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An angioplasty or Percutaneous Transluminal Coronary Angioplasty (PTCA) is a method of dilating a narrowed portion of the heart blood vessels (coronry arteries) by inflating a balloon so that blood can pass through the vessels freely. This can be used as a treatment for angina and reduces the chances of a heart attack.
Coronary angioplasty is a surgical procedure to widen the arteries to the heart (the coronary arteries). Sometimes these arteries can get blocked up, and restrict the amount of blood flowing to the heart.
The heart is mainly made up of muscle, and is responsible for pumping blood around the body. To do this it needs a constant supply of oxygen, which is brought to the heart in the blood from the coronary arteries.
Coronary angioplasty is most commonly used to treat angina, a painful condition when the heart doesn’t get enough oxygen to work properly.
Coronary angioplasty may also be carried out as emergency treatment after a heart attack has happened.
Why is it necessary?
Coronary angioplasty is most commonly used to treat angina, which is pain coming from the heart. Angina happens when the coronary arteries get blocked up with small pieces (‘plaques’) of fatty material called atheroma. This condition is known as atherosclerosis, and is often referred to as ‘hardening of the arteries’. Plaques build up over time – usually a number of years – and can eventually cause blockages. This makes it difficult for blood to flow through the arteries and causes the symptoms of angina.
Pain caused by angina is normally felt during periods of activity, such as playing sport or climbing the stairs. The heart has to work harder to pump oxygen-carrying blood to the muscles and for this it needs a bigger supply of blood. Angina that happens even when you’re resting is a sign that the arteries may be completely blocked, making the chance of a heart attack much more likely.
In many cases, angina can be controlled with drugs. If symptoms still affect daily life, or if you have angina pain even when you’re resting, then coronary angioplasty is usually considered as a treatment option. It works by squashing the fatty plaques against the artery wall and widening the artery at the same time.
How is it performed?
Coronary angioplasty is carried out in a hospital cardiology unit while you are under local anaesthetic. You may also be given a sedative to help you feel calm and sleepy if you’re nervous. Most people can go home the day after the operation.
To carry out the procedure a catheter is passed through a wide needle or small cut in the skin and put into a blood vessel in the groin or arm. A catheter is a thin, hollow, flexible tube that is gently pushed through the blood vessel towards the coronary arteries. The surgeon uses an X –ray machine showing the images of the inside of the body to guide the catheter into the right place.
Once the catheter is in place, another thinner catheter with a tiny balloon on the end is passed through the centre of it and into the artery being treated. The balloon is gently blown up to squash fatty plaques against the artery wall. This briefly stops blood flow, so you may feel an angina-like pain. The balloon is then let down and carefully taken out.
Sometimes, after the balloon has been blown up, a device called a stent is left in the artery. A stent is a short wire, mesh tube that holds the artery open and helps to stop it getting blocked again.
You won’t be able to feel the catheter inside the blood vessel while the procedure is being carried out. However, you may feel an occasional missed or extra heartbeat – this is completely normal. Your heartbeat is monitored throughout the procedure using an electrocardiograph (ECG) machine.
It takes about 30 minutes to treat one section of an artery. If more sections need widening, the coronary angioplasty will take longer.
Results
In many cases, the results are dramatic. Heart pain disappears and the patient is able to return to a more energetic and healthy life. In about a quarter of cases, the artery re-narrows and the angina returns within a few months, however, results so far from operations done since 1992 suggest a success rate of over 90% per cent.
The alternative to angioplasty, coronary artery bypass, now carries very little risk, and the results, especially when a mammary artery is used instead of a vein, are excellent. If angioplasty fails, an emergency coronary artery bypass operation may be necessary, and the risks of this operation may be increased.
Recovery
Most people only need to stay in hospital for one night after the operation and can go home the next day. You may have a bruise under the skin where the catheter was put in which can be painful for a few days.
Try not to do any heavy lifting for about a week after the operation or until the small wound where the catheter was out in has healed up. You should also avoid driving for a week after the operation.
Sometimes, the fatty plaques (atheroma) start to develop again inside the stent. This can happen over the months and years following the operation, and may eventually narrow the artery enough to cause angina pains to come back. If this happens, the procedure can be repeated, or another type of treatment such as a coronary artery bypass may be considered.
Some doctors are starting to try newer techniques, such as using stents coated with drugs that help to stop the arteries becoming blocked again.
If you do have angioplasty, you will still need to take tablets. It’s also important that you try to lose weight if you’re overweight and quit if you’re a smoker. Smoking and being overweight are two of the main causes of heart disease and make treatment less likely to work.
Who can use it?
If your doctor thinks you may need a coronary angioplasty, you will first be referred to a hospital specialist called a cardiologist for some tests. This involves blood tests and a test called an electrocardiogram (ECG) - an electrical recording of the heart to measures how well it is working.
A test called an angiogram is then used to find blockages in the coronary arteries. It’s carried out in a similar way to an angioplasty. A catheter (thin, bendy, hollow tube) is gently inserted into an artery through a small cut in the skin. A special dye is then injected through the catheter into the coronary arteries and X-rays are taken to show up any blockages.
Sometimes there are too many narrow sections in the arteries, parts of the artery are too narrow for a catheter to fit through, the artery is too curved, or there are lots of branches coming off the artery that are also blocked up. In these cases, coronary angioplasty may not be a suitable – doctors use the results of the various tests to decide how best to treat the condition. Alternative operations, such as a coronary artery bypass, may be considered.
Angioplasty can also be used for people who have already had a coronary artery bypass. This is an operation to move blood vessels from different parts of the body in order to bypass a blockage in the heart. If these ‘grafted’ blood vessels become blocked, they too can be widened with an angioplasty operation.(For more information about coronary artery bypass, please see the separate encyclopaedia topic).
Risks
In most cases, there are no serious problems with coronary angioplasty, but as with all surgical procedures, it carries some risks.
Sometimes the small wound where the catheter was put in can get infected. Keep an eye on it after the operation to check it’s healing properly, and tell your GP if it becomes red and sore.
Occasionally, some people have an allergic reaction to the dye, which is used to show up the coronary arteries on X-ray. Tell your doctor if you have any allergies before the operation.
More serious complications are very rare, and mainly a risk for people who already have serious heart disease. They include heart attack, stroke and damage to a coronary artery caused by the catheter.
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