Coronary Angioplasty

Introduction

An angioplasty or PTCA (which stands for percutaneous coronary artery angioplasty) is a surgical procedure in which a catheter is inserted into a partially blocked coronary artery.  A balloon is on the tip of the catheter and is inflated, opening up the area that is blocked.  After that, a metal stent is usually inserted to keep the blood vessel patent. 

Angioplasties are usually done to lessen chest pain caused by a lack of oxygenation to the heart or to decrease the damage to the heart after a heart attack.  As a person ages, plaque can build up on the inner lining of the coronary arteries.  This is also known as “atherosclerosis”.

While atherosclerosis generally involves all of the arteries in the body, it is more dangerous in the coronary arteries because the heart generally has just one blood vessel supplying a given area of heart muscle.  There is no redundancy in the heart muscle circulation. 

The plaque in the coronary arteries can rupture, causing a blood clot that can lead to a heart attack or angina.  Large blood clots can completely occlude the coronary artery, leading to a heart attack.  In order to avoid this complication, an angioplasty is often performed.

The angioplasty can restore adequate blood flow to the heart.  When the catheter is passed into the narrowed artery and inflated, the blood flows better through the coronary artery.  When the stent is given, there is a decreased chance of having the plaque collapse, narrowing the coronary artery again.

Angioplasty goes by several names, including:

  • Percutaneous transluminal coronary angioplasty
  • Percutaneous transluminal angioplasty
  • Percutaneous intervention
  • Coronary artery angioplasty
  • Coronary angioplasty
  • Balloon angioplasty

What to Exресt Aftеr Surgеrу

After having the angioplasty, the patient is often moved to a postoperative coronary care unit.  The average patient stay can be as little as a few hours to as much as an overnight stay.  The patient is asked to be still for a few hours after the procedure so that the site of the incision made in the arm or groin is allowed to clot and to begin to heal.

After recovery, your vital signs will be assessed on a regular basis.  This includes measuring the patient’s temperature, oxygenation, heart rate, and blood pressure.  The incision in the arm or groin is assessed to make sure it does not begin to bleed again.  The incision site may be sore for a few days.

Most patients go home the day after the angioplasty.  Post-procedure instructions will be given, including instructions on the level of activity recommended, a follow-up date, medications to take after the procedure, how to check for infection, and when to call the doctor (if there are complications).

Most patients recover well after an angioplasty and can continue working after a week of rest.  The doctor will likely schedule a follow-up appointment after the patient leaves the hospital.  This appointment is to assess the heart function, and to make sure there is no additional chest pain or other discomfort.

Because the angioplasty can lessen the symptoms of coronary artery disease (CAD), the patient will have a better exercise intolerance.  An angioplasty can help the symptoms of CAD but does not cure the problem or the risk factors that led to the blockage in the first place.  This is why lifestyle changes are so important to the recovery of the patient after the procedure.  Some lifestyle changes include lessening stress, losing weight, staying active, quitting smoking, and changing the diet to become healthier.

The cardiologist may recommend the patient undergo cardiac rehabilitation or “cardiac rehab”.  This is an exercise program involving education on living a healthy lifestyle, exercises to improve cardiac function, and stress reduction counseling.

Patient Preparation bеfоrе Surgery

The procedure is usually done in a hospital and is performed by a cardiologist who specializes in diseases of the heart.  If it isn’t an emergency angioplasty, you will have a pre-procedure appointment at which time the cardiologist will go over the patient’s medical history, family history, and medications, and will perform a physical examination. Blood tests, EKG evaluations, and chest x-rays will be done before the procedure. 

The cardiologist will advise the patient as to when to fast before the procedure (which is usually 6-8 hours’ pre-procedure), what medications can be taken on the day of the procedure, and when to arrive at the hospital. 

Why It Is Done

The coronary angioplasty is usually done when the patient has blocked or narrowed coronary arteries from plaque buildup with the arteries.  Angioplasty is just one of several procedures that can be done to reverse blockages in the arteries leading to the heart.  If the angioplasty fails, the patient may need to have a bypass surgery performed.

The advantages to having an angioplasty include a shorter recovery period, the lack of need for general anesthesia, and the fact that it doesn’t require an open heart surgical procedure.  Not everyone will benefit from having the procedure and will need to have a coronary artery bypass instead. 

Aftеr the Surgеrу

After the angioplasty, the patient will have better oxygenation to the heart and will begin to recover.  The incision site will be manually pressed upon to stop the bleeding. The patient should be able to ambulate with help within 4-6 hours after the procedure and usually remains in the hospital for observation overnight. Some patients can go home several hours after the angioplasty and will not need to have an overnight stay. 

Medications may be prescribed after the procedure that will help the heart to function better and to help decrease the chances that the narrowed area of the blood vessel will form a clot.  This may mean taking aspirin or other blood thinner after the procedure.  Lifestyle changes will be recommended.

