Definition and Overview
Also referred to as percutaneous coronary intervention (PCI), angioplasty is a non-surgical procedure that involves widening a stenotic (narrowed) artery of the heart to allow proper blood flow. It uses a catheter to introduce a balloon, which is expanded to push the plaque deposits on the pathway toward the arterial walls. It is usually performed alongside stenting, in which a stent is attached to keep the artery open.
The heart is a strong muscular organ that is responsible for pumping blood all over the body. It allows oxygen-rich blood to travel through different blood vessels including arteries, which are tube-like vessels that transport blood from the heart to various organs through their connection with the capillaries.
Aside from blood, substances such as cholesterol can also pass through the arteries. While high-density lipoprotein (HDL) cholesterol goes back to the liver where it is processed and then eventually eliminated by the body, the low-density lipoprotein (LDL) has the tendency to "stick" to the arteries, causing blockage over time. When the arteries become narrowed due to blockage, the condition is referred to as stenosis.
As the blockage builds up, the condition progresses to what is referred to as atherosclerosis, which increases a person's risk of hypertension and heart disease. This means that there is a possibility he will develop a stroke or a heart attack as the arterial walls are damaged. The immune system responds by sending platelets to "repair" the damage but this process, which creates blood clots, can aggravate the condition as the said clots can burst or travel to other parts of the body (embolism).
Angioplasty is then performed to restore efficient blood flow and decrease the person's risk of dying from heart disease and atherosclerosis.
Who should undergo and expected results
Angioplasty is recommended to people who are diagnosed with atherosclerosis or coronary heart disease (CHD). Atherosclerosis often leads to CHD when left untreated.
Atherosclerosis usually does not present any symptoms during the early stages, and the plaque buildup can begin as early as childhood. In recent studies, autopsies on deceased teens showed the presence of cholesterol streaks on their arterial walls. Also, as the rate of childhood obesity increases, experts believe atherosclerosis can occur earlier than before.
Certain risk factors can increase the risk of atherosclerosis and coronary heart disease. These include obesity, diabetes, high blood pressure, high levels of LDL and triglycerides, and family history.
Both atherosclerosis and CHD can be diagnosed through a series of tests, including arteriogram or angiography, which uses an X-ray and a contrast dye to assess the internal structure of the artery. An electrocardiogram ( ECG) monitors the heart's electrical activity, and any abnormality may be further investigated to confirm whether or not the patient has artery stenosis.
People who suffer from a heart attack may be treated with angioplasty since it is the quickest way to widen the artery.
A cardiologist determines whether a patient is eligible for this procedure. Normally, if the person has a mild to moderate stenosis and can survive without an open-heart surgery, angioplasty is recommended.
However, for those who are diagnosed with conditions like diabetes, have a poor function on the heart's left chamber, or who have serious stenosis, other options may be considered like coronary artery bypass grafting (CABG).
Patients who go through angioplasty is expected to recover faster since it is minimally invasive and does not involve general anesthesia. Risks of infection and bleeding are significantly low compared to an open-heart bypass surgery.
How the procedure works
Angioplasty is normally performed in a hospital setting either as an out or inpatient by a cardiologist (a doctor that specializes in the heart). It requires a special preparation such as fasting for at least 6 hours before the procedure. The patient is also required to meet with the cardiologist to discuss medications, risks and complications, and how the procedure is performed, among others.
In the actual angioplasty procedure, the insertion site, which is usually the groin (femoral), is shaved and cleansed with antiseptic. In other cases, the wrist (radial) is used. Local anesthesia is then administered, which should keep the patient awake but relaxed. An incision is made and a needle is inserted followed by a guide wire. The needle is removed, and a sheath is added over the wire before a catheter is introduced. At this point, a contrast dye is injected for a procedure called arteriogram or angiography, an X-ray imaging test that reveals the inner structure of the artery. This step allows the doctor to accurately locate the stenosis.
Once the actual site is located, another guide wire is introduced and the catheter is removed. This wire goes all the way through the blockage. Once settled, a catheter with a tipped balloon is then threaded. It is then inflated and deflated multiple times until the plaque moves to the arterial walls.
The procedure is often completed with a stent, which is delivered through the balloon catheter. It is held in position as soon as the balloon inflates and remains in the arteries after the catheter is removed.
The entire procedure can take at least an hour.
Possible risks and complications
There may be a feeling of discomfort after the procedure, as well as disorientation because of the anesthesia. For this reason, the patient is asked to stay for several hours, sometimes overnight, in the hospital. The patient is also not allowed to drive and advised to rest.
Other possible complications involve difficulty in completing the procedure, especially in inserting catheters or inflating the balloon. Although more than 90% of the procedures are successful, at least 5% of the patients experience abrupt closure. This happens when the dilated artery suddenly closes due to thrombosis (formation of blood clot) or tearing because the arterial walls have become too thin. In order to prevent thrombosis, doctors now provide anticoagulants or blood thinners even during the actual procedure. Other options include adding a stent. Heart attack following angioplasty has now become very rare.
Creager MA, Libby P. Peripheral arterial diseases. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 58.
Kinlay S, Bhatt DL. Treatment of noncoronary obstructive vascular disease.In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 60.