Coronary angioplasty and stents

Coronary angioplasty is a procedure to open up narrowed or blocked arteries in your heart. This allows blood to flow more easily and supply your heart muscle with the oxygen it needs.

Coronary angioplasty may be used to treat angina symptoms. If you have a heart attack, it may be used as an emergency treatment and to prevent future problems.

About coronary angioplasty

Your coronary arteries supply your heart with oxygen. In coronary heart disease, these arteries can become narrowed and blocked. If this happens, your heart muscle may not get enough oxygen, and this may lead to angina or a heart attack.

If you have angina or a heart attack, your doctor may recommend a coronary angioplasty. This is carried out through a long, flexible tube (catheter). Your doctor passes the catheter into your coronary artery through a larger blood vessel in your wrist or groin. When the catheter is in position, your doctor inflates a small balloon at the end of the tube to widen or unblock your coronary artery. They’ll usually insert a stent (a short tube of wire mesh) to keep your artery open.

You may hear several different names for a coronary angioplasty. These include percutaneous coronary intervention (PCI), balloon angioplasty and percutaneous transluminal coronary angioplasty (PTCA).

Our information here is a general guide – your individual care may differ. You’ll be given the information you need beforehand by your hospital. Before your procedure, you’ll meet the doctor who’ll carry it out to discuss what’s involved.

Alternatives to coronary angioplasty

Stable angina can sometimes be controlled with medicines and by making changes to your lifestyle, such as exercising or stopping smoking.

A coronary artery bypass graft (CABG) operation may be a better option for you if coronary angioplasty isn’t suitable.

Thrombolysis (an injection of a ‘clot-busting’ medicine) may occasionally be an alternative to emergency coronary angioplasty if you’ve had a heart attack.

Your doctor will be able to explain your options and discuss what’s best for you in your particular circumstances.

Preparing for a coronary angioplasty

Your cardiologist (a doctor who specialises in conditions that affect the heart) or hospital will give you information about how to prepare for your procedure.

If you smoke, you’ll be asked to stop. This is because if you smoke, any treatment you have for heart disease is less likely to work. If you’re taking any medicines, ask your doctor if you need to stop taking them before your angioplasty.

If you're having a planned coronary angioplasty, you may be able to go home the same day. But some people will need to stay overnight in hospital. Someone will need to drive you home when you leave hospital. If possible, they should stay with you for 24 hours.

Usually, you can’t eat or drink anything for a few hours before an angioplasty.

Angioplasty is usually done under local anaesthesia. An injection of local anaesthetic is given in either your groin or wrist, depending on how your doctor is going to do the procedure. You will be awake during the procedure but the anaesthetic will block any pain. You may also have a sedative, which will help you to relax.

Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to ask questions so that you understand what will be happening. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and you agree to have it, your doctor will ask you to sign a consent form.

Coronary angioplasty procedure

You’ll probably have your angioplasty in a specially equipped room called a catheterisation laboratory (‘cath lab’ for short). Coronary angioplasty takes about an hour, depending on how many narrowed arteries need treatment.

Your doctor will give you medicines to stop your blood clotting (anticoagulants). These help to reduce the risk of a blood clot forming in your artery wall or stent.

After the local anaesthetic has taken effect, your doctor will make a small cut in your groin or wrist. Guided by X-ray, your doctor will put a thin flexible tube (a catheter) into the artery that leads to your heart. Once the catheter is in place, they will inject a dye called contrast medium. This shows up the blocked areas of your blood vessels on the X-ray. You may feel a warm sensation when the contrast medium goes in.

Your doctor will use the X-ray images to guide a wire down the catheter to the narrowed or blocked area in your coronary artery. Then they insert a small balloon next to the blockage and gently inflate it. This makes your artery wider to allow blood to flow more easily. Once this is done, they’ll deflate and remove the balloon, along with the wire and the catheter. You may have a bit of chest pain when the balloon is inflated. Tell the doctor so they can give you some painkillers.

Your nurse will press firmly on your entry wound for about 10 minutes to make sure that the artery in your groin or wrist closes and any bleeding stops. They may then use a device to seal the hole in your artery. If you had the procedure through your wrist, your doctor may put a tight band over the artery for a couple of hours.

Stents

It’s very likely that your doctor will put in a stent to keep your coronary artery open. A stent is a very small wire mesh tube. The stent is collapsed when it’s put in, but expands to fit against your artery walls when your doctor inflates the balloon. It stays in place after the balloon is removed.

Your doctor is likely to use a stent coated with a medicine, called a drug-eluting stent. The medicine is released slowly into your artery to stop it closing up again.

Aftercare for a coronary angioplasty

You need to rest after a coronary angioplasty. Your nurse will monitor your blood pressure and pulse regularly and check your wound for bleeding.

If you had the procedure done through a cut in your groin, you’ll need to stay in bed lying on your back for a few hours. If the procedure was done through a cut on your wrist, you’ll be able to sit up soon after the procedure.

You’ll need to arrange for someone to drive you home. Ask them to stay with you for the first 24 hours after your procedure if they can.

If you’ve had a sedative, you might find that you're not as coordinated as usual or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.

You may be given a date for a follow-up appointment, and details of who to contact if you have any problems.

Recovering from a coronary angioplasty

If you have any pain from the wound, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine. If you have any questions about taking medicines, ask your pharmacist.

When you get home, check your wound regularly. You may have some bruising. But if you get any swelling or the area becomes hard to the touch or painful, contact your hospital. If your wound starts to bleed, press on it firmly and contact your hospital straightaway. If it’s bleeding heavily, reach out to the hospital or doctor.

It usually takes about a week to recover fully from a planned coronary angioplasty but this can vary. Follow your doctor's advice about what you can do during this time. Depending on your job, you may be able to return to work after a few days or you may need to take more time off. But don’t lift anything heavy or do any strenuous activity for the first week or so.

If you had an emergency angioplasty it may take longer to recover – ask your doctor or nurse for advice.

You’ll usually be invited to attend a cardiac rehabilitation programme soon after your procedure. This will tell you how to exercise and get back to everyday life while keeping your heart healthy.

You’ll probably need to take medicines such as aspirin and clopidogrel for up to a year or more after angioplasty. This is to help prevent your blood from clotting.

An angioplasty should improve the flow of blood to your heart. So if you had angina symptoms before, these should get better. If all goes well with the procedure, you should be able to do more, and your quality of life may improve as a result.

Side-effects of a coronary angioplasty

During an angioplasty and for the first few hours afterwards, you may have some mild pain or discomfort in your chest. Tell your doctor or nurse if this happens. You may have some pain or bruising where the catheter was inserted. This is common, and doesn’t need any special treatment. If you have any redness, swelling or lots of bruising after you get home, contact the hospital.

Complications

Complications are problems that occur during or after a procedure. Possible complications of angioplasty are listed here.

• Bleeding from your wound causing a collection of blood (haematoma) to form – you may need a small operation to repair your artery.

• Narrowing of the treated coronary artery (re-stenosis), usually within six months of having the procedure – you may need another angioplasty.

• A blockage within the stent can happen during the procedure or at any time afterwards – this stops blood flowing to your heart muscle and you may need emergency coronary artery bypass surgery.

• An allergic reaction to the dye used during the procedure may cause a rash or breathlessness – your doctor will be checking for this.

• A stroke or heart attack – caused by a clot breaking away from the original blockage to block an artery further on.

Some of these complications are very rare, and the chance of them happening will differ from person to person. Ask your doctor to explain how these risks apply to you.