If you or your family member has been diagnosed with coronary artery disease (CAD) and recommended for angioplasty procedure with implantation of stent by doctor, we at Wockhardt take this opportunity to educate you on angioplasty procedure.
Ageing and other complex factors cause the blood vessels to become hard. In addition, cholesterol and minerals from the blood are deposited on the inner surface of the coronary arteries. When this material builds up, they form a plaque. A raised plaque may restrict the blood ﬂow through the coronary artery.
A raised plaque may also change the surface of the artery from smooth to rough, and these rough surfaces may stimulate the formation of a blood clot, which may lead to narrowed artery. A blood clot can also build up quickly and abruptly close oﬀ the artery.
If a coronary artery suddenly closes, blood ﬂow to a part of the heart may stop completely. In this case, some of the heart muscle may be permanently damaged. This is often accompanied by severe chest pain that won’t go away. This is called myocardial infarction, or more commonly, a heart attack.
If you have an increased risk of coronary artery disease or certain symptoms of the disease, your doctor may recommend a stress test, or exercise electrocardiogram (ECG). The stress test measures changes in the electrical activity of your heart as you perform controlled exercise.
If the results of the stress test indicate a need for fur ther testing, your doctor may arrange for you to have a coronary angiogram. The coronary angiogram is the most useful test for diagnosing CAD because it allows the doctor to see exactly where the coronary arteries are narrowed or blocked.
Before the angiogram begins, you will receive a local anesthetic or pain medicine. The doctor then inserts an introducer sheath into an artery in your groin or forearm. Then the doctor inserts a long thin tube called catheter, into the artery and advances it into the blocked artery. By injecting a contrast dye that can be seen on an X – ray screen, the doctor can observe the arteries in your heart. You may be asked to take a deep breath and hold it while the doctor is taking the angiogram. Any narrowing or blockage that exists can then be identiﬁed. Based on the result of the angiogram the doctors may advise medical therapy, angioplasty or coronary by pass graft surgery. In some cases, the doctor performs a angioplasty procedure, immediately following the angiogram in order to open the coronary artery for blood ﬂow.
Angioplasty is also performed in a cardiac catheterization laboratory (Cath lab). Patients usually receive medication before and during angioplasty procedure to help relax. You are awake and alert throughout the procedure.
Angioplasty begins by inserting a sheath for the catheter into a blood vessel, usually the upper leg or groin area, but sometimes in the arm. A hollow tube termed catheter is placed through the sheath in to the mouth of the coronary artery.
A very small balloon catheter is passed through the guiding catheter in to the coronary arteries.
Once the balloon is at the narrowing of the artery, the balloon is inﬂated to widen the narrowed position of the artery.
Every situation is unique, but is most cases the inﬂation will last from 30 seconds, up to several minutes, depending on the nature of the blockage.
While the balloon is inflated, some people feel a chest pain that is similar to the angina they have experience. This happens because the balloon is temporarily blocking off the flow of blood and the oxygen that it carries to the heart. Patients should describe to the doctor any pain they feel during the procedure.
After the block has been opened the balloon is deflated and retracted back through the blood vessel.
A stent is an expandable metallic tube which is crimped on to a thin balloon. A stent is implanted to support the artery and keep the vessel open like a structural framework. It is introduced into your artery just after balloon angioplasty and is positioned at the site of the obstruction. Inﬂation of the balloon deploys the stent at the site thus widening the narrowed part of the artery.
The stent is implanted permanently in the artery.Stent implantation helps in two ways,
- After balloon dilatation of the narrowed artery, artery may suddenly occlude termed acute vessel closure. This is prevented by stents.
- After balloon angioplasty many patients can develop recurrence of the block by a process known as restenosis. Stents reduce the risk of restenosis.
Drug-eluting stent is a metal stent that has been coated with a pharmacologic agent (drug) that is known to reduce the chance of restenosis (reblocking). With the metal stents, the risk of restonosis is reduced to 15 – 25%, where as drug eluting stents reduce this risk to 6 – 8%.
After the angioplasty procedure, patients are monitored overnight in intensive care unit. Blood pressure, pulse monitoring and ECGs are per formed routinely after angioplasty procedures and do not signify any special problems. I f a patient experiences any chest discomfor t or pressure, the nurse should be notified immediately.
Most patients are required to hold their leg or arm straight and still for the ﬁrst six to eight hours. After the angioplasty, you are required to stay in the hospital for 2 -3 days. You can resume full activity within a few days of returning home.
Angioplasty is not a cure, but a treatment to reduce the eﬀects of coronary artery disease. Following angioplasty, diet and medications have to be strictly followed to reduce the risk of recurrences.
This booklet has talked about procedures and doctors to treat your heart. There is also a lot you can do, both before and after your procedure, to help yourself
- Stop smoking
- Maintain ideal body weight
- Control cholesterol level
- Exercise regularly
- Take medication regularly
- Have regular follow ups and monitor the progress with appropriate tests as recommended by doctor
At Wockhardt, we care for your well being. We strongly recommend practicing prevention and securing health. In a world where lifestyle evolves by the day, it is essential to stay in the pink of health. Wishing you and your family good health and happiness always.
The information in the booklet is not intended as a substitute for medical advice but is to be used as an aid in understanding ailment. Always consult your doctor about your medical condition.