Coronary Angioplasty is sometimes referred to as “PTCA”. This stands for “Percutaneous Transluminal Coronary Angioplasty”. The procedure is also called simply “Angioplasty” or “Percutaneous Coronary Intervention” (PCI). It is a treatment for narrowings identified by coronary angiography. It involves the use of balloons and small metal coils called stents.
Angioplasty is always preceded by coronary angiography. Sometimes the angiogram will have been done on a previous occasion and sometimes the angioplasty will be done on the same day immediately after the angioplasty.
Patients usually come in on the day of their procedure. Before the angioplasty you will be told not have anything to eat or drink for about four hours before the time of your arrival at the hospital. In most cases you will be told to take your heart tablets (including aspirin) as usual on the day of the test. If you are diabetic then you should discuss this with the cardiologist. Often diabetic treatment may be stopped or reduced on the morning of the test.
It is helpful to bring all the tablets and medicines that you may be taking, with you when attending for the test. This makes it much easier to discuss with you, any adjustments in your treatment.
The angioplasty is done in the specially equipped room with x-ray equipment that was used when you had your angiogram. During the procedure you have to lie on an x-ray table. You are surrounded by a lot of equipment that will come close to you but will not actually touch you. The angioplasty is usually done though an artery at the top of the right leg. At the start of the procedure the area is cleaned and your body and legs are covered by sterile towels. A local anaesthetic is given and once this has worked a small cut is made in the skin and a fine tube is put up through an artery into the heart. It is not possible to feel the tube inside you. A small tube is also often put into a vein at the top of the leg. This allows you to be given fluids and drugs as required.
Once the tube is in place, more pictures are taken to check to see if things have changed since the angiogram was taken. A fine wire is passed down the heart artery and across the narrowing being worked on. A small deflated balloon on the end of a tube is then slid down the wire so that the balloon is in the middle of the narrow area of the artery. The balloon is then blown up in order to stretch the narrowing. This may be done several times. During this time you may get some discomfort in the chest, neck or arms. It is important to tell the team if this happens. During this procedure a decision will be made will decide if it is necessary to put a small metal coil, called a stent, into the artery. Currently a stent is used in about eighty percent of cases.
Angioplasty is safe but does carry a small degree of risk. On average this is about 1 per 100 (1%) for death, a heart attack or stroke. The procedure is therefore 99% but not 100% safe. Typically the risk for the narrowing in the artery reoccurring is about 5 - 10% depending on the nature of the narrowing and the type of stent used. Reoccurrence is usually in the first year after the procedure. Angioplasty is designed to widen narrowings in the arteries. Sometimes in working on these narrowings the artery closes. Usually this can be sorted out using more balloons and stents. Occasionally however this is not possible and the patient has to have an immediate bypass operation. This occurs in about 1 per 100 cases (1%). For this reason a cardiac surgical team will be available to intervene if required.
After the procedure you will be told what medication to take. In most cases, patients take a combination of aspirin and clopidogrel (Plavix) after a stenting procedure. Aspirin treatment is usually for an indefinite period but clopidogrel is usually stopped after a period of time. With some stents currently this is a year but with others the period may be shorter. You will be given individual advice about this. It is most important not to stop these drugs without expert advise. Stopping them prematurely can result in the stent suddenly blocking off and causing a heart attack.
At the end of the procedure the tubes in the leg are removed and any bleeding is stopped. Often I use a collagen plug or other device to do this for the tube in the artery. In other cases pressure is applied at the top of the leg.
For many patients undergoing angioplasty the worst part is the worry beforehand. In my practice I do everything possible to look after patients during their admission and encourage them to discuss any concerns.
Unlike a cardiac catheterisation patients usually stay one night in hospital after an angioplasty. Patients are generally off work for about a week to ten days. If you hold an ordinary driving licence, you are not allowed to drive for one week after the procedure. You should tell your motor insurance company that you have had an angioplasty. You do not need to tell the driving licence authorities (DVLC) until your next licence renewal. Different rules apply if you hold a special licence to drive a taxicab or heavy goods vehicle.
I hope that this article has been useful, if you have any questions please do use the Contact me section.