WHAT IS ANGIOPLASTY?

 Angioplasty is a type of Percutaneous Intervention but the two terms are often used to talk about the same procedure. Angioplasty is much like an angiogram procedure. It is also done in the catheterization lab or “cath lab”. It is a procedure used to widen the narrowing in the arteries of your heart without open surgery.

In an angioplasty, a catheter with a small inflatable balloon attached is positioned within the narrowed section of the artery. When the balloon is inflated it pushes outward against the narrowing and the walls of the artery. This opens up the artery so that your blood flows freely through the artery. The balloon is then deflated and removed from the artery. In some patients, a stent is placed within the artery once it is opened.

A stent is a small metal mesh tube that is put inside your blood vessel on a balloon catheter. When the balloon is inflated, the stent opens up against the wall of your blood vessel. After the balloon catheter is taken out, the stent stays in place permanently, holding the walls of the vessel open for better blood flow. Stents lower the risk of this area narrowing again. There are several types of stents available. Your physician will select the best type of stent for your medical condition.

In some cases, an angioplasty may be performed on you at the same time or during the same day as your angiogram. You might also be asked to return for a second time to have your angioplasty performed. This decision is made by your doctor.

Angioplasty is not a cure for coronary artery disease. It needs lifelong management. You can control your condition with a healthy lifestyle.

ADVANTAGES OF ANGIOPLASTY

 Over 90% of angioplasties are successful immediately. Blood flow through the artery returns to normal or near normal and patients get complete relief from angina. People with severe coronary artery disease may not have complete relief but their symptoms are improved, allowing them to be more active and comfortable. Unlike surgery, you do not need stitches and you are not put to sleep (general anaesthesia). People recover more quickly from angioplasty than from heart surgery. Most people are up walking on the same day. Some people go home the next morning.

DISADVANTAGES OF ANGIOPLASTY

 Angioplasty is not for everyone. It does not work well when there are many narrowings in many arteries or in certain locations. Your doctor will decide if angioplasty is suitable for you.

An artery may become narrow again after angioplasty. This is called restenosis. If the artery narrows enough you may feel angina again. The use of stents has reduced the restenosis rate to 0-15% of cases. Restenosis is usually treated with a second angioplasty but occasionally bypass surgery is needed or medical therapy is used.

Who will perform the procedure?

This procedure will be performed by a consultant cardiologist or cardiology specialist registrar.

Talking with your doctor about benefits, risks, and alternatives

 The below lists the most common potential benefits, risks, and alternatives for this procedure. Other benefits and risks may apply in your unique medical situation. The conversation you have with your healthcare provider is the most important part of learning about these risks and benefits. Don’t be afraid to ask questions. It’s important to have all your questions answered before you agree to a recommended procedure.

Potential benefits

• Relief of symptoms, such as chest discomfort or shortness of breath.
• Restoration of blood supply to the heart muscle. This can prevent a heart attack or stop heart damage if you’ve had a heart attack.
• Faster recovery than with surgery. The procedure doesn’t require a major cut or general anesthesia.
• Lower risk and cost when compared to surgery.

RISKS DURING CATHETERIZATION AND/OR ANGIOPLASTY

 What could possibly happen?

• Leg numbness or weakness for a few hours after (rare)
• Bruising and bleeding at the site of arterial puncture due to blood thinning medication. Haematoma – if there is bleeding from the areas where the catheter was placed, you may have a patch where blood collects under the skin, called ahaematoma. This usually clears up on its own. False aneurysm – Rarely, a pulsating lump develops in the groin at the site of the puncture. This is because bleeding occurred when the catheter was removed. The clot produced a small sac on the side of the artery via the hole made in the artery. This sac is called a false aneurysm and can be treated with a small injection into the sac to block the hole to the artery.
• Infection – There is a risk of the puncture wound becoming infected. This can be treated with antibiotics
• Allergy/reaction to the dye used in the procedure, leaking of the contrast dye into tissues (rare and temporary)
• Radiation exposure from the X-rays, which can slightly increase your lifetime cancer risk (for more information, see Intermountains Guide to Understanding Radiation)
• Reduced kidney function (kidney failure in rare cases) – tell your doctor or the imaging technician if you have kidney disease or diabetes
• Need for surgical repair of the artery that held the sheath
• Dislodged plaques and clots from your coronary artery – causing stroke, paralysis, heart attack, permanent kidney failure, the need for urgent Dialysis, death
• After Angioplasty, the artery becomes blocked again in the days to weeks after the procedure.
• After Angioplasty, scarring of the artery happens and the procedure needs to be repeated
• Damage to the artery or heart muscle (extremely rare)
• Heart attack or stroke (extremely rare, and not typically caused by the procedure itself)
• In rare angioplasty cases, the artery collapses or is damaged by the wire or balloon. A stent(s) can often fix this, but sometimes patients need emergency coronary artery bypass surgery. If you need bypass surgery, you will be flown immediately to the Operation Theatre. Talk to your doctor about your risks and the benefits of this procedure for you.
• Restenosis or renarrowing at same site
• Failure to cross the lesion.
• Edge dissection
• Arrhythmia -During and post procedure for which Need of DC Shock
• Requiring intubation and prolonge ventilation
• Death
• Risks of stent placement include blood clots in the stent – youll need to take medication to prevent clots for at least 6 to 12 months afterward