The complication rate of an angioplasty is very low and much lower than having a coronary artery bypass surgery.  While it doesn’t cure coronary artery disease, the angioplasty can be a good option for patients who need to have better oxygenation of the heart muscle but don’t want to have a big procedure.

Definition of the surgery

Percutaneous Transluminal Coronary Angioplasty PTCA is known as a procedure used to repair coronary artery dysfunction; due to artery blockage which leads to inhibit blood supply that reaching the heart muscle. Doctors usually insert a catheter through one of the main blood vessels in the arm or the thigh, then reach the blocked area of the coronary arteries and install a special stent that allows the blood circulation in the heart of the patient to return to work properly.

Treatment in Jordan takes approximately "5 days".

What are the reasons to undergo Percutaneous Transluminal Coronary Angioplasty (PTCA)?

A cardiothoracic surgeon may decide to perform a PCTA for a patient because of:

  • Alleviate the patient's chest pain caused by poor oxygen delivery to the heart.
  • Reduce the size of the damage after a heart attack.
  • Coronary atherosclerosis, which is a health problem that involves the accumulation of plaques on the inner walls of the arteries which block or obstruct normal blood flow as a result of narrowing of the coronary arteries. Coronary atherosclerosis considered to be one of the health problems that required treatment as soon as possible; because of the importance of these arteries in supplying the heart muscle.

Pre-requisite tests before Percutaneous Transluminal Coronary Angioplasty (PTCA)

After a diagnosis of a coronary artery disease and deciding a coronary angioplasty, a cardiovascular surgeon asks for series of tests before the procedure is scheduled, including:

  • Recording patient's family medical history.
  • Know the type of medication the patient is taking.
  • Physical examination of the patient, including a comprehensive cardiac assessment.
  • Blood tests.
  • Electrocardiogram (EKG).
  • X-rays of the heart area.
  • Angiography.

Risks of Percutaneous Transluminal Coronary Angioplasty (PTCA)

Despite the high rates of success of the surgery and its ability to repair the defect to a large extent, but like most surgeries, it may include some of the risks that the patient may suffer after the surgery, such as:

  • The need for a re-operation of PTCA again as a result of re-blockage or narrowing, especially in cases where no stent is placed in the arteries.
  • Blood clots form at the sites where the stent is fixed in the arteries, so taking aspirin is important for patients who have undergone this type of surgeries.
  • Bleeding in the arm or leg through which the catheter was inserted.

Steps of Percutaneous Transluminal Coronary Angioplasty (PTCA)

This surgery consists of three main stages, including:

  • Preparing the patient

The patient is usually informed by his cardiologist of the date of the pre-operative examinations, after receiving the results and evaluating them by the surgeon and taking an appointment of the surgery, it is required to fast for food and drink for about 6 to 8 hours before the surgery. In addition to informing him of the type of medications he must take on the day of the surgery, also to notifying him of the date of arrival to the hospital to complete the check-in process.

  • During the surgery:
  1. Anesthetize the area from the arm or thigh and insert a catheter (small tube) into the artery.
  2. The catheter is thread through the arteries until it reaches the coronary arteries of the heart.
  3. The surgeon then moves the catheter into the artery while monitoring what is happening via a video monitor (special screen that reflects what is going on using X-rays),once the catheter reaches the site of blockage, a special dye is injected, and the surgeon will take a picture of the coronary arteries then, a very thin wire is inserted through the catheter to pass through the arterial blockage, where a balloon that connects to the tip of this wire is passed through the blockage area.
  4. The balloon is Inflate at the blockage site; to push and compress the accumulated plaques against the walls of the arteries and create an easy passage for blood to flow again.
  5. In most cases, the balloon is attached to a stent that is fixed at the site of the arterial blockage so that it keeps the artery open for blood flow.
  6. Deflate the balloon and remove it with the catheter.
  • After the surgery:

The wound from which the catheter was inserted is closed by pressing it with cotton to avoid bleeding. 

A cardiothoracic surgeon often prefers that the patient stays in hospital for monitoring, but he can walk around 4 to 6 hours after surgery with assistance. Some patients can go home several hours after the surgery if the surgeon approves, depending on their general health.

Recovery period after PTCA

As with most surgical surgeries, a patient's recovery after the surgery and a return to normal activities require a series of tips that may help him to return to his former life faster. In the case of coronary artery catheterization, the patient is advised to follow:

  • Take prescribed medications that will help the heart to work better and to reduce the chances of narrowing the arteries again, such as aspirin or some other blood thinners recommended by the responsible surgeon.
  • Drink clear liquids, such as water, to wash blood from dyes that were added during the PTCA, and make sure to eat food that is heart-friendly and healthy.
  • Avoid lifting heavy objects or doing stressful activities for at least one day after the surgery.

Top treatment providers

Inquiry about treatment