About 45,000 ⁽¹⁾ coronary angioplasty or percutaneous transluminal coronary angioplasty (PTCA) procedures are carried out in the UK each year.

Why do I need a coronary angioplasty?

You may need to have a coronary angioplasty if you suffer from a condition called angina or if you have had a heart attack.

Angina is chest pain and usually occurs when you exercise or, in more serious cases, when you're simply walking or even resting. It is caused when the arteries in the heart become narrowed by fatty deposits (atheroma). The narrowing of the arteries reduces blood flow, and therefore oxygen, to your heart, causing pain and reducing your heart's efficiency.

If an artery becomes completely blocked, the flow of blood to the heart stops and a heart attack may follow. If you have angina while resting, you must see your doctor or cardiologist.

To help diagnose your condition and find out whether coronary angioplasty will help, you'll first have a coronary angiogram (cardiac catheterisation), which is an X-ray to diagnose if you have narrowed arteries.

During the coronary angiogram procedure, a fine tube (catheter) is inserted into an artery (usually in your groin) and pushed slowly up to your heart. The doctor will be watching a monitor with the X-ray on it to help guide the catheter.

Dye, which is fed through the tube into your blood stream, flows to your heart. Narrowed areas of artery will show up on the X-ray monitor. If you have already discussed it with your doctor, and it is felt to be the right treatment, the angioplasty may be done at the same time.

Is angioplasty the right treatment for me?

Coronary angioplasty is not suitable for everyone, with some patients not needing any treatment at all and being able to manage their angina with medication. Some patients, however, may need a heart bypass operation, properly known as a coronary artery bypass graft (CABG).

You may be recommended for coronary angioplasty if medication is not keeping your angina under control or if the X-ray reveals narrowing in your heart arteries and your doctor thinks angioplasty will help. You will also be considered for the procedure if you have already had a heart bypass, but your artery has narrowed again.

If you have already had a heart attack, your cardiologist may suggest you have a coronary angioplasty, as this can reduce your risk of having another one.

In some cases, people who have just had a heart attack have a coronary angioplasty as part of their emergency treatment. It is also known as direct angioplasty (door-to-balloon time).

What questions should I ask my doctor?

• How many times has the doctor performed a coronary angioplasty? Research shows that doctors who have carried out this procedure more times have better results
• Are there any alternative treatments I should consider?
• What are the risks to my health if I don't have this procedure?
• What are the risks, based on my circumstances, if I do have this procedure?
• Will I feel better if I have this procedure?

Getting ready for the procedure

If you know you are going to have a coronary angioplasty there are steps you can take beforehand to aid recovery and improve your health:

• If you are overweight you should lose some weight
• Giving up smoking is the single best step you can take for your health. You will have fewer side-effects from the anaesthetic and will heal much faster
• Take a close look at your diet. To eat healthily you need to have five portions of different types of fruit and vegetables a day, plenty of fibre, not very much fat, and no more than six grammes of salt a day
• Reduce your alcohol consumption and drink in moderation
• Try to stay active. Naturally this will depend on the severity of your angina symptoms and on what your doctor advises

The nurse will discuss your medication and tell you to stop taking warfarin four days before the procedure, metformin 24 hours before the procedure and beta-blockers or ace inhibitors on the morning of your procedure ⁽²⁾.

You will be asked to shave the hair from the right groin a day or so before the test and you must not eat anything six hours prior to the procedure and only drink clear fluids up to hospital admission ⁽²⁾.

How is a coronary angioplasty performed?

Your coronary angioplasty will probably be carried out in hospital or in a catheterisation room or laboratory by a cardiologist (heart specialist).

