Coronary Angioplasty – Understand the Basics

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Editor: Dr S Venkatesh MD DM

What is coronary angioplasty?

Coronary angioplasty is a procedure where a narrowed coronary artery is opened up using a balloon and a stent. It is often offered to patients who have suffered from heart attacks or those who were experiencing constant chest pain on exertion or at rest. Coronary angioplasty is not a diagnostic test but is a form of treatment.

How is the procedure performed?

The procedure is extremely similar to a coronary angiogram. The only additional aspect to coronary angioplasty is that an additional wire that contains a balloon or a metallic stent at its tip is inserted through the sheath into the coronary artery that needs opening up. Once the balloon or stent is in place, it is inflated or expanded to open up the artery. The stent keeps the artery open allowing for normal blood flow through the coronary artery.

The image below demonstrates how coronary angioplasty works.

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The rest of the procedure following coronary angioplasty is similar to coronary angiography. The procedure takes around 30 to 45 min to perform though sometimes it may take longer if the coronary artery disease is a lot more complex and multiple interventions need to be performed.

During the procedure, as the balloon is inflated, the artery in which it is placed may be temporarily blocked off. Patients may experience mild chest discomfort when this occurs but it is reassuring to know that this only last for a few seconds and disappears once the balloon is deflated. Following the procedure, the cardiologist will ensure that the arteries are patent by injecting dye into them again. Patients are then moved to the observation area and are discharged home if there are no complications.

Limitations

Coronary angioplasty may not necessarily be the best treatment option for patients who have coronary artery disease. Some patients may benefit from a bypass operation rather than undergo this procedure. Furthermore, this procedure is often not recommended to patients who suffer from kidney disease as the contrast dye can place pressure on this organ and cause it to not function normally.

Risks of the procedure

The risks of coronary angioplasty are more than that of a coronary angiogram because wires, balloons and stents are moved around in the artery. Heart attacks may occur in around 1% (1 in 100) of cases and stroke may occur in 0.5% (5 in 1000) of cases. Patients may experience excessive bleeding from the site of the procedure. Death has been reported in around 1 in 500 cases.

It is important to recognise the fact that despite the risks, the procedure has benefits that outweigh them. It is only in such situations that coronary angioplasty is performed.

In fact, coronary angioplasty can be life-saving treatment in patients suffering from an acute heart attack. Every patient who undergoes coronary angioplasty will have a full assessment to ensure that they are safe to undergo the procedure. The procedure will not be performed if any suspicion of high-risk is felt.

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