Coronary angioplasty: Understanding the procedure

If you have narrowed or blocked coronary arteries, you may require a coronary angioplasty. Here to explain what’s involved in this operation is leading interventional cardiologist Dr Saqib Ghani.

What is a coronary angioplasty?

A coronary angioplasty, also known as percutaneous coronary intervention (PCI), is a minimally invasive procedure used to treat narrowed or blocked coronary arteries. During the procedure, a small balloon-tipped catheter is inserted into the narrowed artery and inflated to widen the artery and improve blood flow to the heart muscle.

Why is a coronary angioplasty performed?

A coronary angioplasty may be performed to:

Relieve symptoms

Angioplasty can alleviate symptoms of coronary artery disease, such as chest pain (angina), shortness of breath and fatigue, by restoring blood flow to the heart.

Prevent heart attack

By opening blocked arteries, angioplasty reduces the risk of a heart attack by restoring blood supply to the heart muscle.

Treat acute coronary syndromes

Angioplasty is often used as an emergency treatment for acute coronary syndromes, such as unstable angina or myocardial infarction (heart attack), to restore blood flow and prevent further damage to the heart.

Improve heart function

In some cases, coronary angioplasty may be performed to improve heart function and reduce the risk of heart failure in patients with severely narrowed arteries.

How is a coronary angioplasty performed?

The coronary angioplasty procedure involves the following steps:

• Access: The patient is positioned on an examination table, and the access site (usually the groin or wrist) is cleaned and numbed with a local anaesthetic.
• Insertion of catheter: A thin, flexible tube called a catheter is inserted into the access site and guided through the blood vessels to the coronary arteries using X-ray guidance (fluoroscopy).
• Angiography: A contrast dye is injected through the catheter into the coronary arteries, and X-ray images (angiograms) are taken to visualize any blockages or narrowed areas in the arteries.
• Balloon inflation: Once the blockage is identified, a balloon-tipped catheter is advanced to the site of narrowing. The balloon is inflated to compress the plaque and widen the artery, restoring blood flow.
• Stent placement: In many cases, a stent - a small mesh tube - is placed in the treated artery to help keep it open and prevent re-narrowing (restenosis) after the balloon is deflated.
• Completion angiography: After the procedure, additional angiograms may be performed to ensure that blood flow has been restored and the artery is adequately widened.

What are the risks and complications associated with coronary angioplasty?

While coronary angioplasty is generally considered safe, there are potential risks and complications, including:

• Bleeding: Bleeding or bruising at the catheter insertion site is common, particularly if the access site is in the groin.
• Infection: There is a risk of infection at the catheter insertion site, although this is rare.
• Blood vessel damage: The blood vessels may be damaged during catheter insertion, leading to bleeding or blood vessel narrowing (stenosis).
• Heart attack or stroke: In rare cases, angioplasty can cause blood clots to dislodge and travel to the heart (causing a heart attack) or brain (causing a stroke).
• Restenosis: Despite stent placement, the treated artery may become narrowed again over time, requiring additional procedures.

What is the recovery process after a coronary angioplasty?

After the procedure, patients are typically monitored closely in a recovery area for several hours to ensure that there are no complications. Most patients can return home the same day or after an overnight stay in the hospital. It’s essential to follow the post-procedure instructions provided by your healthcare team, including taking prescribed medications, avoiding strenuous activity, and attending follow-up appointments.

Concerned you may need a coronary angioplasty? Arrange a consultation with Dr Ghani via his Top Doctors profile.