Angioplasty: Definition, Procedure, and Aftercare

Definition: What is the principle of angioplasty?

Angioplasty is a cardiology method used to widen a narrowing (stenosis) in a coronary artery that reduces blood flow to the heart by inflating one or more balloon catheters.

 

In most cases, the stenosis is due to the presence of atherosclerotic plaques.

 

Coronary angioplasty, which may be performed following a diagnostic coronary angiography, differs in that it is a true surgical procedure. Angioplasty is a minimally invasive surgery performed under local anesthesia.

 

During the procedure, an interventional cardiologist (vascular surgeon or interventional radiologist) inserts a long, thin tube (catheter) into an artery, usually the wrist (radial artery), groin (femoral artery), or arm (brachial artery). The catheter is advanced closer to the narrowed artery. A contrast medium is then injected to determine the location and extent of the narrowing (arteriography).

 

If an artery is accessible for percutaneous treatment, a guidewire is advanced through the catheter and beyond the blockage in the blocked or narrowed artery. In this way, a special balloon can be pushed over the guidewire. Once in place, the guidewire is briefly inflated to reopen the blocked artery.

 

A metallic stent may then be implanted to keep the critical area open for an extended period.

 

What are the types of angioplasty?

The technical complexity and success rate of angioplasty vary depending on the severity of coronary atherosclerotic disease.

 

Not all atheromatous plaques have the same composition, but vary depending on their fibrotic, lipidic, or calcified component.

 

In general, commonly used crushing balloons ensure angioplasty success in more than 95% of cases.

 

However, for more resistant atherosclerotic plaques, there are various additional techniques and materials that ensure an optimal outcome in more than 99% of cases.

 

For more complex angioplasty cases, the technique and materials to be used are planned before the procedure, and potential risks/benefits are always shared with the patient.

 

In particular, our center has been using sophisticated imaging techniques for years.

 

Here are the angioplasty techniques:

  • High-pressure angioplasty: This involves using special balloons capable of reaching pressures of 30 atmospheres to widen the toughest plaques);
  • Rotational atherectomy: This involves using a diamond burr to crush particularly calcified plaques;
  • Lithotripsy: This involves using shock waves similar to those used to crush kidney stones;
  • Laser therapy: This involves the use of ultraviolet ray pulses capable of vaporizing any thrombi;

   

Why have coronary angioplasty?

Angioplasty is a possible treatment for:

  • Narrowing or blockage of the heart's coronary arteries. The existence of these problems is known under the more general term of coronary artery disease;
  • Narrowing of large arteries due to atherosclerosis;
  • Peripheral arterial disease. This is a vascular disease characterized by a narrowing of the arterial vessels of the extremities (upper or lower) and the organs of the trunk;
  • Carotid artery stenosis. This is a narrowing or blockage of one or both carotid arteries, the arterial vessels that branch off the main arteries in the neck to carry oxygen-rich blood to the brain;
  • Narrowed or blocked veins in the chest, abdomen, pelvis, or extremities (upper or lower);
  • Renal artery stenosis associated with renovascular hypertension. This affects kidney function. Stenosis of the arteriovenous fistula in patients requiring hemodialysis;

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Why have angioplasty with stent placement?

Stent implantation has been used for the treatment of coronary artery disease for over ten years. The insertion of a stent to ensure patency of coronary arteries and allow normal blood circulation after angioplasty is now a common practice.

 

Stent implantation is a minimally invasive procedure in which a stent and balloon are used in combination to compress plaque deposits in the coronary artery and thus resolve or mitigate a cardiac problem.

 

A coronary stent is an expandable tube with a mesh-like structure, made of cobalt alloy or medical-grade steel. Stents can help reduce recurrent obstruction or narrowing of the vessel after an angioplasty procedure. Once implanted, the stent remains permanently in place.

 

How to prepare for an angioplasty?

Coronary angioplasty is a common medical procedure that involves widening narrowed coronary arteries to improve blood flow to the heart. If your doctor has recommended angioplasty, it's important to prepare well before the procedure. First, be sure to follow all your doctor's instructions regarding medication before the procedure. It is also recommended that you do not eat or drink anything for at least 8 hours before the angioplasty. Your doctor will also give you instructions on how to dress and information about the procedure itself, such as how long it will take and what you will feel during the procedure. Finally, it is important to arrange for someone to drive you to the clinic and take you home after the angioplasty, as you will not be able to drive in the hours following the procedure.

 

How does balloon angioplasty work?

Balloon angioplasty is a minimally invasive procedure that allows dilation of narrowed coronary arteries from within the vessel. Along with bypass surgery, these are widely used standard procedures for treating coronary artery disease and peripheral arterial disease. The goal of all these procedures is to restore blood circulation and sufficient oxygen supply to the heart and peripheral areas of the body.

 

What is the aftercare for angioplasty?

Coronary angioplasty usually involves an overnight hospital stay to keep the patient under observation, and medication is prescribed to prevent thrombus formation.

 

To avoid reopening the wound, it is best to avoid wetting the incision site for about a week and to avoid strenuous physical activity for a few days.

 

Coronary angioplasty improves blood flow to the heart and therefore the symptoms of angina, but does not cure coronary artery disease. After the operation, it is important to follow a healthy lifestyle and take the medication prescribed by the cardiologist.

 

What are the possible complications of angioplasty?

Although coronary angioplasty is minimally invasive, like any surgical procedure, it carries a risk of complications, which can occur during or after the treatment. The most common complications are bleeding or hematomas at the site where the catheter was inserted.

 

Less frequently, artery damage, hemorrhages, allergic reactions to the contrast fluid used during the procedure, blood clot formation due to the stent, detachment of atheromatous plaques from the artery, stroke, and heart attack can occur.

 

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