Angioplasty and Stent Placement for the Heart
What is angioplasty?
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
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
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.
Why might I need angioplasty?
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.
What are the risks of angioplasty?
Possible risks linked to angioplasty, stenting, atherectomy, and related procedures
Bleeding at the site where the catheter is put into the body (usually the groin, wrist,
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
Chest pain or discomfort
Rupture of the coronary artery or complete closing of the coronary artery, needing
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.
How do I get ready for angioplasty?
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. Radiation exposure
during pregnancy may lead to birth defects.
Tell your healthcare team if you have any body piercings on your chest or belly (abdomen).
Tell your healthcare team of all prescription and over-the-counter medicines, vitamins,
herbs, and supplements that you are taking.
Tell your healthcare team if you have a history of bleeding disorders or if you are
taking any blood-thinning medicines (anticoagulant or antiplatelet), aspirin, or other
medicines that affect blood clotting. You may need to stop some of these medicines
before the procedure. But for planned angioplasty procedures, your doctor may want
you to continue taking aspirin and antiplatelet medicines, so be sure to ask.
Your provider may request a blood test before the procedure to find out how long it
takes your blood to clot. Other blood tests may be done as well.
Tell your healthcare team if you have a pacemaker or other implanted device.
You may get a sedative before the procedure to help you relax.
Based on your health condition, your doctor may give you other instructions on how
to get ready.
What happens during angioplasty?
Angioplasty may be done as part of your stay in a hospital. Procedures may vary depending
on your condition and your doctor's practices. Most people who have angioplasty and
stent placement are monitored overnight in the hospital.
Generally, angioplasty follows this process:
You will be asked to remove any jewelry or other objects that may interfere with the
procedure. You may wear your dentures or hearing aid if you use either of these.
You will be asked to remove your clothing and will be given a gown to wear.
You will be asked to empty your bladder before the procedure.
If there is a lot of hair at the area of the catheter insertion (often the groin area),
the hair may be shaved off.
An IV (intravenous) line will be started in your hand or arm before the procedure.
It will be used for injection of medicine and to give IV fluids, if needed.
You will be placed on your back on the procedure table.
You will be connected to an electrocardiogram (ECG) monitor that records the electrical
activity of your heart and monitors your heart rate using electrodes that stick to
your skin. Your vital signs (heart rate, blood pressure, breathing rate, and oxygen
level) will be monitored during the procedure.
There will be several monitor screens in the room, showing your vital signs, the images
of the catheter being moved through your body into your heart, and the structures
of your heart as the dye is injected.
You will get a sedative in your IV to help you relax. However, you will likely stay
awake during the procedure.
Your pulses below the catheter insertion site will be checked and marked so that the
circulation to the limb below the site can easily be checked during and after the
Local anesthesia will be injected into the skin at the insertion site. This may be
in your leg, arm, or wrist. You may feel some stinging at the site for a few seconds
after the local anesthetic is injected.
Once the local anesthesia has taken effect, a sheath, or introducer, will be put into
the blood vessel (often at the groin). This is a plastic tube through which the catheter
will be threaded into the blood vessel and advanced into the heart.
The catheter will be threaded through the sheath into the blood vessel. The doctor
will advance the catheter through the aorta into the heart. Fluoroscopy will be used
to help see the catheter advance into the heart.
The catheter will be threaded into the coronary arteries. Once the catheter is in
place, contrast dye will be injected through the catheter into your coronary arteries
in order to see the narrowed area(s). You may feel some effects when the contrast
dye is injected into the IV line. These effects include a flushing sensation, a salty
or metallic taste in the mouth, or a brief headache. These effects usually last only
a few moments.
Tell your doctor if you feel any breathing trouble, sweating, numbness, itching, nausea
or vomiting, chills, or heart palpitations.
After the contrast dye is injected, a series of rapid X-ray images of the heart and
coronary arteries will be taken. You may be asked to take in a deep breath and hold
it for a few seconds during this time.
When the doctor locates the narrowed artery, the catheter will be advanced to that
location and the balloon will be inflated to open the artery. You may have some chest
pain or discomfort at this point because the blood flow is temporarily blocked by
the inflated balloon. Any chest discomfort or pain should go away when the balloon
is deflated. However, if you notice any continued discomfort or pain, such as chest
pain, neck or jaw pain, back pain, arm pain, shortness of breath, or breathing trouble,
tell your doctor right away.
