About the ProcedureCare at Mediora

Overview

• Angioplasty, also known as percutaneous coronary intervention (PCI), is a minimally invasive procedure that opens blocked or narrowed coronary arteries to restore blood flow to the heart muscle.
• The procedure involves threading a thin catheter through blood vessels to the affected artery, where a small balloon is inflated to compress plaque against artery walls, often followed by placement of a stent to keep the artery open.
• Performed on over 500,000 patients annually in the United States, angioplasty has revolutionized treatment of coronary artery disease, offering immediate symptom relief and reducing heart attack risk.

Why You Need Angioplasty

• Coronary Artery Disease: Buildup of atherosclerotic plaque causing significant narrowing (typically >70%) of one or more coronary arteries, restricting blood flow to heart muscle and causing chest pain or angina.
• Acute Heart Attack: Emergency angioplasty performed within 90 minutes of arrival for ST-elevation myocardial infarction (STEMI) to quickly restore blood flow, minimize heart muscle damage, and save lives.
• Unstable Angina: Worsening chest pain occurring at rest or with minimal exertion despite medication, indicating high risk of imminent heart attack requiring urgent intervention.
• Failed Medical Therapy: Persistent symptoms limiting daily activities despite optimal medical management with antianginal medications, necessitating mechanical intervention to improve quality of life.
• Abnormal Stress Test: Non-invasive testing revealing significant cardiac ischemia with exercise or pharmacological stress, indicating hemodynamically significant coronary stenosis requiring revascularization.

Key Advantages of Angioplasty

• Minimally Invasive Approach: Performed through small puncture in wrist or groin avoiding need for open-heart surgery; typically requires only local anesthesia with conscious sedation.
• Rapid Recovery: Most patients discharged within 24-48 hours; return to normal activities within one week compared to 6-8 weeks recovery after bypass surgery.
• Immediate Symptom Relief: Over 90% of patients experience significant reduction or complete resolution of chest pain and shortness of breath immediately following successful procedure.
• Lower Complication Rates: Significantly fewer risks compared to coronary artery bypass surgery including reduced bleeding, infection, and respiratory complications; mortality rate less than 1% for elective procedures.
• Repeatable Procedure: Can be performed multiple times if restenosis occurs or new blockages develop, unlike bypass surgery which becomes increasingly complex with repeat operations.
• Improved Quality of Life: Enables patients to resume work, exercise, and daily activities without limitations from debilitating chest pain and fatigue.

Preparing for Angioplasty

• Pre-Procedure Testing: Comprehensive evaluation including electrocardiogram (ECG), echocardiogram, blood tests (complete blood count, kidney function, electrolytes), and review of coronary angiography images to plan intervention strategy.
• Medication Adjustments: Discussion of current medications; may need to temporarily discontinue blood thinners, diabetes medications, or certain supplements; aspirin and P2Y12 inhibitor (clopidogrel or ticagrelor) typically started before procedure.
• Fasting Requirements: Nothing to eat or drink for 6-8 hours before procedure to prevent aspiration risk during conscious sedation; clear liquids may be permitted up to 2 hours beforehand.
• Allergy Assessment: Inform medical team of allergies particularly to iodine, contrast dye, shellfish, or latex; premedication with steroids and antihistamines if contrast allergy history exists.
• Access Site Preparation: Hair removal and cleaning of wrist (radial approach) or groin (femoral approach) area where catheter will be inserted; radial approach increasingly preferred for patient comfort and reduced bleeding risk.
• Informed Consent: Detailed discussion with interventional cardiologist about procedure risks, benefits, alternatives, potential complications, and what to expect during and after intervention.
• Arrange Transportation: Plan for someone to drive you home after procedure as sedation medications impair driving ability; avoid planning to return to work for at least 24 hours post-procedure.

How Angioplasty is Performed

• Anesthesia and Sedation: Local anesthetic injected at access site (wrist or groin) numbing area; intravenous conscious sedation provided for relaxation while maintaining ability to follow instructions during procedure.
• Vascular Access: Small puncture made in radial artery (wrist) or femoral artery (groin); introducer sheath inserted providing pathway for catheter advancement; radial approach preferred due to fewer complications.
• Catheter Navigation: Thin flexible guide catheter carefully threaded through arterial system to heart using fluoroscopic (X-ray) guidance; specialized catheters shaped to engage left and right coronary arteries.
• Coronary Angiography: Contrast dye injected through catheter making coronary arteries visible on X-ray images; blockage location, severity, length, and complexity assessed to determine optimal treatment strategy.
• Guidewire Crossing: Ultra-thin guidewire maneuvered across blockage serving as rail for subsequent equipment; requires skill navigating tortuous vessels and crossing tight stenoses without vessel injury.
• Balloon Inflation: Small deflated balloon catheter advanced over guidewire to blockage site; balloon inflated to high pressure (8-20 atmospheres) compressing plaque against artery walls and stretching vessel open.
• Stent Deployment: Drug-eluting stent (mesh metal scaffold coated with medication) mounted on balloon catheter; expanded at blockage site and left in place permanently maintaining artery patency and preventing recoil.
• Final Assessment: Repeat angiography performed confirming adequate blood flow restoration; intravascular ultrasound or optical coherence tomography may be used ensuring optimal stent expansion and positioning.

