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Coronary angioplasty

This factsheet is for people who are considering having a percutaneous transluminal coronary angioplasty (PTCA) operation.

PTCA - often called angioplasty - is a procedure to treat coronary artery disease. It involves flattening the fatty material (atheroma) that can build up inside the walls of the main blood vessels (arteries) to the heart causing them to narrow. Angioplasty does not involve open heart surgery; a catheter is threaded through an artery in the groin or arm to reach the coronary arteries of the heart.

Why have angioplasty?

The heart muscle is supplied with oxygen by blood arriving in the coronary arteries. If fatty material (atheroma) builds up in the coronary arteries, it causes them to narrow. This starves the heart of oxygen, which causes pain in the chest called angina. If the arteries are almost completely blocked, it makes a heart attack more likely.

Angioplasty can open up the narrowed arteries so that blood can flow more easily to the heart muscle.

Angioplasty can also be used for people who have had coronary artery bypass graft surgery (CABG) and who have narrowing in the grafted blood vessels used as bypasses. For more information on CABG, please see the separate BUPA factsheet, Coronary artery bypass graft.

What are the alternatives?

Angioplasty is not suitable for everyone with angina as you may have too many narrowed sections in your coronary arteries or the narrowed sections may be too long or too narrow.

For more information on the different treatments for angina, please see the separate BUPA factsheet, Angina. Your doctor will discuss which treatment is best for you.

What happens before angioplasty?

Your surgeon will discuss how to prepare for angioplasty.

Tests

You may have tests prior to angioplasty including:

• blood tests
• electrical recordings (ECG) of your heart to assess how well it is working
• an angiogram (see below)

An angiogram is a dye test to find where the narrowings are in the coronary arteries. This is similar to angioplasty but a special dye that shows up on X-ray pictures is injected into the coronary arteries. The balloon is not used.

On the basis of these tests, the surgeon decides whether angioplasty is the most appropriate treatment. In some cases the angiogram progresses straight to angioplasty in the same operation.

What should I expect in hospital?

An angioplasty usually requires one night in hospital.

Before angioplasty, you will be asked not to eat or drink anything for about four hours. A nurse will clean (and may shave) your groin or arm where a catheter will be inserted during the operation.

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. This is a good time to ask any unanswered questions about the operation.

The operation

Angioplasty is usually performed in a specially-equipped room called a catheterisation lab. The procedure lasts around 30 minutes, but may take longer depending on how many arteries need to be treated.

Angioplasty is carried out under a local anaesthetic which numbs the area but you will be awake. If needed, your anaesthetist can also give you an injection of a sedative, which will make you feel relaxed and possibly drowsy.

Your surgeon will make a small incision in your groin or arm and thread a catheter through an artery which leads to your heart. Your surgeon will use X-ray pictures to direct the catheter to the narrowed section of the artery. You will not feel the catheter inside the blood vessels but you may feel an occasional missed or extra heartbeat - this is completely normal.

A guidewire, with a tiny deflated balloon at the end, will be passed down the catheter. When it reaches the fatty deposit, the balloon will be gently inflated to squash the fatty material. The balloon will be deflated after about a minute and removed, leaving more room in the artery for blood to flow to your heart.

A short tube of stainless-steel mesh (a stent) is commonly used to hold the artery open after the balloon has been removed. The collapsed stent covers the balloon and is opened when the balloon is inflated. The stent may be a bare metal stent (also known as an uncoated stent) or a drug-eluting stent. Drug-eluting stents are coated with a drug which reduces the risk of the artery becoming narrow again after the angioplasty.

Your surgeon will advise whether a stent is suitable in your case and if so, which type of stent is best for you.

An angiogram will be done to check that the artery has opened up and then the catheter will be removed. A nurse will press firmly on your groin (or arm) for up to 20 minutes to seal the artery. Alternatively, a special pressure dressing may be applied. You are unlikely to need stitches.

Sometimes, the device used to insert the catheter into your artery is left in your groin or arm for a couple of hours. This helps reduce bleeding when it is taken out.

Illustration showing angioplasty

After the operation

All being well, you should be able to go home the day after the procedure. You should organise a friend or relative to take you home.

Before discharge, you will be given:

• medicines, such as anti-platelet drugs that help to stop blood clots forming around the stent after your operation
• advice about how you can improve your diet and lifestyle once you get home
• a follow-up appointment

Recovering from angioplasty

Although you may feel well, you should take it easy for the first week after your operation.

You shouldn't drive until you can perform an emergency stop without discomfort - this is generally about a week after angioplasty or six weeks if you drive a large vehicle such as a minibus or truck.

If you have questions about what you can and can't do, ask your surgeon or nurse for guidance.

Deciding to have an angioplasty

Angioplasty is a commonly performed and generally safe surgical procedure. For most people, the benefits are greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. For angioplasty, side-effects include:

• symptoms of angina, such as chest pain while the balloon is being inflated in your artery
• pain and bruising in your groin (or arm) where the catheter was inserted>

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main complications of any operation are bleeding during or soon after the procedure, infection and an abnormal reaction to the anaesthetic.

Specific complications of angioplasty are rare but can include the following.

• Restenosis, where the treated arteries gradually re-narrow occurs in about 20 percent of patients. Stents, particularly drug-eluting stents, may help to slow down restenosis. If restenosis does occur, you may need to have some further tests and the angioplasty may need to be repeated.
• Some people are allergic to the dye used in the angiogram.
• The coronary artery may become completely blocked during or soon after the procedure. The angioplasty may need to be repeated straight away or, in about two out of 100 people who have an angioplasty, emergency coronary artery bypass graft surgery may be needed to bypass the affected veins.
• The tip of the catheter can dislodge a clot of blood or fatty plaque from the wall of a blood vessel. It is possible for these to block an artery leading to the heart or brain, causing a heart attack or stroke.
• There is a risk of death. It is estimated that serious complications result in death during fewer than 5 in 1000 patients having an angioplasty operation.

The chance of complications depends on the exact type of procedure you are having and factors such as your general health. Ask your surgeon to explain how these risks apply to you.

Further information

• The British Heart Foundation
  08450 70 80 70
  www.bhf.org.uk

References

• Coronary artery stents - Understanding NICE guidance - information for people with heart disease, their families and carers, and the public. National Institute of Clinical Excellence (NICE). October 2003.
  www.nice.org.uk
• Coronary angioplasty summary. British Heart Foundation.
  www.bhf.org.uk
  accessed 14 December 2005.
• Coronary Angioplasty. UK Department of Health. PRODIGY patient information leaflet.
  www.prodigy.nhs.uk
  accessed 14 December 2005.
• Coronary angioplasty and coronary bypass surgery. British Heart Foundation. Heart Information Series Number 10. August 2004.
  www.bhf.org.uk
• Guidance on the use of coronary artery stents. National Institute of Clinical Excellence (NICE). October 2003, Technology Appraisal Guidance 71.
  www.nice.org.uk
• At a Glance. Guide to the current Medical Standards of Fitness to Drive. Driver and Vehicle Licensing Agency (DVLA). September 2005.
  www.dvla.gov.uk
• PRODIGY Guidance - Angina. UK Department of Health. PRODIGY.
  www.prodigy.nhs.uk
  accessed 14 December 2005.

Published by BUPA's health information team, healthinfo@bupa.com, February 2006.

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