Angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent to help prop the artery open and decrease its chance of narrowing again.
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- Angioplasty and stent placement - heart: MedlinePlus Medical Encyclopedia.
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Some stents are coated with medication to help keep your artery open drug-eluting stents , while others are not bare-metal stents. Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart. If you have too many cholesterol particles in your blood, cholesterol may accumulate on your artery walls.
Eventually, deposits called plaques may form. The deposits may narrow — or block — your arteries. These plaques can also burst, causing a blood clot to form. Angioplasty is used to treat a type of heart disease known as atherosclerosis. Atherosclerosis is the slow buildup of fatty plaques in your heart's blood vessels. Your doctor might suggest angioplasty as a treatment option when medications or lifestyle changes aren't enough to improve your heart health, or if you have a heart attack, worsening chest pain angina or other symptoms.
Angioplasty isn't for everyone. If the main artery that brings blood to the left side of your heart is narrow, if your heart muscle is weak or if you have multiple diseased blood vessels, then coronary artery bypass surgery may be a better option than angioplasty. In coronary artery bypass surgery, the blocked part of your artery is bypassed using a blood vessel from another part of your body. If you have diabetes and multiple blockages, your doctor may suggest coronary artery bypass surgery.
The decision of angioplasty versus bypass surgery will depend on the extent of your heart disease and overall medical condition. Although angioplasty is a less invasive way to open clogged arteries than bypass surgery is, the procedure still carries some risks. Blood clots can form within stents even after the procedure. These clots can close the artery, causing a heart attack. It's important to take aspirin, clopidogrel Plavix , prasugrel Effient or another medication that helps reduce the risk of blood clots exactly as prescribed to decrease the chance of clots forming in your stent.
Talk to your doctor about how long you'll need to take these medications. Never discontinue these medications without discussing it with your doctor. Before a scheduled angioplasty, your doctor will review your medical history and do a physical exam.
Coronary angioplasty and stents - Mayo Clinic
You'll also have an imaging test called a coronary angiogram to see if your blockages can be treated with angioplasty. A coronary angiogram helps doctors determine if the arteries to your heart are narrowed or blocked. In a coronary angiogram, liquid dye is injected into the arteries of your heart through a catheter — a long, thin tube that's fed through an artery from your groin, arm or wrist to arteries in your heart. As the dye fills your arteries, they become visible on X-ray and video, so your doctor can see where your arteries are blocked.
If your doctor finds a blockage during your coronary angiogram, it's possible he or she may decide to perform angioplasty and stenting immediately after the angiogram while your heart is still catheterized. You'll receive instructions about eating or drinking before angioplasty. Usually, you'll need to stop eating or drinking six to eight hours before the procedure is scheduled. Your preparation may be different if you're already staying at the hospital before your procedure.
Whether the angioplasty is pre-scheduled or done as an emergency, you'll likely have some routine tests first, including a chest X-ray, electrocardiogram and blood tests. Your body isn't cut open except for a very small incision in the skin over a blood vessel in the leg, arm or wrist through which a small, thin tube catheter is threaded and the procedure performed. Angioplasty can take up to several hours, depending on the difficulty and number of blockages and whether any complications arise.
Angioplasty is performed by a heart specialist cardiologist and a team of specialized cardiovascular nurses and technicians in a special operating room called a cardiac catheterization laboratory. This room is often called the cath lab. Angioplasty is commonly performed through an artery in your groin femoral artery.
Less commonly, it may be done using an artery in your arm or wrist area. Before the procedure, the area is prepared with an antiseptic solution and a sterile sheet is placed over your body. A local anesthetic is injected to numb the area where the catheter will be inserted. Small electrode pads are placed on your chest to monitor your heart during the procedure. General anesthesia isn't needed. You'll be sedated but awake during the procedure. You'll receive fluids, medications to relax you and blood-thinning medications anticoagulants through an IV catheter.
