Coronary Artery Disease is an ill medical condition in which the arteries in the heart are narrowed or blocked by a sticky material called “Plaque”.
The surgical procedure to restore blood flow in these narrowed or blocked arteries that are known as ANGIOPLASTY, which is the standard treatment for Coronary Artery Disease and Acute Coronary Syndrome (Heart Attack).
Angioplasty can also be referred to as the PERCUTANEOUS CORONARY INTERVENTION (PCI) or PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY.
During the PCI, the surgeon inserts a tube into an artery in the groin or wrist. Then the tube is guided through the use of X-Rays and a Contrast dye, towards the affected arteries which are around the heart. Finally, a balloon or stent (metal tube) is inserted to open the artery.
WHAT IS ANGIOPLASTY?
The term ‘Angioplasty‘ is a combination of two words; Angio and Plasty. Angio means “blood vessel” and Plasty means “opening up”. Hence, angioplasty is characterized by surgical operations to open the blood vessels that supply blood to your heart muscle also called “coronary arteries”.
The alternative name PERCUTANEOUS CORONARY INTERVENTION (PCI). Percutaneous means “through the skin” and coronary means “the location of blood vessels around the heart”.
In these ill conditions, CAD and ACS, there is a build-up of plaque or atherosclerosis, on the walls of the arteries. As this accumulates, it narrows the arteries and finally blocks them when it becomes excess.
In heart attacks, the plaque may rupture, spilling cholesterol into an artery, and potentially leading to a clot that stops blood flow.
Angioplasty does not involve the opening of the chest. So it’s a minor surgery compared to heart surgery.
WHO IS ELIGIBLE FOR ANGIOPLASTY
This surgery is recommended for:
- Abnormal Stress Test
- The increased blood flow to the heart.
- The treatment of Angina.
- Treatment to improve blood supply to the heart muscle during or after a heart attack.
- As support for more activity for people with chest pain.
TYPES OF ANGIOPLASTY
There are two main types:
- Balloon Angioplasty: This involves using the pressure of an inflating balloon to clear the plaque that is blocking an artery. It is only done in cases where the doctor cannot place a stent in the required position.
- Stent Placement: This involves a tube or a stent, made out of wire mesh. This helps to prevent the artery from narrowing again after the surgery. The stent is made of bare metal or has a medication coating. If they include medication, they are called Drug-Eluting Stents (DES) and are less likely to plug up again.
WHY IS ANGIOPLASTY DONE?
Angioplasty is done to:
- Help improve blood flow to the heart
- Help reduce the incidence of heart attack caused
- It also reduces pains at the chest
- Prevent shortness of breath and improve breathing.
PREPARATION FOR ANGIOPLASTY
The procedure for Angioplasty is a minor invasive procedure, so the patient must be prepared as long as it is a surgery.
The first step in preparation involves informing the doctor of any medications and supplements they may be taking. There are cases that the patient needs to stop taking these medications, especially blood thinners, before surgery.
Secondly, the patient may need to avoid food or drinks for several hours before the surgery.
Since doctors use Contrast dye during the surgery, a kidney test is required before the surgery because contrast dye can affect kidney functions.
First, before the surgery begins, the surgeon's assistant will clean and numb the part of the body where the tube will enter. That part is usually the groin or the wrist.
After this, the surgeon inserts the tube into the artery and directs it towards the Coronary artery using the feed from the X-Ray. Once the tube is in position, the contrast dye is injected through the artery. This will help identify the blockages. A second tube is inserted together with a guidewire, this usually comes with a balloon at the tip.
When the second tube is in position, the balloon is inflated. The inflated balloon pushes the plaque build-up away and opens up the artery. Sometimes a stent is inserted to keep the artery propped open.
You will be transferred to the ICU for monitoring and will be administered pain killers to numb the pains.
SIDE EFFECTS & COMPLICATIONS OF ANGIOPLASTY
Angioplasty is a safe procedure. However, research shows an estimate of 5 complications out of 100 people.
These complications include:
- Prolonged bleeding from the tube insertion site in the groin or wrist.
- Damage to blood vessels, kidneys, or arteries.
- An allergic reaction to the contrast dye.
- Chest pain.
- Arrhythmia, or abnormal heart rhythm.
- A blockage that requires an emergency bypass.
- Blood clot.
- Heart Attack.
- A tear or damage to an artery or major blood vessels.
- Death; Older people have a higher risk of complications, along with people with the following conditions;
- Heart disease
- Several blocked arteries
- Chronic Kidney Disease
Also, there is a chance of the artery becoming blocked again with plaque through restenosis, plaque shift, or stent thrombosis which is a clot in the stent.
