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Coronary angioplasty (percutaneous coronary intervention)

A coronary angioplasty is a procedure to open up narrowed or blocked arteries that can be caused by coronary heart disease. This will allow blood to flow more easily and supply your heart muscle with enough oxygen.

You may need to have a coronary angioplasty to treat chest pain (angina), or if you have a heart attack. You can have an angioplasty as a planned procedure or as an emergency treatment, and you can have it more than once.

Coronary angioplasty is sometimes called percutaneous coronary intervention (PCI), balloon angioplasty or percutaneous transluminal coronary angioplasty (PTCA). During the procedure, your doctor will inflate a small balloon in your coronary artery (the artery that supplies your heart with blood). They may also insert a stent to keep your artery open.

You might have an angioplasty at the same time as having an angiogram test. 

Your care may not be quite as we describe here as it will be designed to meet your individual needs. But before your procedure, you’ll meet the doctor who’ll carry it out to discuss what will be involved.

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Coronary angioplasty
How the procedure is carried out
Image showing a blood vessel treated with balloon angioplasty and stent

Details

  • Preparation Preparing for a coronary angioplasty

    Your doctor will explain how to prepare for your procedure. If you smoke, you’ll be asked to stop. This is because if you smoke, you’ll take longer to recover and smoking also increases the risk of your artery blocking again. If you’re taking any medicines, ask your doctor if you need to stop taking them before your angioplasty.

    If you're having a planned coronary angioplasty, you may be able to have the procedure and go home the same day. But some people will need to stay overnight in hospital.

    Usually, you can’t eat or drink anything for a few hours before an angioplasty. You might need to shave your groin before you have the procedure, but your hospital will tell you if you need to do this.

    Angioplasty is usually done under local anaesthesia, which will block the pain and you stay awake during the procedure. You’ll have an injection of local anaesthetic either in your groin or wrist depending on how your doctor is going to do the procedure. You may also have a sedative, which will help you to relax.

    Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand exactly what will happen. You might find it helpful to prepare some questions to ask about the risks, benefits and alternatives to the procedure. This will help you to inform yourself about the procedure so you can give your consent for it to go ahead. You will be asked to sign a consent form.

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  • Alternatives What are the alternatives to coronary angioplasty?

    Stable angina can sometimes be controlled with medicines and by making changes to your lifestyle, such as exercising or stopping smoking.

    A coronary artery bypass graft (CABG) operation may be a better option for you if coronary angioplasty isn’t suitable.

    Your doctor may refer you to see a surgeon who will talk to you about the options available.

  • The procedure What happens during a coronary angioplasty?

    You’ll probably have your angioplasty in a specially equipped room called a catheterisation laboratory (cath lab for short). The procedure will take about 45 minutes to an hour. This will depend on how many of your arteries need to be treated.

    Your doctor will give you a medicine called heparin during the procedure. This is to stop your blood clotting. They may give you anti-platelet medicines too, such as aspirin and clopidogrel. These help stop the blood from becoming too sticky, and so reduce the risk of a blood clot forming in your artery wall or stent.

    After the local anaesthetic has taken effect, your doctor will make a small cut in your groin or wrist. They’ll then insert a thin flexible tube called a catheter into the artery that leads to your heart. Once the catheter is in place, your doctor will inject a special dye called contrast medium. This is a colourless liquid, but it shows up on an X-ray. This will help to show the blocked areas of your blood vessels. You shouldn't feel the catheter inside your blood vessels but you may feel a warm sensation when your doctor injects the contrast medium.

    Next, your doctor will use X-ray images to guide a wire down the catheter to the narrowed or blocked area in your coronary artery. They’ll then insert a small balloon across this narrowing or blockage and gently inflate it. This will make your artery wider to allow blood to flow more easily. They’ll then deflate and remove the balloon, along with the wire and the catheter. You may have some chest pain when your doctor inflates the balloon but this should get better soon after they deflate it.

    When the procedure is finished, your doctor will remove the catheter from your artery. Your nurse will press firmly on your wound for about 10 minutes to make sure that the artery closes and any bleeding stops. If you had the procedure through a cut in your groin, your doctor may leave the tube in for a few hours to prevent bleeding. They may then use a device to seal the hole in your artery. If you had the procedure through your wrist, your doctor may put a tight band over the artery for a couple of hours.