Then, the procedure begins:. If you have several blockages, the procedure may be repeated at each blockage. Because the balloon temporarily blocks blood flow to part of your heart, it's not uncommon to experience chest pain while it's inflated. Most people who have angioplasty also have a stent placed in their blocked artery during the same procedure.
The stent is usually inserted in the artery after it's widened by the inflated balloon. The stent supports the walls of your artery to help prevent it from re-narrowing after the angioplasty. These medicines help prevent blood clots from forming in the stent. You'll need to know how long you should take these medicines and why they're important. This procedure usually takes about an hour. It might take longer if stents are inserted into more than one artery during the procedure. Before the procedure starts, you'll get medicine to help you relax.
You'll be on your back and awake during the procedure. This allows you to follow your doctor's instructions.
Your doctor will numb the area where the catheter will be inserted. You won't feel the doctor threading the catheter, balloon, or stent inside the artery. You may feel some pain when the balloon is expanded to push the stent into place. Before the procedure, you'll be given medicine to help you relax.
If your doctor is placing the stent in your abdominal aorta, you may receive medicine to numb your stomach area. However, you'll be awake during the procedure. If your doctor is placing the stent in the chest portion of your aorta, you'll likely receive medicine to make you sleep during the procedure. Once you're numb or asleep, your doctor will make a small cut in your groin upper thigh. He or she will insert a catheter into the blood vessel through this cut. Sometimes two cuts one in the groin area of each leg are needed to place fabric stents that come in two parts. You will not feel the doctor threading the catheter, balloon, or stent into the artery.
After either type of stent procedure for arteries narrowed by plaque or aortic aneurysms , your doctor will remove the catheter from your artery. The site where the catheter was inserted will be bandaged. A small sandbag or other type of weight may be put on top of the bandage to apply pressure and help prevent bleeding.
You'll recover in a special care area, where your movement will be limited. While you're in recovery, a nurse will check your heart rate and blood pressure regularly. The nurse also will look to see whether you're bleeding from the insertion site. Eventually, a small bruise and sometimes a small, hard "knot" will appear at the insertion site. This area may feel sore or tender for about a week.
After a stent procedure, your doctor will likely recommend that you take aspirin and another anticlotting medicine. A blood clot can lead to a heart attack , stroke , or other serious problems. If you have a metal stent, your doctor may recommend aspirin and another anticlotting medicine for at least 1 month. If your stent is coated with medicine, your doctor may recommend aspirin and another anticlotting medicine for 12 months or more. Your doctor will work with you to decide the best course of treatment.
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Your risk of blood clots significantly increases if you stop taking the anticlotting medicine too early. Taking these medicines for as long as your doctor recommends is important. He or she may recommend lifelong treatment with aspirin. If you're considering surgery for some other reason while you're on these medicines, talk to your doctor about whether it can wait until after you've stopped the medicine.
Anticlotting medicines may increase the risk of bleeding. Also, anticlotting medicines can cause side effects, such as an allergic rash. Talk to your doctor about how to reduce the risk of these side effects. You should avoid vigorous exercise and heavy lifting for a short time after the stent procedure. Your doctor will let you know when you can go back to your normal activities. Metal detectors used in airports and other screening areas don't affect stents. Your stent shouldn't cause metal detectors to go off.
Why the Procedure is Performed
If you have an aortic fabric stent, your doctor will likely recommend followup imaging tests for example, chest x ray within the first year of having the procedure. After the first year, he or she may recommend yearly imaging tests. However, stents aren't a cure for atherosclerosis or its risk factors.
Making lifestyle changes can help prevent plaque from building up in your arteries again. Talk with your doctor about your risk factors for atherosclerosis and the lifestyle changes you'll need to make. Lifestyle changes may include changing your diet, quitting smoking , being physically active , losing weight , and reducing stress.
Angioplasty and stent placement - heart
You also should take all medicines as your doctor prescribes. Your doctor may suggest taking statins, which are medicines that lower blood cholesterol levels. For more information about lifestyle changes, go to the treatment section of the Health Topics Atherosclerosis article. PCI carries a small risk of serious complications, such as:. Another problem that can occur after PCI is too much tissue growth within the treated portion of the artery.
