Listed below is the step by step procedure of angioplasty:
Coronary angioplasty or percutaneous coronary intervention, is used to open clogged heart arteries. It involves temporary insertion and inflation of a tiny balloon where an artery is clogged for widening it. Upon suffering from a heart attack, ideally the patient needs to be subjected to an angioplasty within the first 1 to 1.5 hours. This time is known as golden hour. Beyond this time frame, heart muscle cells get irreversibly damaged.
This type of angioplasty is known as primary angioplasty. In cases where angioplasty is not possible, an intravenous clot buster is given as an alternative. Even though using this clot buster is an easy option, it is less effective than angioplasty.
Angioplasty surgery helps in improving symptoms of blocked arteries. These symptoms include shortness of breath and chest pain. It is useful during a heart attack for quick opening of a blocked artery. It helps in reducing the heart damage. It also helps in clearing of plaque from coronary arteries. Angioplasty surgery is beneficial as the artery returns back to normal size without need of major surgery.
An emergency angioplasty with or without stenting is carried out normally as the first treatment of choice for the patients of heart attack. Given below are the cases where an angioplasty is required to be carried out
Prior to angioplasty, following tests are required to be done.
In case of emergency angioplasty, the patient cannot be made to wait for a day to undergo the procedure. But in case of planned angioplasty, the patient should follow certain restrictions since a day prior to surgery. It is not advisable to consume food since midnight prior to surgery. The patient may consume liquids depending on the surgeon's instructions. The patient should avoid undergoing physical stress prior to surgery.
An angioplasty is carried out in a catheterization laboratory. It starts with an insertion of catheter through previously inserted sheath into an artery of the arm or the leg. For better visibility of coronary arteries, a radio-opaque dye is given through injection to the patients. Blood pressure from the various parts of the heart is recorded. Functioning of valves is also examined. Using specialized cameras, images of the heart can be captured during the process. A balloon catheter is placed at the location of blockage and slowly used for inflation of fatty plaque deposits. This helps in free flow of the blood to the heart muscle.
Stent insertion by a cardiologist into the blockage site and expansion of the same with the help of balloon gives better results. Stent provides better medium for blood flow via artery. This gives long-term better results.
Angioplasty is one of the minor surgeries used for treatment of clogged blood vessels which help in restoring normal blood flow to the heart and throughout the body of the patient. For patients who are at the risk of heart disease or stroke, surgeon may recommend to go for an angioplasty instead of bypass surgery. Based on the patient's condition, type of angioplasty is decided. Given below are the main types used for angioplasty surgery.
Balloon angioplasty is a commonly used angioplasty method. It involves passing of a thin and long tube called catheter into an artery (obstructed) via a small incision in the arm or the thigh of the patient. With the help of X-ray, guidance is provided to the catheter so that it can travel smoothly through the blood vessels into an artery. Upon entry into the narrowed artery, balloon attached to the catheter tip is inflated. The balloon in expanded state presses and flattens the plaque and widens the artery. Once the artery gets clear, blood flow is restored back.
After insertion of balloon, it is normal to experience discomfort in the chest by the patient. Stents are commonly used during balloon angioplasty. These are small devices made up of metal which can be placed with the help of catheter after completion of angioplasty process. It remains inside the artery under treatment for preventing narrowing of the artery.
Most of the times, patients with stent insertion, find it beneficial. Sometimes, patients with weak heart may develop blood clots as a result of stent insertion. In most cases, stents have proven to be beneficial for those who receive them, but in rare cases, when someone has a weak heart, blood clots can develop due to the stent.
In laser angioplasty, catheter is used, but instead of balloon, laser is used. The laser is then moved to the plaque and blockage gets vaporized. It is common to use balloon and laser angioplasty one after the other. While balloon is used first for the destruction of hard plaque, remaining plaque is removed by the laser. Time interval between both procedures is decided by the cardiologist.
Even though this is the case, laser angioplasty is not used frequently as compared to other angioplasty methods.
This procedure is done when the plaque is so hard that it cannot be removed with balloon angioplasty or laser angioplasty. The plaque is then cut completely using a surgical blade. The blade helps to shave off the plaque from the walls of the affected artery.
This type of atherectomy involves use of a diamond-tipped high speed drill for the destruction of plaques deposits. Excessively hard plaque is removed by this method.
For cutting the plaque deposits present inside the walls of artery, a small rotating blade similar to that of food processor cutter is used in an extraction atherectomy.
In this method, balloon and shaving blade are used in combination for shaving the plaque away.
In case of non-emergency angioplasty surgery, patient remains hospitalized based on the health condition. Usually, patients can return back to normal routine after a week post angioplasty. In case of angioplasty and stenting during heart attack, hospitalization period and recovery time can increase.
After returning home, patients need to drink plenty of fluids for flushing out the contrast dye from the body. Strenuous exercise and heavy weight lifting needs to be avoided post angioplasty surgery. Rest of the activities are required to be followed as per recommendation of the surgeon. Post angioplasty, if following symptoms are observed, patients need to inform to the surgeon immediately.
It is very essential for patients to follow recommendations of surgeons regarding medications after angioplasty. Most of the times, the angioplasty patients need to take Aspirin indefinitely post surgery. Patients with stent placement will require a blood-thinning medication. Clopidogrel is given in such cases for a period of an year or longer.
It is very essential to keep the heart healthy post angioplasty. Given below are the guidelines required to be followed after angioplasty surgery.
Factors increasing the risk of angioplasty complications are listed below.
A. When a vessel is split inside or gets dissected, an angioplasty fails immediately. A hardened artery cannot be broken by angioplasty when artery is not getting recoiled.
A. In cases where angioplasty does not give desired results, a bypass surgery is carried out for preventing heart damage.
A. In case of large blood vessels with shorter narrowing, an angioplasty gives best results. Angioplasty has less advantages when the blood vessels are blocked or unevenly narrowed.
A. Angioplasty is not time consuming. It takes approximately an hour. But post angioplasty, additional 12-16 hours are required for recovery. Post surgery, patient needs to be hospitalized overnight and can be discharged on the following day. Hospitalization duration depends on the condition of the patient.
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