    Stents

    Your doctor may leave a stent in place to keep your artery open after they remove the balloon. A stent is a very small wire mesh tube. The stent goes into your artery in a collapsed form, but expands to fit against your artery walls when your doctor inflates the balloon. It stays in place after the balloon is removed.

    Some stents are metal and are called bare-metal stents. Other stents are coated with a medicine and are called drug-eluting stents. The medicine is released slowly into your artery to stop it closing up again. These stents stay in place unless they are removed. Another type, called a bioresorbable stent, dissolves in your body over time.

  • Heart treatment on demand

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  • Aftercare What to expect afterwards

    After a coronary angioplasty, you will need to rest for a while. Your nurse will check your blood pressure and pulse regularly. They’ll also check your wound for any bleeding.

    If you had the procedure done through a cut in your groin, you’ll need to stay in bed lying on your back for a few hours. If the procedure was done through a cut on your wrist, you’ll be able to sit up soon after the procedure.

    You’ll need to arrange for someone to drive you home. Ask them to stay with you for the first 24 hours after your procedure too if they can.

    If you’ve had a sedative, you might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.

    Your nurse will give you some advice before you go home, including information about:

    • medicines that help to stop blood clots forming around the stent after your operation (if you have a stent) 
    • how you can improve your diet and lifestyle once you get home

    You may be given a date for a follow-up appointment.

  • Recovery Recovering from a coronary angioplasty

    If you have any pain from the wound, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine. If you have any questions, ask your pharmacist for advice.

    When you get home, check your wound regularly. You may have some bruising. But if you get any swelling, or the area becomes hard to the touch or painful, or you get any chest pain, contact your doctor. If your wound starts to bleed, press on it firmly and contact your hospital straightaway.

    It usually takes about a week to make a full recovery from a planned coronary angioplasty but this can vary between people. Follow your doctor's advice about what you can do during this time. Depending on the type of work you do, you may be able to return to work after a few days. Don’t lift anything heavy for the first week and don’t drive. You’ll usually be invited to attend a cardiac rehabilitation programme soon after your procedure. This will give you information on how to exercise and tips on how to get back to everyday life and keep your heart healthy.

    If you had an emergency angioplasty it may take longer to recover – ask your doctor or nurse for advice. Check the driving restrictions with the Driver and Vehicle Licensing Agency (DVLA) too.

    You may need to take medicines to help prevent your blood from clotting, for example aspirin and clopidogrel. You’ll usually need to take these for six months to a year after your angioplasty. This will depend on the type of stent you have (if you have one).

    An angioplasty should improve the flow of blood to your heart so your angina symptoms should get better. If all goes well with the procedure, you should be able to do more, and your quality of life may improve as a result.

  • Side-effects and complications Side-effects and complications

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. For the first few hours after your angioplasty, you may have some mild pain or discomfort. Tell your doctor or nurse if this happens.

    You may have some pain or bruising where the catheter was inserted. If you have any redness, swelling or lots of bruising when you get home, contact your GP.

    Complications are when problems occur during or after the procedure. Possible complications of an angioplasty are listed below.

    • Bleeding from your wound. This can sometimes be severe and you may need to have a small operation to repair your artery.  
    • Narrowed arteries. If you have a stent, your artery can become narrow again, which is called restenosis. This is more likely to happen in the first six months after the procedure, when the cells covering the stent grow too quickly. If this happens, you may need to have another angioplasty.  
    • An allergic reaction to the dye used during the procedure. Your doctor will treat this quickly if it happens. 
    • A blocked coronary artery. Your artery may become completely blocked during, or soon after the procedure. You may need to have the angioplasty done again straight away or you may, very rarely, need emergency heart surgery.  
    • A stroke or heart attack. This is a possibility if the tip of the catheter dislodges a clot of blood or fatty material from the wall of a blood vessel. This can block your artery, leading to these conditions. 
    • A tear to the blood vessel during the procedure. You may need an operation to repair it.

