Angioplasty is a procedure used to open blocked coronary arteries caused by coronary artery disease. It restores blood flow to the heart muscle without open-heart surgery. Angioplasty can be done in an emergency setting such as a heart attack. Or it can be done as elective surgery if your healthcare provider strongly suspects you have heart disease. Angioplasty is also called percutaneous coronary intervention (PCI).

For angioplasty, a long, thin tube (catheter) is put into a blood vessel and guided to the blocked coronary artery. The catheter has a tiny balloon at its tip. Once the catheter is in place, the balloon is inflated at the narrowed area of the heart artery. This presses the plaque or blood clot against the sides of the artery, making more room for blood flow.

The healthcare provider uses fluoroscopy during the surgery. Fluoroscopy is a special type of X-ray that’s like an X-ray "movie." It helps the doctor find the blockages in the heart arteries as a contrast dye moves through the arteries. This is called coronary angiography.

The healthcare provider may decide that you need another type of procedure. This may include removing the plaque (atherectomy) at the site of the narrowing of the artery. In atherectomy, the provider may use a catheter with a a rotating tip. When the catheter reaches the narrowed spot in the artery, the plaque is broken up or cut away to open the artery.

Stents

Coronary stents are now used in nearly all angioplasty procedures. A stent is a tiny, expandable metal mesh coil. It is put into the newly opened area of the artery to help keep the artery from narrowing or closing again.

Once the stent has been placed, tissue will start to coat the stent like a layer of skin. The stent will be fully lined with tissue within 3 to 12 months, depending on if the stent has a medicine coating or not. You may be prescribed medicines called antiplatelets to decrease the "stickiness" of platelets. Platelets are special blood cells that clump together to stop bleeding. The medicine can also prevent blood clots from forming inside the stent. Your healthcare team will give specific instructions on which medicines need to be taken and for how long.

Most stents are coated with medicine to prevent scar tissue from forming inside the stent. These stents are called drug-eluting stents (DES). They release medicine within the blood vessel that slows the overgrowth of tissue within the stent. This helps prevent the blood vessel from becoming narrow again. Some stents don't have this medicine coating and are called bare metal stents (BMS). They may have higher rates of stenosis, but they don't require long-term use of antiplatelet medicines. This may be the preferred stent in people who are at high risk of bleeding.

Because stents can become blocked, it's important to talk with your healthcare team about what you need to do if you have chest pain after a stent placement.

If scar tissue does form inside the stent, you may need a repeat procedure. This may be using either balloon angioplasty or with a second stent. In some cases, radiation therapy may be given through a catheter placed near the scar tissue to stop the growth of scar tissue and open up the vessel. This is called brachytherapy.Angioplasty is done to restore coronary artery blood flow when the narrowed artery is in a place that can be reached in this manner. Not all coronary artery disease (CAD) can be treated with angioplasty. Your doctor will decide the best way to treat your CAD based on your circumstances.

Risks of angioplasty-

Possible risks linked to angioplasty, stenting, atherectomy, and related procedures include:

• Bleeding at the site where the catheter is put into the body (usually the groin, wrist, or arm)
• Blood clot or damage to the blood vessel from the catheter
• Blood clot within the treated blood vessel
• Infection at the catheter insertion site
• Abnormal heart rhythms
• Heart attack
• Stroke
• Chest pain or discomfort
• Rupture of the coronary artery or complete closing of the coronary artery, needing open-heart surgery
• Allergic reaction to the contrast dye used
• Kidney damage from the contrast dye

You may want to ask your healthcare team about the amount of radiation used during the procedure and the risks related to your particular situation. It's a good idea to keep a record of your radiation exposure, such as previous scans and other types of X-rays, so that you can tell your healthcare team. Risks linked to radiation exposure may be related to the total number of X-rays or treatments over a long period.

For some people, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain.

There may be other risks depending on your specific health condition. Discuss any concerns with your healthcare team before the procedure.

• Your healthcare team will explain the procedure to you and you can ask questions.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is unclear.
• Tell your healthcare team if you have ever had a reaction to any contrast dye, or if you are allergic to iodine.
• Tell your healthcare team if you are sensitive to or are allergic to any medicines, latex, tape, and local or general anesthesia.
• Follow any directions you are given for not eating or drinking before surgery.
• Tell your healthcare team if you are pregnant or think you could be.
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