Coronary Balloon Angioplasty and Stent

What Is Atherosclerosis?

Atherosclerosis is the buildup of cholesterol and fatty deposits (plaque) on the inner walls of the arteries that restrict blood flow to the heart.

Coronary artery disease is the narrowing or blockage of the coronary (heart) arteries. Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. When one or more of the coronary arteries are completely blocked, a heart attack may occur.

What Is an Interventional Procedure?

An interventional procedure is a nonsurgical treatment used to open narrowed coronary arteries to improve blood flow to the heart.

An interventional procedure can be performed during a diagnostic cardiac catheterization when a blockage is identified, or it may be scheduled after a catheterization has confirmed the presence of coronary artery disease.

Description

Balloon Angioplasty

Balloon angioplasty is a procedure in which a small balloon at the tip of the catheter is inserted near the blocked or narrowed area of the coronary artery.

When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the heart.

This procedure is sometimes complicated by vessel recoil and restenosis.

Balloon Angioplasty with Stenting

In most cases, balloon angioplasty is performed in combination with the stenting procedure.

A stent is a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery. A balloon catheter, placed over a guidewire, is used to insert the stent into the narrowed artery.

Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed, and the stent stays in place permanently. During a period of several weeks, the artery heals around the stent. In this way, restenosis is somewhat diminished.

Angioplasty with stenting is most commonly recommended for patients who have a blockage in one or two coronary arteries. If there are blockages in more than two coronary arteries, coronary artery bypass graft surgery may be recommended.

Drug-Eluting Stents (DES)

Drug-eluting stents contain a medication that is actively released at the stent implantation site.

DES have a thin surface of medication to reduce the risk of restenosis. If you receive a DES, your doctor will prescribe blood thinners along with aspirin for at least 12 months after your procedure to prevent the risk of clotting in the stent. It is extremely important to keep taking the medications as prescribed until your doctor tells you otherwise.

Rotablation

A special catheter is guided to the point of narrowing in the coronary artery. The tip spins around at a high speed and grinds away the plaque on the arterial walls.

This process is repeated as needed to treat the blockage and improve blood flow. The microscopic particles are washed safely away in your blood stream and filtered out by your liver and spleen.

Cutting Balloon

The cutting balloon catheter has a balloon tip with small blades. When the balloon is inflated, the blades are activated.

The small blades score the plaque. Then, the balloon compresses the fatty matter into the arterial wall. This type of balloon may be used to treat the buildup of plaque within a previously placed stent (restenosis) or other types of blockages.

FAQS

Are These Procedures Considered To Be Surgical Procedures?

No. Cardiac catheterization and interventional procedures are not considered to be surgical procedures because there is no large incision used to open the chest, and the recovery time from catheterization is much shorter than that of surgery.

In some cases, surgery may be recommended afterward, depending on the results of the procedure.

Will I Be Awake For The Procedure?

Yes. You will be given a mild sedative to relax you, but you will be awake and conscious during the entire procedure. The doctor will use a local anesthetic to numb the catheter insertion site.

How Long Do The Procedures Take To Perform?

Plan on staying at the hospital all day for the procedure and remaining in the hospital overnight.

Does An Interventional Procedure Cure Coronary Artery Disease?

For most people, interventional procedures increase blood flow to the heart, diminish chest pain, and decrease the risk of a heart attack.

Although an interventional procedure opens up blocked arteries, it does not cure coronary artery disease. You will still need to reduce your risk factors and make certain lifestyle changes to prevent future disease development or progression.

To achieve the best results, you must be committed to living a heart-healthy lifestyle. Your healthcare team can help you achieve your goals, but it is up to you to take your medications as prescribed, make dietary changes, quit smoking, exercise regularly, keep your follow-up appointments, and be an active member of the treatment team.

Risks

What Are the Possible Risks of the Procedure?

If you need to have a cardiac catheterization or an interventional procedure, your cardiologist will discuss the specific risks and potential benefits of the recommended procedure with you.