• You'll be asked to lie on your back, on an X-ray table, and be given a local anaesthetic and a drug called clopidogrel®, which helps stop clots forming in the stent device ⁽³⁾
• The doctor may also give you aspirin, if you are not already prescribed it to thin your blood. An anticoagulant, such as heparin, may also be administered ⁽³⁾
• You may also have an intravenous (IV) line in a vein, in case you need painkillers or a sedative. This procedure is not normally painful, and you won't be able to feel the catheter while the angioplasty is under way ⁽²⁾
• The doctor will then make a small incision in an artery, usually in your groin, through which a balloon-tipped catheter is passed ⁽³⁾
• Using the X-ray to help guide it, your cardiologist will pass the catheter up through your artery, to your heart. When the tip of the catheter reaches the narrowed - or blocked - section of artery, the balloon will be gently inflated ⁽³⁾
• The inflating balloon presses against the deposits lining your artery, squashing them against the artery walls. This may be done a number of times, and widens the artery to allow blood to flow through it more freely ⁽³⁾
• You may feel some angina pain in your chest when the balloon is inflated, because it can temporarily block the blood flow. However the pain will go once the balloon is deflated ⁽³⁾
• Your cardiologist will check that the procedure has been successful by injecting dye into the catheter, and checking on the X-ray monitorthat it is flowing through your artery as it should ⁽²⁾

How long does the procedure take?

It usually takes about 30 minutes ⁽⁴⁾ to carry out a coronary angioplasty.

If you have more than one section of narrowed artery to be treated, it will take longer. In nine out of 10 cases ⁽⁵⁾, coronary angioplasty successfully widens narrowed arteries and restores blood flow.

What is a coronary stent?

In many cases, the procedure will include the use of a bare stent, which is a tube made of stainless steel mesh. The stent expands to fit your artery as the balloon is inflated. Once your cardiologist is happy with the procedure, the balloon is deflated, and the catheter is withdrawn, leaving the stent behind to keep the artery open.

If your cardiologist knows in advance that you are going to have a bare stent, you'll be prescribed antiplatelet drugs (clopidogrel ®) to prevent blood clots from forming around it and an anticoagulant drug (aspirin) ⁽⁵⁾. Your doctor will advise you on any medication you need to take after the procedure. You will need to take this for between two weeks and six months, depending on the type and number of stents that you have ⁽⁵⁾.

Advantages and disadvantages of stents

Stents can reduce the risk of your artery furring up again, while reducing the need to have the procedure repeated. They can be particularly beneficial if your artery was completely blocked.

One disadvantage of using a stent in a coronary angioplasty is that it can put you at greater risk of blood clots - and extra tissue - forming around it. In the past, this meant that in some cases the arteries became narrowed again (restenosis), and the procedure had to be repeated.

What are drug-eluting stents?

Drug-eluting stents are sometimes used to avoid clots forming again and are coated with a drug which reduces the risk of extra tissue growth, helping the artery stay open for longer. These stents are not used in all hospitals and are not suitable for all patients ⁽⁶⁾. Your doctor will tell you if this type of stent is suitable for you, if it is available and if it is the best choice. You will still need to take anticoagulant drugs for a period of time after the operation, even if you have a drug-eluting stent fitted.

What happens after the procedure?

In most cases, you will need to spend only one night in hospital after the procedure and may even be able to go home on the same day.

You shouldn't drive for up to a week ⁽⁷⁾, so try to arrange for someone to pick you up and take you home and take care of you for the duration.

Avoid lifting anything heavy until the wound in your groin has healed. You should be able to return to work after a week ⁽⁷⁾ and have sex ⁽⁷⁾ when you feel up to it.

If your angioplasty was carried out following a heart attack, however, you will need to keep to the rehabilitation programme set out for you at the hospital.

What are the risks associated with coronary angioplasty?

Coronary angioplasty is generally a very safe procedure. There are some risks involved, however:

• You could develop an infection at the site of the original incision, which can make it sore
• You shouldn't experience chest pain following a coronary angioplasty. If you do, tell a member of the medical team caring for you immediately. They'll check to find the cause of the pain
• In a small number of cases, the procedure blocks the artery being treated. If your cardiologist thinks this poses a threat to your heart a coronary artery bypass graft (CABG) may be arranged for you straight away
• If your angioplasty does not successfully clear your narrowed artery, your cardiologist may recommend that you have heart surgery at a later date
• There is also a slight risk of heart attack, stroke and damage to the artery, which is greater for people who already have severe heart disease

Infolink:

• British Heart Foundation