Coronary Angioplasty:

 

Coronary angioplasty (PTCA or PCI) is a technique for treating coronary artery disease. It helps open blocked or narrowed coronary (heart) arteries. The procedure improves blood flow to the heart muscle.


Over time, a fatty substance called plaque can build up in arteries, causing them to harden and narrow. This condition is called atherosclerosis which can affect any artery in the body. When atherosclerosis affects the coronary arteries, the condition is called coronary artery disease (CAD).


Angioplasty can restore blood flow to the heart if the coronary arteries have become narrowed or blocked because of CAD.





Blockage of coronary artery





Angioplasty and stenting

How it is done?


While the patient is awake and pain-free (local anesthesia), the catheter is inserted into an artery at the top of the leg (the femoral artery) or hand (radial artery). X-ray pictures are taken to view the catheter as it passes up to artery, into aorta, and into the blocked coronary artery. The small balloon at the end of the catheter is inflated and widens the area of the blockage, restoring adequate blood flow through the artery to the heart muscle.


Often, a metallic device called a stent may be placed. This is a small tube that is placed within the coronary artery to keep the vessel open. A stent may be used for coronary artery bypass graft as well.

 


How long does coronary angioplasty take?


If just one section of artery is widened the procedure usually takes about 15-30 minutes in an experienced hand. If several blocks are to be widened then the procedure takes longer. One may need to stay in hospital overnight for observation following the procedure.


How successful is coronary angioplasty?


More than 9 in 10 procedures are successful at relieving angina. However, coronary angioplasty may not be used for all people with angina. This is because in many cases there are too many blockages, too long blockages or blockages with branches. 


After an angioplasty


One should avoid heavy activities such as lifting for about a week until the small wound where the catheter was inserted has healed. One should not drive a car for a week after having an angioplasty.


Are there any possible risks, complications or side-effects?


One common problem is that a bruise may form under the skin where the catheter was inserted (usually the groin). This is not serious, but it may be sore for a few days.


Risks of the procedure


The risks are negligible in expert hands and are as follows


  • Infection of groin or hand..
  • Allergic reaction to the dye.
  • A heart attack during the procedure.
  • The catheter may damage a coronary artery. 
  • A stroke is another rare complication.


Long - term complications


In some cases, the atheroma re-forms within the stent over the next few months and years. This may narrow the artery again and angina pains may return again. When it occurs, the procedure can be repeated.

Newer techniques are being developed to try to prevent this possible problem. For example, stents that are coated with chemicals (drug coated stents) which prevent the local formation of atheroma are being developed. 

 

Benefits of Coronary angioplasty


  • Quicker and less painful recovery
  • Short hospital stay, does not require general anesthesia
  • Small incision
  • The chest cage does not need to be opened
  • Chances of major post-operative complications like stroke are very less as compared to bypass surgery.