    The exact risks are specific to you and will differ for every person, so we haven’t included statistics here. Ask your doctor to explain how these risks apply to you.

  • Is it safe to exercise after angioplasty? Is it safe to exercise after angioplasty?

    Answer

    Yes, but it's best to take things easy for the first few days and gradually increase the amount of activity you do. Ask your doctor how much to do.

    More information

    It’s completely understandable if you feel worried about being active after your angioplasty. You might be concerned it will make your condition worse, or bring on a heart attack. These are natural worries to have. But your heart is a muscle so it needs exercise to keep it fit. It's really important for the long-term health of your heart that you stay active.

    Take it easy for the first few days after your angioplasty. Only do gentle activities, such as walking or going up and down the stairs. You can then gradually build up the amount of activity you do and aim to do a little bit more each day.

    Walking is a great way to do this and you can build up the distance you walk as the days go by. After a few weeks, you might want to try riding a bike or going for a gentle jog. You may be offered a rehabilitation course after your angioplasty – this will give you advice about exercise. It will also give you information about healthy eating and emotional support.

    If you become breathless or have any chest pain when you exercise, stop and rest and contact your GP.

  • How can I reduce my risk of heart problems after coronary angioplasty? How can I reduce my risk of heart problems after coronary angioplasty?

    Answer

    If you’ve had coronary angioplasty, there are lots of things you can do to keep your heart healthy. These include living a healthy lifestyle and keeping on top of any health conditions such as high blood pressure.

    More information

    A coronary angioplasty isn't a cure for heart disease. It opens up your arteries and improves the flow of blood to your heart muscle. But it can't stop the build up of more fatty deposits in the future.

    There are lots of things you can do to keep your heart and your blood vessels healthy and prevent this. See our information on Looking after your heart for tips on how.

  • Will I still get chest pain from angina after a coronary angioplasty? Will I still get chest pain from angina after a coronary angioplasty?

    Answer

    Coronary angioplasty opens up the blood vessels that supply your heart muscle. Angioplasty is very effective at treating angina but you might find your symptoms come back after the procedure.

    More information

    For most people, angioplasty will improve the blood flow through the artery that’s been treated. But it’s possible that your arteries can get blocked again so you may still get angina after the procedure.

    If you have a bout of angina, the British Heart Foundation advice is to follow the steps listed below.

    • Stop what you're doing. 
    • Sit down and rest. 
    • If you have glyceryl trinitrate (GTN) spray or tablets, take this as your doctor or nurse has told you to. The pain should ease within a few minutes. If it doesn't, take your GTN again. 
    • If the pain doesn't ease within about five minutes of taking the GTN a second time, call 999 immediately. 
    • If you're not allergic to aspirin and have some on you, chew an adult aspirin tablet (300mg). If you don't have an aspirin on you or are allergic to it, just stay resting until the ambulance arrives.
  • Other helpful websites Other helpful websites

    Further information

    Sources

    • National audit of percutaneous coronary interventional procedures public report. British Cardiovascular Intervention Society. www.hqip.org.uk, published 29 January 2014 
    • Percutaneous coronary intervention. National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published 28 August 2014 
    • Percutaneous coronary intervention. PatientPlus. www.patient.info/patientplus, reviewed 21 February 2013 
    • Coronary angioplasty helped me to keep active. British Heart Foundation. www.bhf.org.uk, published 1 December 2015 
    • Angioplasty and stenting. British Society of Interventional Radiology. www.bsir.org, accessed 10 December 2015 
    • Stable angina. BMJ Best Practice. www.bestpractice.bmj.com, reviewed 16 September 2015 
    • Percutaneous coronary intervention. Medscape. www.emedicine.medscape.com, published 25 June 2015 
    • Bioresorbable stent implantation for treating coronary artery disease. National Institute for Health and Care Excellence (NICE), 1 February 2013. www.nice.org.uk  
    • Heart, cardiac and coronary angioplasty or driving. Gov.UK. www.gov.uk, published 2 October 2015 
    • Car or motorcycle drivers with heart conditions. Driver and Vehicle Licensing Agency. www.gov.uk, published May 2013
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