Angioplasty

What is angioplasty?

Angioplasty is a minimally invasive procedure that opens arteries (large blood vessels) to let blood flow more easily. It most commonly treats atherosclerosis (a collection of plaque made of fat and cholesterol) in your arteries.

Angioplasty involves a tiny medical balloon that pushes plaque through in spots that are too narrow or blocked.

Angioplasties are generally safe procedures. They’re less invasive than other heart and vascular procedures, like bypass surgery.

Your cardiovascular health is very important to your overall health. Angioplasties are often necessary to try to prevent serious complications of atherosclerosis, like heart attack and stroke.

Types of angioplasty

Healthcare providers use certain words to explain which arteries they’re treating. The two most common include:

• Coronary artery angioplasty. The coronary arteries are major blood vessels that supply blood to your heart. Another name for this procedure is percutaneous coronary intervention (PCI).
• Peripheral artery angioplasty. Peripheral arteries are blood vessels that carry blood away from your heart to your extremities, like your legs and arms.

Different angioplasty techniques include:

• Balloon angioplasty. Most angioplasty procedures involve a tiny medical balloon to move the plaque out of the way and off to the side of the artery wall.
• Angioplasty with or without stenting. Your provider may or may not place a permanent stent (a small tube) in the newly opened artery to help keep it open. Stent placement comes after most angioplasties.
• Excimer laser coronary angioplasty (ELCA). This is an alternative to using a balloon to unblock a coronary artery. The laser destroys the plaque. It’s not as common as balloon angioplasty.

When might I need angioplasty?

You may need angioplasty if you have:

• A heart attack. Angioplasty may limit damage to your heart during or right after a heart attack. In this case, it’s an emergency treatment.
• Carotid artery disease. The carotid arteries are in your neck. Left untreated, blocked carotid arteries can lead to a stroke.
• Chronic kidney disease. When plaque collects in the arteries in your kidneys, it affects how much blood and oxygen can reach them. Sometimes, a renal (kidney) artery angioplasty can help.
• Coronary artery disease (CAD). Your coronary arteries make it possible for your heart to beat and pump blood throughout your body. A blocked coronary artery can cause chest pain and/or a heart attack.
• Peripheral artery disease (PAD). Angioplasty can clear plaque in the major arteries in your arms, legs and pelvis. Without treatment, PAD can lead to pain, ulcers and gangrene.

Your healthcare provider will use an angiogram (an imaging procedure) to help guide the angioplasty.

How do I prepare for angioplasty?

Your provider will give you specific instructions for preparing for the procedure. They’ll also go over your medications and health history. In general, your provider will likely:

• Tell you to not eat or drink anything except water (fast) for eight hours before the test
• Adjust your medications (especially if you take anticoagulants)
• Ask if you’ve had an allergic reaction to contrast dye or anesthesia before
• Ask if you’re pregnant

For your safety, you won’t be allowed to drive yourself home on the same day of the procedure. You should figure out transportation from the hospital if you’re going home the same day. You may need to stay overnight at the hospital.

What happens during angioplasty?

In general, you can expect the following during angioplasty:

1. You change into a medical gown and lie on your back for the procedure.
2. A healthcare provider gives you medicine that makes you feel relaxed (a sedative) through an IV. But you’ll still be awake enough to follow instructions.
3. Certain monitors will keep track of your vital signs, like your pulse and oxygen levels, during the procedure.
4. A provider gives you local anesthesia to numb the area where they’ll access an artery. This is usually in your groin or arm. You may feel pressure in this area during the procedure, but you shouldn’t feel pain.
5. A provider accesses a blood vessel with a needle. They slide a sheath (or tube) over the needle and into a large artery.
6. They pass wires and catheters through the tube to the artery they’re targeting.
7. An X-ray machine rotates around you (called fluoroscopy). It allows the provider to see where the catheter is going from all angles.
8. Once your provider gets to the targeted artery, they put a special dye into the tube. They look at X-rays to watch the dye go through your artery. For a few seconds, you might feel flushed or like you need to pee.
9. The provider can find the blockage or narrowing of your artery with the imaging. They’ll cross the problem area with a guide wire. This allows the balloon-tipped catheter to pass over the wire.
10. Once across the blockage, they’ll briefly inflate the balloon. They may need to do this more than once.
11. The provider will look at more X-rays to see how much blood flow has improved.
12. They’ll usually then put in a permanent stent. Stronger than a balloon, the stent keeps the artery open after balloon removal.

After the procedure, the healthcare provider takes out the catheter. A provider will use a bandage to cover the place where the catheter went into your skin. They’ll put pressure on the site to stop or prevent any bleeding. You may need to lie on your back for a few hours if the catheter was in your groin.

How long does angioplasty take?

A typical angioplasty procedure can take 30 minutes to two hours. You’ll then need to recover in the hospital afterward. Your healthcare provider can give you a better idea of what to expect for your overall hospital stay.

What are the risks of angioplasty?

The risks of angioplasty include:

• A repeat blockage if you don’t get a stent in your artery
• Abnormal heartbeats (arrhythmia)
• Allergic reaction to the contrast dye or anesthetic
• Blood vessel or kidney damage
• Blood clots
• Heart attack
• Low blood pressure
• Pain, bleeding or infection where a needle or catheter went into your skin
• Stroke

It’s a good idea to get angioplasty from a healthcare provider who does them often (at a high-volume center). Most of the time, they’re safe procedures. Serious complications are rare.

You’re more likely to have complications if you:

• Are over 65 years
• Have kidney disease
• Have several blocked arteries

What is the recovery time for angioplasty?

You’ll need to stay at the hospital for several hours or even overnight to recover from angioplasty. If you’re leaving the hospital the same day, someone else needs to drive you home.

You may feel tired after the procedure. Get rest at home and drink fluids. Your provider may tell you to limit your activities for a couple of days after you get home. Your wound may be sensitive or bruised for a week or more.

You may need to take medicines like aspirin or other blood thinners after the angioplasty. If your provider prescribed blood thinners, it’s important to take these as directed. Don’t miss any doses. If you think you need to stop taking them, you should discuss it with your provider before you do.

You should be able to drive and go back to work about a week after the angioplasty. But this can vary depending on the type. Check with your provider.

When should I call my healthcare provider?

You’ll have a follow-up visit after you go home. But you should contact your healthcare provider after an angioplasty if:

• You have bleeding or an infection where the catheter went through your skin
• Your leg color changes
• It hurts or feels warm where the catheter was

What is the success rate of angioplasty?

The success rate of angioplasty varies for several reasons, including:

• The type of angioplasty and the artery that’s blocked
• The severity of the blockage
• Your overall health
• Your age

Your healthcare provider will give you a better idea of what you can expect. Don’t hesitate to ask questions.

Is angioplasty painful?

Overall, angioplasty should involve minimal pain. You may feel some temporary mild pain or discomfort when the provider:

• Inserts an IV line with a needle to give you a sedative
• Injects local anesthesia
• Inflates the angioplasty balloon

You shouldn’t feel pain from the catheter during the procedure. You also won’t feel the provider threading the catheter through your blood vessels and arteries.

After the procedure, the sites where the IV and catheter went into your skin may be sore. But this should go away after a week or so.

Tell the provider immediately if you feel intense pain during any part of the procedure.