant in cardiology at the Western New York VA Healthcare System in Buffalo in a released statement. "I think the best we can say is that it's palliative (pain and symptom reducing).

"The findings suggest that if a patient with heart disease is doing well, the latest available medications are very effective and there is no need for PCI," said Peter Liu, M.D., scientific director of the CIHR Institute of Circulatory and Respiratory Health.

The bottom line: Aggressive medical treatment of patients with stable disease in the coronary arteries that provide blood to the heart prevents heart attacks and death as well as adding angioplasty and stents to that same aggressive treatment. However, angioplasty and stents do reduce chest pain and other symptoms of heart disease.