The doctor may inflate and deflate the balloon several times. The decision may be
made at this point to put in a stent to keep the artery open. In some cases, the stent
may be put into the artery before the balloon is inflated. Then the inflation of the
balloon will open the artery and fully expand the stent.
The doctor will take measurements, pictures, or angiograms after the artery has been
opened. Once it has been determined that the artery is opened sufficiently, the catheter
will be removed.
The sheath or introducer is taken out and the insertion site may be closed with a
closure device that uses collagen to seal the opening in the artery, by the use of
sutures, or by applying manual pressure over the area to keep the blood vessel from
bleeding. Your doctor will decide which method is best for you.
If a closure device is used, a sterile dressing will be applied to the site. If manual
pressure is used, the doctor (or an assistant) will hold pressure on the insertion
site so that a clot will form on the outside of the blood vessel to prevent bleeding.
Once the bleeding has stopped, a very tight bandage will be placed on the site.
Staff will help you slide from the table onto a stretcher so that you can be taken
to the recovery area. NOTE: If the insertion was in the groin, you will not be allowed
to bend your leg for several hours. If the insertion site was in the arm, your arm
will be kept elevated on pillows and kept straight by placing your arm in an arm guard
(a plastic arm board designed to immobilize the elbow joint). In addition, a plastic
band (that works like a belt around the waist) may be secured around your arm near
the insertion site. The band will be loosened at given intervals and then removed
when your doctor decides the pressure is no longer needed.
What happens after angioplasty?
In the hospital
After the procedure, you may be taken to the recovery room for observation or returned
to your hospital room. You will stay flat in bed for several hours after the procedure.
A nurse will monitor your vital signs, the insertion site, and circulation and sensation
in the affected leg or arm.
Tell your nurse right away if you feel any chest pain or tightness, or any other pain,
as well as any feelings of warmth, bleeding, or pain at the insertion site.
Bed rest may vary from 2 to 6 hours depending on your specific condition. If your
doctor placed a closure device, your bed rest may be shorter.
In some cases, the sheath or introducer may be left in the insertion site. If so,
the bedrest will be last until the sheath is removed. After the sheath is removed,
you may be given a light meal.
You may feel the urge to urinate often because of the effects of the contrast dye
and increased fluids. You will need to use a bedpan or urinal while on bed rest so
that your affected leg or arm will not be bent.
After the specified period of bed rest has been completed, you may get out of bed.
The nurse will help you the first time you get up, and will check your blood pressure
while you are lying in bed, sitting, and standing. You should move slowly when getting
up to avoid any dizziness from the long period of bed rest.
You may be given pain medicine for pain or discomfort at the insertion site or from
having to lie flat and still for a long time.
You will be encouraged to drink water and other fluids to help flush the contrast
dye from your body.
You may go back your usual diet after the procedure, unless your doctor decides otherwise.
You will most likely spend the night in the hospital after your procedure. Depending
on your condition and the results of your procedure, your stay may be longer. You
will get detailed instructions for your discharge and recovery period.
Once at home, monitor the insertion site for bleeding, unusual pain, swelling, abnormal
discoloration, or temperature change. A small bruise is normal. If you notice a constant
or large amount of blood at the site that can't be contained with a small dressing,
tell your healthcare team.
If your doctor used a closure device at your insertion site, you will be given specific
information regarding the type of closure device that was used and how to take care
of the site. There will be a small knot, or lump, under the skin at the site. This
is normal. The knot should slowly disappear over a few weeks.
It will be important to keep the insertion site clean and dry. Your healthcare team
will give you specific bathing instructions. In general, don't use a bathtub or hot
tub or go swimming until the skin has healed.
You may be advised not to participate in any strenuous activities. Your healthcare
team will instruct you about when you can return to work and resume normal activities.
Tell your healthcare team if you have any of the following:
Fever or chills
Increased pain, redness, swelling, bleeding, or other drainage from the insertion
Coolness, numbness or tingling, or other changes in the affected arm or leg
Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness, or fainting
Your doctor may give you other instructions after the procedure, depending on your
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure