Angioplasty is a medical procedure to open narrowed or blocked blood vessels of the heart called the coronary arteries. Angioplasty is not considered to be a type of surgery. First used in 1977, it’s now as common as heart bypass surgery. It’s sometimes called percutaneous transluminal coronary angioplasty (PTCA) and percutaneous coronary intervention (PCI). Angioplasty is also used in other parts of the body, usually to treat peripheral artery disease.
Angioplasty may be used to improve symptoms of coronary artery disease (CAD) such as angina and shortness of breath. Angina is a form of chest pain or discomfort that occurs when an area of the heart muscle is deprived of enough oxygen-rich blood. Angina may feel like pressure or squeezing in the chest. The pain also may occur in the shoulders, arms, jaw, neck, or back. Angina can feel like indigestion.
Remarkably, angina itself is not a disease. Rather, it’s a symptom of an underlying heart problem and usually a symptom of coronary artery disease (CAD), the most common type of heart disease. In CAD, coronary arteries (the arteries that supply blood and oxygen to your heart) become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis.
Coronary angioplasty is also used to reduce damage to the heart muscle resulting from a heart attack. Atherosclerosis usually leads to heart attack. When plaque is formed, an area of plaque can rupture, resulting in a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.
Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women in the United States.
The doctors will review preoperative tests and assessments like the initial history, physical examination, and electrocardiographic (ECG) assessment to identify and define disease severity, stability, and treatment.
If patients have been taking blood thinner warfarin, they will need to stop taking this before the admission. This is to reduce the risk of excessive bleeding from the site where the catheter is inserted.
If the patient does not have an artificial valve / had a stroke previously then warfarin should be stopped at least 3 days before the coronary angioplasty. If patients have had a stroke before or have an artificial valve then they should consult their physician to discuss when to stop warfarin.
If the patient is a diabetic taking metformin they will need to stop taking this for 48 hours before coming into hospital for coronary angioplasty, and for 48 hours afterwards.
Patients are also instructed to avoid eating or drinking anything for six to eight hours before the test and to empty their bladders before your procedure.
Angioplasty is performed while patient is awake, under local anesthetic. Sometimes patients find it uncomfortable, but it is not usually painful. Balloon angioplasty (percutaneous transluminal coronary angioplasty or PTCA) is widely used for treatment of the blockages of coronary artery disease.
The surgeon makes a small incision in the groin or arm and inserts a thin tube, called a catheter, into the artery. The catheter includes a small balloon and a small wire tube, called a stent. The stent is usually a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed coronary artery.
Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. This is to compress the plaque and enlarge the artery, and provide an adequate area for blood to flow through. The balloon is deflated and removed, and the stent stays in place permanently. The procedure may be repeated for one or more other narrowed sections within the coronary arteries.
Patients usually do not feel the catheter inside the blood vessels. Occasionally, the patient may feel a ‘missed’ or ‘extra’ heartbeat during the procedure. This is considered normal and of little concern. During the procedure patient heartbeat is monitored by electrodes placed on patient’s chest which provide a tracing on an ECG machine (electrocardiograph).
The duration of the procedure also depends on various factors. If just one section of artery is widened the procedure usually takes about 30 minutes. If several sections are to be widened then the procedure takes longer.
Most people are admitted to hospital and monitored overnight after angioplasty. They are usually sent home early the next day. More than 9 in 10 procedures are successful at relieving angina. However, coronary angioplasty cannot be used for all people with angina.
Over a several-week period, the artery heals around the stent. Stents are commonly placed during interventional procedures such as angioplasty or atherectomy to help keep the coronary artery open.
Patients are advised to avoid any heavy activities such as lifting for about a week until the small wound where the catheter was inserted has healed. They’re also proscribed from driving a car for a week after having an angioplasty. If patient has an LGV or PSV license, they should check with the DVLA about driving a bus or lorry following an angioplasty.
More than 9 in 10 coronary angioplasty procedures are successful at relieving angina. However, the use of coronary angioplasty is not possible with all people with angina. The reason for this is in some cases there are too many narrowed sections in the coronary arteries. Or, the sections that are narrowed are too long or too narrow for coronary angioplasty.
In some other cases, it is not possible to stretch the narrowed artery. This occurs in about 1 in 20 cases where coronary angioplasty is tried. An alternative treatment coronary artery bypass grafting may then be an option to treat angina. Bypass grafting involves involve major surgery hence most patients feel that it was worth trying a coronary angioplasty first.
Patients need to keep in mind that you may not always be able to make your own choice between angioplasty and bypass surgery. This is because many factors are taken into consideration when selecting the best treatment approach for an individual with coronary artery disease.
The doctor checks the severity and extent of coronary artery disease and also the symptoms of the patient. Overall heart function and co-existing medical conditions, such as heart valve disease, diabetes, kidney disease, peripheral artery disease, or prior stroke or heart attack.
If narrowing in the arteries is severe enough to reduce blood flow to patient’s heart, angioplasty with stenting is usually recommended. However, if patient has multiple blockages, bypass surgery may be a better option.
There is a third possibility where some types of narrowing become more difficult to treat. For instance, if the patient has severe narrowing and very small blood vessels neither angioplasty nor bypass surgery would not be recommended. In these instances, medications may be the only treatment option.
For many patients in U.S. and U.K. coronary angioplasty operation is usually very expensive. In such cases, patients can opt to go for coronary angioplasty in countries like Mexico, India, Turkey and Costa Rica.
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This package includes hospital stay, lab tests, anesthesia, operation theater fees, doctors fees, ride to & from the hospital, ride to & from recovery center, medicines, etc.
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