Coronary Balloon Angioplasty & Stent Placement

Coronary Balloon Angioplasty is also known as percutaneous coronary intervention. This is a procedure which is utilised to open clogged arteries of the heart. Balloon angioplasty temporarily involves inserting & inflating a tiny balloon where the artery is clogged. This procedure is meant to help the patient by widening his/her artery.

Quite often balloon angioplasty is combined with permanent placement of a wire mesh tube known as a stent. This stent will go on to help artery remain open at that spot & decrease chances of the artery narrowing once again. Some stents are also coated with medications which help keep the artery open. These stents are known as drug-eluting stents. There are many other stents which are also used & are known as bare-metal stents. Balloon angioplasty can improve signs & symptoms of blocked arteries like shortness of breath & chest pain.

Moreover, balloon angioplasty can also be used during a heart attack so as to quickly open blocked arteries & thereby reduce the amount of damage to the heart.

Preparing for Balloon Angioplasty Procedure

Balloon angioplasty does not cut open the body for operation instead it works through a small incision made in the skin over a blood vessel in the groin, arm or wrist. A small thin tube called a catheter is threaded through this small hole & the procedure is performed. Balloon angioplasty operation can take up to several hours of time largely depending upon the number & difficulty of blockages & whether there are any complications involved.

Balloon angioplasty is typically performed by heart specialists called cardiologists along with a specialised team of cardiovascular nurses & technicians inside a specialty operating room known as cardiac catheterisation laboratory. Commonly, this room is known as the cath lab.

Commonly performed through the femoral artery in the groin, balloon angioplasty can also be performed through an artery in the wrist or arm area. The area of the keyhole incision is prepared with an antiseptic solution before the procedure & a sterile sheet is placed over the body. Following this, a local anaesthetic is injected to numb the area where the catheter is to be inserted.

Along with this small electrode pads are placed on the patient’s chest so as to monitor the heart during the procedure. Most often general anaesthesia is not needed for balloon angioplasty procedure; however, the patient will be sedated & will stay awake during the procedure. Patients will receive medications & fluids to relax along with blood-thinning anticoagulant medications through an IV line. Subsequently, the balloon angioplasty procedure is now all set to begin.

During Balloon Angioplasty Procedure

  • Following numbing of incision area, a small sized needle is used for accessing an artery in the groin or arm. A small cut is made on the skin over the artery for the purpose of the operation.
  • Cardiologists will then thread a thin guided wire followed by a catheter into the artery & push until it reaches the blockage site within the heart.
  • The patient is likely to feel the pressure in the area where the catheter is inserted but it should not be any sharp pain. They should, therefore, make it a point to tell the cardiologist in case they do so. However, balloon angioplasty patients will not be able to feel the catheter inside the body.
  • A small amount of dye is subsequently injected through the catheter. This is meant to help the cardiac surgeon look at blockages on x-ray tests known as angiograms.
  • At the blockage site, a small balloon which is attached to the catheter is inflated & which will help in widening the blocked site of the artery. Once the artery is stretched, the balloon is finally deflated & removed. The cardiologist might inflate & deflate the balloon many times before it is finally removed. This is meant to stretch the artery a bit more every time.

This procedure will have to be repeated at every blockage for patients who are having several such sites. It is however not uncommon for the balloon angioplasty patient to experience chest pain while the balloon is inflated, because it will eventually temporarily block the flow of blood to that part of the heart.

Stent Placement Procedure Following Balloon Angioplasty

Most people undergoing balloon angioplasty also have stents placed within their blocked arteries during the same operation procedure. These stents are usually inserted in arteries after the blockage site is widened by the inflated balloon. Stents are placed so as to support the walls of the artery & which in turn helps prevent re-narrowing of the same after balloon angioplasty. Normally, these stents look like tiny coils of wire mesh.

  • Coronary Artery Stent Placement Process

Here is what happens during the stent placement operation.

  • The stent is collapsed around the angioplasty balloon at the tip of catheter & is guided through the artery to the blockage site.
  • This balloon is now inflated & the spring-like stent expands in response & locks into place inside the artery at the blockage site.
  • The stent is meant to stay permanently inside the artery in order to hold it open & improve blood flow to heart muscle. Moreover, in some cases, more than one stent may be required to keep open a blockage site.
  • The balloon catheter is deflated & removed once the stent is in place. More images or angiograms are taken to observe how blood flow has improved through the newly widened artery.
  • The guide catheter is finally removed & the procedure is completed with stitching of the keyhole wound.

After the stent has been placed the patient is required to undergo prolonged treatment with medications like clopidogrel (Plavix) or aspirin so as to reduce chances of formation of blood clots on the stent.

Coronary Artery Balloon Angioplasty & Stent Placement Outcomes

Coronary balloon angioplasty is greatly able to increase blood flowing through the previously narrowed or blocked coronary arteries. Moreover, chest main should also generally decrease & the CHD patient may be able to exercise better.

However, undergoing balloon angioplasty & stent placement does not mean that the heart disease has gone away. The patient will need to continue with a healthy lifestyle & take medications as prescribed by the cardiologist. In case symptoms like shortness of breath or chest pain are found to return or other similar symptoms like previous ones recur, the cardiologist must be immediately informed. Take the following steps so as to keep the heart healthy following balloon angioplasty procedure.

  • Quit Smoking
  • Get Regular Exercise
  • Maintain Healthy Weight
  • Lower levels of Alcohol
  • Control other health conditions like High Blood Pressure & Diabetes

Successful balloon angioplasty also means that the patient may not have to undergo CABG surgery in future. CABG is a surgical intervention involving the use of artery or a vein harvested from a different part of the body & sewn to the surface of the heart to take over by bypassing the blocked coronary artery. CABG surgery, however, requires an incision to be made in the chest. Moreover, recovery from CABG procedure is usually longer & more uncomfortable than coronary balloon angioplasty.

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