What to Expect: Before, During, and After

• Before Procedure: Arrive at hospital 1-2 hours early for registration, vital signs, IV placement, blood draws; meet with interventional cardiology team reviewing plan and answering questions; medication administered including antiplatelet agents and anxiolytics.
• During Procedure: Lying flat on narrow table in catheterization laboratory; continuous monitoring of heart rhythm, blood pressure, oxygen saturation; may feel pressure at access site during catheter insertion; possible brief chest discomfort when balloon inflated but should resolve quickly; procedure typically lasts 30-90 minutes depending on complexity.
• Immediate Post-Procedure: Transferred to recovery area with access site compression device or pressure bandage; must lie flat with limited movement preventing bleeding at puncture site; continuous cardiac monitoring for 2-6 hours; frequent vital sign checks and access site assessments.
• First 24 Hours: Most patients admitted overnight for observation; progressive mobilization starting with sitting, standing, short walks; light diet resumed once fully awake; access site monitored for bleeding, hematoma, or pulse abnormalities.
• Pain Management: Mild discomfort at access site common; acetaminophen usually sufficient; chest soreness may persist few days from balloon inflation; severe chest pain, shortness of breath, or access site bleeding requires immediate medical attention.
• Hospital Discharge: Typically discharged 12-24 hours post-procedure if uncomplicated; receive detailed instructions regarding medications, activity restrictions, wound care, warning signs requiring emergency evaluation, follow-up appointments.
• Recovery at Home: Avoid strenuous activities, heavy lifting (>10 pounds), or vigorous exercise for one week; gradual return to normal activities as tolerated; most patients resume work within 3-7 days depending on job requirements.

Risks and Complications

• Bleeding and Hematoma: Most common complication occurring at catheter access site; ranges from minor bruising to large hematoma requiring transfusion; risk reduced with radial approach and proper post-procedure compression; occurs in 2-5% of patients.
• Vessel Injury: Coronary artery dissection (tear in vessel lining) occurring in 1-2% of cases; usually treated with additional stenting; rarely progresses to emergency bypass surgery if extensive.
• Restenosis: Re-narrowing of treated artery occurring in 5-10% of drug-eluting stent cases within first year; symptoms recur requiring repeat angiography and possible re-intervention with balloon angioplasty or additional stenting.
• Stent Thrombosis: Blood clot formation within stent causing sudden complete artery blockage and heart attack; rare (1-2%) but serious complication prevented by dual antiplatelet therapy (aspirin plus P2Y12 inhibitor) for recommended duration.
• Kidney Dysfunction: Contrast-induced nephropathy from iodinated dye particularly in patients with pre-existing kidney disease or diabetes; prevented by adequate hydration, limiting contrast volume, using iso-osmolar agents.
• Allergic Reactions: Contrast dye allergies ranging from mild itching to severe anaphylaxis; pre-medication with steroids and antihistamines reduces risk in patients with known allergies or prior reactions.
• Heart Attack or Stroke: Rare complications occurring in less than 1% of elective procedures; risk higher in emergency cases; caused by plaque dislodgement, vessel closure, or embolization to brain.
• Arrhythmias: Temporary irregular heart rhythms during procedure from catheter manipulation or vessel injury; usually self-limited though rarely require temporary pacing or cardioversion.

Results and Outcomes

• Immediate Success Rate: Over 95% procedural success rate achieving less than 30% residual stenosis with normal blood flow; technical advances in equipment and operator experience contribute to excellent outcomes.
• Symptom Relief: 85-90% of patients experience complete or near-complete resolution of angina symptoms within days following successful angioplasty; significant improvement in exercise tolerance and daily functioning.
• Long-Term Patency: Modern drug-eluting stents maintain artery opening in 90-95% of cases at one year; 85-90% remain patent at five years; restenosis rates dramatically reduced compared to bare-metal stents or balloon angioplasty alone.
• Mortality Benefit: In acute heart attack settings, primary angioplasty reduces 30-day mortality by 25-50% compared to clot-dissolving medications; long-term survival depends on extent of heart damage and risk factor modification.
• Quality of Life Improvement: Significant improvements in physical function, exercise capacity, freedom from angina, emotional well-being, and ability to work measured on standardized quality of life assessments.
• Medication Requirements: Dual antiplatelet therapy (aspirin plus clopidogrel/ticagrelor) required minimum 6-12 months preventing stent thrombosis; lifelong aspirin therapy; continuation of cholesterol, blood pressure, and other cardiac medications essential for optimal outcomes.
• Need for Repeat Procedures: 10-20% of patients require repeat revascularization within five years due to restenosis of treated lesions or progression of disease in other vessels; emphasizing importance of aggressive risk factor management.