This can cause the artery to become narrow or blocked again. When this happens, it's called restenosis RE-sten-no-sis. Using drug-eluting stents can help prevent this problem. These stents are coated with medicine to stop excess tissue growth. Treating the tissue around the stent with radiation also can delay tissue growth. For this procedure, the doctor threads a wire through a catheter to the stent.
The wire releases radiation and stops cells around the stent from growing and blocking the artery. Figure A shows the coronary arteries located on the surface of the heart. Figure B shows a stent-widened artery with normal blood flow. The inset image shows a cross-section of the stent-widened artery. In figure C, tissue grows through and around the stent over time. This causes a partial blockage of the artery and abnormal blood flow.
The inset image shows a cross-section of the tissue growth around the stent. About 1—2 percent of people who have stented arteries develop a blood clot at the stent site. Blood clots can cause a heart attack , stroke , or other serious problems. The risk of blood clots is greatest during the first few months after the stent is placed in the artery. Your doctor will likely recommend that you take aspirin and another anticlotting medicine, such as clopidogrel, for at least 1 month or up to a year or more after having a stent procedure.
These medicines help prevent blood clots. The length of time you need to take anticlotting medicines depends on the type of stent you have. Your doctor may recommend lifelong treatment with aspirin. Stents coated with medicine may raise your risk of dangerous blood clots. These stents often are used to keep clogged heart arteries open. However, research hasn't proven that these stents increase the chances of having a heart attack or dying, if used as recommended. Although rare, a few serious problems can occur when surgery or a fabric stent is used to repair an aneurysm in the abdominal aorta.
Another possible problem is the fabric stent moving further down the aorta. This sometimes happens years after the stent is first placed. The stent movement may require a doctor to place another fabric stent in the area of the aneurysm. Learn more about participating in a clinical trial. View all trials from ClinicalTrials.
Visit Children and Clinical Studies to hear experts, parents, and children talk about their experiences with clinical research. What Is a Stent? How Are Stents Used? For the Carotid Arteries Doctors also may use stents to treat carotid artery disease.
For Other Arteries Plaque also can narrow other arteries, such as those in the kidneys and limbs. For the Aorta in the Abdomen or Chest The aorta is a major artery that carries oxygen-rich blood from the left side of the heart to the body. How Are Stents Placed? For Arteries Narrowed by Plaque Your doctor will use special dye to help show narrow or blocked areas in the artery. Coronary Artery Stent Placement. Talk with your doctor about: When to stop eating and drinking before coming to the hospital What medicines you should or shouldn't take on the day of the procedure When to come to the hospital and where to go If you have diabetes, kidney disease, or other conditions, ask your doctor whether you need to take any extra steps during or after the procedure to avoid complications.
For Arteries Narrowed by Plaque This procedure usually takes about an hour. For Aortic Aneurysms Although this procedure takes only a few hours, it often requires a 2- to 3-day hospital stay. Recovery After either type of stent procedure for arteries narrowed by plaque or aortic aneurysms , your doctor will remove the catheter from your artery. You should let your doctor know if: You have a constant or large amount of bleeding at the insertion site that can't be stopped with a small bandage You have any unusual pain, swelling, redness, or other signs of infection at or near the insertion site Common Precautions After a Stent Procedure Blood Clotting Precautions After a stent procedure, your doctor will likely recommend that you take aspirin and another anticlotting medicine.
Other Precautions You should avoid vigorous exercise and heavy lifting for a short time after the stent procedure. What Are the Risks of Having a Stent? PCI carries a small risk of serious complications, such as: Bleeding from the site where the catheter was inserted into the skin Damage to the blood vessel from the catheter Arrhythmias irregular heartbeats Damage to the kidneys caused by the dye used during the procedure An allergic reaction to the dye used during the procedure Infection Another problem that can occur after PCI is too much tissue growth within the treated portion of the artery.