Alternatives

• Medication
• Healthy lifestyle changes
• Surgery to bypass blocked arteries

ABOUT YOUR PROCEDURE (ANGIOPLASTY)

 Before the Procedure  

• You may eat a light meal up to 4 hours before your procedure
• You may have clear fluids to drink.
• You will be asked to change into a hospital gown and to remove your undergarments.
• A small area on each side of your groin will be shaved and a medication patch put there.
• If you haven’t already watched our video about the procedure, you and your family can view this program from your stretcher in the recovery area.
• An intravenous catheter will be started on a vein in your hand or arm. In the Cardiac Catheterization Lab You will be escorted to the Catheterization Lab either walking, by wheelchair, stretcher or bed. You might find the temperature in the room is cold. You will lie on a narrow x-ray table and you will be attached to a heart monitor. Your groin will be washed with a cold solution and sterile sheets will be placed over you. It is important that you lie still and do not touch the top of the sheets once they are in place. You may be asked to put your arms above your head for a period of time. A nurse is available to help you.  You will be given medication to help you relax during the procedure. The procedure is not pain. You will be awake so that you can talk with the doctor and nurses and you will be asked to follow instructions. The doctor will put local anaesthesia in your groin to make it numb. A small catheter will be threaded into a blood vessel and floated up to the heart. Dye is injected through this catheter to highlight the coronary arteries. Many people feel warmth throughout their body from the dye – this is normal.  X-ray pictures will be taken throughout the procedure. You do not have to move, the x-ray machine will move very close to your body.  During the procedure, you may be asked to take a deep breath and hold it for a few seconds or to cough. If you have any discomfort or chest pain, please let one of the nurses know right away. It is not unusual to experience some chest pain but it is important to let us know if you have discomfort. The usual time for the procedure inside the lab is between 30 minutes and 90 minutes. If your condition is complex, your procedure will take longer. In rare cases, there may be a lengthy wait in the lab waiting area or you may be returned to your room without your procedure being done

After your Cardiac Catheterization and/or Angioplasty

 You will be brought to the Recovery area of the Cardiac Catheterization Lab on your stretcher bed. Depending on the type of procedure that was performed, your sheath (the catheter that was put in your blood vessel through your skin) will be managed with one of these options:

• Removed right after the procedure with a closure device put in. There are different types of closure devices. They are a seal or plug for the tiny hole in your artery.
• Removed right after the procedure and a special band/brace will be put around your wrist.
• removed after you are transferred back to the Cath Recovery area
• In place for a few hours
• In place overnight

If you have a sheath in your groin, the nurses will place a special clamp over your groin to stop the bleeding after they remove it (unless you have had a closure device). This clamp will apply pressure for about 20 – 45 minutes. The nurses will check your pulse, blood pressure, pulses in your feet or wrist and the puncture site often.

You must rest in bed for a few hours after the procedure. It is very important to keep your head on the pillow and your leg (the one that held the catheter/sheath) straight to prevent bleeding from the puncture site. If your back becomes sore, please let your nurse knows. You may be given some medication to help lessen your discomfort or your nurse may reposition you. During this time you may sleep, read, or rest. You will be given a snack.

If the doctor used your arm (radial artery) you will have a clamp applied to your arm after the procedure before you leave the lab to prevent bleeding. You will be on bed rest for approximately one hour after the procedure. It is important to keep your arm on the pillow. Do not twist or bend your wrist. You may move your fingers but please do not use your hand. Your nurse will be available to help you while the clamp is in place.

It is important to drink a lot of fluids for the dye to flush out through your kidneys. Ask your nurse for help as soon as you feel the need to empty your bladder because you will not be able to sit up. Once your bed rest is complete, your nurse will help you to stand. You will be encouraged to walk.