Some of the possible risks of cardiac catheterization and interventional procedures include:

Allergic reaction to the medication or contrast material used during the procedure
Irregular heart rhythm
Infection
Bleeding at the catheter insertion site
Continued chest pain or angina
Mild to moderate skin reactions from X-ray exposure
Kidney failure
Heart attack, blood clots, stroke, or death
Acute closure of coronary artery
Emergency coronary artery bypass graft (CABG) surgery

There may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand why the procedure is recommended and what all of the potential risks are.

Before the Procedure

Taking Medication

Discuss your medications with your physician; he or she may want to stop or adjust the doses several days prior to or on the day of as well as immediately after the procedure, especially those listed below:

Anticoagulant medications
Diabetes medications

How to Prepare

The preprocedure tests that are necessary before your cardiac catheterization
Do not drink or eat anything for 8 hours before the procedure
Tell your doctor if you are allergic to anything

What to Bring

Someone to drive you home after your procedure
Toiletries and any other items you would like to make your stay more comfortable

After the Procedure

Care for the Insertion Site

Procedures may be performed in the femoral artery in the groin or in the radial artery in your arm. When you go home, there will be a bandage over the catheter insertion site.

The morning after your procedure, you may take the bandage off. The easiest way to do this is when you are showering and then getting the tape and bandage wet to remove it.

After the bandage is removed, cover the area with a small adhesive bandage. It is normal for the catheter insertion site to be black and blue for a couple of days. The site may also be slightly swollen and pink, and there may be a small lump at the site.

Wash the catheter insertion site at least once daily with soap and water. Place soapy water on your hand or washcloth and gently wash the insertion site, but do not rub.

Important things to note:

When you are not showering, keep the area clean and dry
Do not use creams, lotions, or ointment on the wound site
Wear loose clothes and loose underwear
Do not take a bath, go in a jacuzzi, or go swimming in a pool for one week

Activity Guidelines

Your doctor will tell you when you can resume activities. In general, you will need to take it easy for the first two days after you get home. You can expect to feel tired and weak the day after the procedure. Take walks around your house and plan to rest during the day.

For femoral cardiac catheterization (groin):

To prevent bleeding, do not strain during bowel movements for the first 3 to 4 days after the procedure
Avoid lifting, pushing, or pulling heavy objects for the first 5 to 7 days after the procedure.
Do not participate in strenuous activities (jogging, golfing, tennis, etc.) for 5 days after the procedure
Walk up and down stairs more slowly than usual
Within one week after the procedure, gradually increase your activities until you reach your normal activity level

For radial cardiac catheterization (wrist):

Do not participate in strenuous activities (jogging, golfing, tennis, etc.) for 2 days after the procedure
Within 2 days after the procedure, gradually increase your activities until you reach your normal activity level

Ask your doctor when it is safe to:

Return to work
Resume sexual activity
Resume driving

Medication

Please review your medications with your doctor before you go home and ask if you should continue taking the medications you were taking before the procedure.

If you have diabetes, your doctor may adjust your diabetes medication(s) for one to two days after your procedure. Please be sure to ask for specific directions about taking your diabetes medication after the procedure.

Depending on the results of your procedure, your heart doctor may prescribe new medication. Please make sure you understand what medications you should be taking after the procedure and how often to take them.

Fluid Guidelines

Be sure to drink eight to ten glasses of clear fluids (water is preferred) to flush the contrast material from your system.

Importance of a Heart-Healthy Lifestyle

It is important for you to be committed to living a heart-healthy lifestyle.

Your healthcare team can help you achieve your goals, but it is up to you to take your medications as prescribed, make dietary changes, quit smoking, exercise regularly, keep your follow-up appointments, and be an active member of the treatment team.

Please call the office the day you are discharged to schedule a follow-up appointment within two to three weeks of your procedure with your cardiologist.