During the procedure
Your body isn't cut open except for a very small incision in the skin over a blood vessel in the leg, arm or wrist through which a small, thin tube (catheter) is threaded and the procedure performed. Angioplasty can take up to several hours, depending on the difficulty and number of blockages and whether any complications arise.
Angioplasty is performed by a heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians in a special operating room called a cardiac catheterization laboratory. This room is often called the cath lab.
Angioplasty is commonly performed through an artery in your groin (femoral artery). Less commonly, it may be done using an artery in your arm or wrist area. Before the procedure, the area is prepared with an antiseptic solution and a sterile sheet is placed over your body.
A local anesthetic is injected to numb the area where the catheter will be inserted. Small electrode pads are placed on your chest to monitor your heart during the procedure.
General anesthesia isn't needed. You'll be sedated but awake during the procedure. You'll receive fluids, medications to relax you and blood-thinning medications (anticoagulants) through an IV catheter. Then, the procedure begins:
- After numbing the incision area, a small needle is used to access an artery in your leg or arm. A small cut is made in the skin.
- Your doctor then threads a thin guidewire followed by a catheter into the artery until it reaches the blockage in your heart.
- You might feel pressure in the area where the catheter is inserted, but you shouldn't feel sharp pain. Tell your doctor if you do. You also won't feel the catheter in your body.
- A small amount of dye is injected through the catheter. This helps your doctor look at the blockage on X-ray images called angiograms.
- A small balloon at the end of the catheter is inflated, widening the blocked artery. After the artery is stretched, the balloon is deflated and removed. Your doctor might inflate and deflate the balloon several times before it's removed, stretching the artery a bit more each time.
If you have several blockages, the procedure may be repeated at each blockage. Because the balloon temporarily blocks blood flow to part of your heart, it's not uncommon to experience chest pain while it's inflated.
Most people who have angioplasty also have a stent placed in their blocked artery during the same procedure. The stent is usually inserted in the artery after it's widened by the inflated balloon.
The stent supports the walls of your artery to help prevent it from re-narrowing after the angioplasty. The stent looks like a tiny coil of wire mesh.
Here's what happens:
- The stent, which is collapsed around a balloon at the tip of the catheter, is guided through the artery to the blockage.
- At the blockage, the balloon is inflated and the spring-like stent expands and locks into place inside the artery.
- The stent stays in the artery permanently to hold it open and improve blood flow to your heart. In some cases, more than one stent may be needed to open a blockage.
- Once the stent is in place, the balloon catheter is removed and more images (angiograms) are taken to see how well blood flows through your newly widened artery.
- Finally, the guide catheter is removed, and the procedure is completed.
A new drug-eluting, fully absorbable stent has recently been approved by the Food and Drug Administration to treat coronary artery disease. The stent is designed to dissolve and be absorbed by the body over time. Long-term effects aren't yet known. This stent may be available at some medical centers.
After your stent placement, you may need prolonged treatment with medications, such as aspirin or clopidogrel (Plavix) to reduce the chance of blood clots forming on the stent.
After the procedure
If you had a non emergency procedure, you'll probably remain hospitalized one day while your heart is monitored and your medications are adjusted. You generally should be able to return to work or your normal routine the week after angioplasty. If you needed angioplasty and stenting during a heart attack, your hospital stay and recovery period will likely be longer.
When you return home, drink plenty of fluids to help flush your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for at least a day afterward. Ask your doctor or nurse about other restrictions in activity.
Call your doctor's office or hospital staff immediately if:
- The site where your catheter was inserted starts bleeding or swelling
- You develop pain or discomfort at the site where your catheter was inserted
- You have signs of infection, such as redness, swelling, drainage or fever
- There's a change in temperature or color of the leg or arm that was used for the procedure
- You feel faint or weak
- You develop chest pain or shortness of breath
It's important that you closely follow your doctor's recommendations about your treatment with blood-thinning medications — aspirin and clopidogrel or similar medications.
Most people who have undergone angioplasty with or without stent placement will need to take aspirin indefinitely. Those who have had stent placement will need a blood-thinning medication such as clopidogrel for a year or longer in some cases. If you have any questions or if you need noncardiac surgery, talk to your cardiologist before stopping any of these medications.