After an angioplasty, you will stay overnight in a recovery area of the hospital. You are welcome to have visitors, however, due to our limited space, only one family member may visit at a time.

After your procedure, you need to have someone pick you up at the hospital and drive you home. An adult needs to stay with you overnight on your first night at home. If this is a problem, please let your nurse know. If you live more than 60 miles (or approximately 100 kilometers) outside the city, please make arrangements to spend the night in the city after your procedure.

IF YOU DEVELOP ANY OF THE FOLLOWING, CALL YOUR DOCTOR RIGHT AWAY (OR GO TO A WALK-IN CLINIC OR HAVE SOMEONE DRIVE YOU TO THE EMERGENCY DEPARTMENT):

• Sudden or severe pain at your puncture site
• Swelling in your site that is bigger than the size of a golf ball or wider than a hockey puck
• More than usual tenderness or soreness
• Bruising that has spread to your knee or past your hip (toward your buttock)
• Pulsing at the site
• Tingling or numbness or sudden coolness in your leg (or your hand, if your arm was used for the procedure)
• Redness, warmth or drainage at your puncture site or you have an unexplained fever.

IF YOU HAVE ANY OF THE FOLLOWING, CALL AMBULANCE OR HAVE SOMEONE DRIVE YOU TO THE EMERGENCY DEPARTMENT, DO NOT DRIVE YOURSELF

• Bleeding at the site. If it starts to bleed, lie down and put firm pressure over top of the site with your fingers or your fist (or have someone else do this). If the bleeding continues after ten minutes of holding pressure, have someone drive you to the hospital right away. Keep holding pressure.

• Any chest discomfort (sharp pain, pressure, burning, and heaviness, squeezing feeling in your chest, neck, down your arm or in your upper back). Sit down and rest. If you do not feel relief of your symptoms within five minutes, call for an ambulance.

Caring for Your Puncture Site:

• Check your groin site for bleeding every half hour for two hours; then every couple of hours over the next day.
• Remember to hold your fist over your groin site (apply pressure) when you have to sneeze or cough.
• It is normal to have some bruising over your puncture site. It might take a week or more for it to disappear.
• It is normal to feel a hard pea sized lump at the site. It is scar tissue that will gradually go away.
• You may shower today but no tub baths for three days.
• No swimming or going into whirlpools or hot tubs for two weeks.
• If your dressing comes off, pat the area dry (do not rub). You can put a bandaid over your puncture site and put a new one on every day for the next three days. After three days, you do not need to have a bandaid or a dressing on your site.
• Do not put any creams or lotions on the site.

Activity for the Next 7 Days:

• Avoid strenuous activities to allow the puncture site to heal completely, for example: no jogging, bicycling or curling.
• No heavy lifting (nothing heavier than ten pounds). This includes children, groceries, etc. It takes approximately 7 days for your puncture site to heal.
• If you have had a radial site puncture (in your wrist), do not bend or strain your wrist for the first few days. This includes computer work, gardening, bowling, knitting, etc.

 On your first day at Home:

• If you have a puncture site in your groin: You can climb a flight of stairs once but try to limit this as much as possible. Try to do the stairs with one leg straight legged (do not bend your knee on the same side as your procedure).

Avoid squatting, deep knee bends, or sitting in low chairs. A recliner or lounge chair is better because it will not bend your groin as much.

Walk at a slow pace as much as is comfortable for you.

• Most people have no problems after a successful angioplasty. They can do their usual activities within a few weeks. How quickly you return to your usual activities will depend on whether you have had a recent heart attack and the type of activities you do. Ask your doctor about this.

Driving Your Car:

• Ask your cardiologist when you can begin driving again. The timing will depend on the reason you were admitted to hospital. In general:
• Wait one month if you were admitted with a heart attack. Wait three months if you drive a commercial vehicle, a school bus or use your private car for your job.
• You can begin driving after two days if you have had a cardiac catheterization or an angioplasty. Wait one week if you drive a vehicle for your job.
• Avoid stressful driving situations such as rush hour traffic, poor weather conditions, night driving and high speed.

Anaesthesia

You will be given a local anaesthetic by the person carrying out the procedure, using a small needle to numb the area where the catheter is put in. A local anaesthetic is a drug which numbs a specific area of the body for an operation. It stings for a few seconds when injected and then the area becomes progressively more numb. You will be fully awake during the procedure although you should feel no pain. The numbness usually fades after a few hours but occasionally it may last longer.

General anaesthesia may be given if at all required as per your condition.