After few days of surgery, the cardiologist removes the tubes and bandages. Bruising, soreness and possible bleeding are common around the areas where the tube was inserted into the body.
The patient will recover in the hospital a few hours later or overnight.
Patients are not advised to drive home as they may still have sedative medication in their system.
Lifting objects will also be restricted for about a week or more.
The patient can return to work within a week but on the doctor's advice on how active they will have to be.
A check-up visit is required to review the patient's recovery, adjust medications and develop an ongoing treatment plan. This aspect of recovery is very important.
What is an angioplasty?
Angioplasty is a surgery which involves reconstruction of the damaged/narrowed blood vessel wall using stents/metal tubes which are specially designed to lodge inside and keep the blood vessel wide enough for sufficient blood circulation.
Can I lead a healthy normal life again after angioplasty?
Angioplasty is a safer way of improving blood flow through the coronary arteries hence there are excellent chances of you returning to an almost normal lifestyle within 3 days and after making adjustments in your diet, exercise level, smoking habit, etc.
Can I get Coronary Artery Disease again?
Since Angioplasty opens your dangerous block on your coronary arteries, it can not be ascertained if you might likely develop coronary artery disease again but if you exercise regularly, eat properly, avoid smoking and reduce alcohol intake, you might reduce your chances of developing heart disease.
How much alcohol I can take?
It is best If you don’t take alcohol before the surgery that you continue to avoid it but if you do, Moderate drinking is fine because Excess alcohol can raise your blood pressure.
When can I resume my sexual life after angioplasty?
Well, it is quite difficult to ascertain when is the right time due to individuality difference and how severe the case was before surgery but If you can climb two sets of stairs without shortness of breath, you can resume sexual activity.
What kind of diet I should follow?
You should avoid fried, fatty things especially saturated trans fat in milk, sweets, cheese, etc. Try eating more vegetables, fruits, whole grains, and food rich in fiber. Eat nuts more and reduce salt intake.
Patients, who have narrowed blood vessels due to formation of plaques in the wall of vessel which lead to narrowing because of fat deposition on it, should undergo angioplasty to ensure blood is flowing normally through that vessel.
What predisposes to having narrowed blood vessels?
Deranged lipid profile (high LDL and cholesterol, low HDL levels) along with other factors like level of physical activity, dietary intake (of fibre, quality of fats etc.) and history of similar problem in family predispose to this condition.
What are the advantages of angioplasty?
It provides instant relief to symptoms of narrowed blood vessels (pain, difficulty breathing and easy fatigability). It also reduces the chances of developing heart attack and stroke significantly.
What are the limitations of an angioplasty?
Angioplasty does not treat the derangement in the body; it only provides symptomatic relief in the already-damaged blood vessels. Hence, it is associated with recurrence of narrowing in other vessels in prone individuals.
What investigation is prescribed before an angioplasty?
Other than routine tests like complete blood count, a special investigation indicated before angioplasty is angiography- wherein a dye is injected into the blood vessels to visualise the exact location and number of the narrowing in the circulatory system. It is a safe and frequently performed test.
What complications can arise during or after an angioplasty?
Common complications are re-narrowing of blood vessel, clot formation at the stent site, bleeding – these are prevented by medical intervention. Other rare risks include heart attack, irregularity in heart rhythm or stroke during the surgery and tearing of the vessel. However, these are now minimised by advancement in the procedure.
What is the success rate of angioplasty?
Most studies report a symptomatic relief immediately in about 90% patients. Various studies which follow the patients after the surgery have reported emergence of re-narrowing in 30-40% patients after the surgery.
When can I return to work after an angioplasty?
In most cases, heart monitoring and drug adjustment are followed thoroughly after angioplasty. Patient is able to return to work after about a week to ten days of stenting.
What activities are prohibited after an angioplasty, are there any lifestyle or dietary modifications?
No heavy lifting or strenuous activity should be performed right after the surgery. In long term, Smoking should be discontinued. Diet should be modified to include less cholesterol and more of polyunsaturated fatty acids (like fish oil) and fibre. Weight reduction should be targeted and BP, blood sugar should be controlled.
Is there an alternative to angioplasty?
An alternative frequently suggested and performed is an Arterial Bypass Graft surgery-wherein a grafted blood vessel acts as a transit for blood to bypass the vessels which are narrowed. This is, however, usually recommended when narrowing occurs in more than 1 or 2 locations as it is a more invasive and risky surgery with a longer recovery time.