Coronary angioplasty is a procedure through which we can open the cholesterol block in the coronary artery and after opening/dilating the block we can deploy the stent at that site, which is also called coronary stenting. So angioplasty includes balloon dilation of the block/legion and stenting.
Coronary angioplasty is done in patients with significant block, where block is more than 70% of coronary lumen diameter. This heart block is generally identified by a Echo-cardiography which warrants an angiography. The patient is fully conscious during the procedure. The procedure requires introducing a tube through the radial artery of the hand of the femoral artery at the groin area. A local anaesthesia is given at the place where the puncture is to be made. After the anaesthesia puncture is made with a needle and a wire is inserted in the radial or femoral artery. Through the needle a wire is inserted and then over this wire fine tube also called coronary angioplasty catheters are introduced. It is engaged on the coronary artery.Once this is in place a very thin wire also known as angioplasty wire or Percutaneous transluminal coronary angioplasty (PTCA) wire which has a very thin and soft tip is introduced through the catheter and is inserted in the coronary artery beyond the block.
Then multiple views are taken during the process to know where the block is and the length of the block, size of the artery is calculated, based on whichhow the length of the stent is calculated. Following which the block is opened with a balloon catheter. Now over the PTCA wire balloon catheter is introduced, this balloon catheter has the balloon at the tip. It is inserted through the artery till it reached the block. It is then kept between the block and this catheter is inflated with a high pressure Indiffilator. As the balloon expands the block compresses and the passage opens up. Once the block is opened another balloon catheter loaded with the stent is passed along the artery to the location of the block. Once at the balloon catheter is at the tight location of the now opened area. The balloon is inflated with high pressure. As the balloon expands the spring/stent also expands. It is kept in position with high pressure for about 10-20 second and then the balloon is deflated. Even though the balloon deflates the stent remain in the place where the blockage had occurred.
The angioplasty procedure takes about 30-45 minutes. Once, the procedure is successfully completed the catheter is removed and the patient is put on anti-platelet drugs, which are continued for 2-7 years or more.
After the angioplasty the patient is kept in ICCU for 24 hours. After which he is shifted the room and after another 24hrs observation the patient is discharged. After 10 Hrs. of angioplasty patient can be mobilised.
What are the types of Coronary Stents:
There are two types of stents:
- Bare metal stents made of steel, cobolt chromium, nitinol stent. These stents have 20% chances of restenosis or re-block.
- Drug eluting stent which are metal stents with drug embeded on the metal. These stents have 7% chances of restenosis.
Precautions to take Before angioplasty?
Six hours of fasting, blood tests, CBC, Kidney function, Creatinine, viral marker test./
What is the success rate of Angioplasty?
Success rate is as high as 90% but varies from patient to patient
What are the chances of heart attack after angioplasty?
The chances of heart attack after angioplasty is extremely rare.