10 Key Points to Know Before Undergoing Angioplasty

Widening of a blood vessel does not require surgery. In an angioplasty, a cardiac catheter—a very narrow tube—will be inserted into a blood vessel in the groin or near the wrist. The balloon is then guided with a catheter to the point at which the blood vessel is narrow. There it is inflated, expanding the blood vessel around it. The balloon is then deflated and removed from the blood vessel.

There is fear that after the procedure, the blood vessel may narrow again. To prevent narrowing of the blood vessel, a device called a stent (a small mesh tube that can be made of either metal or plastic) is inserted to hold open the blood vessel permanently. The recurrence rate of intervention after stent insertion is under 10%.

According to the American Heart Association, angioplasty is not painful. The area of catheter insertion will be numbed so that you may feel a little pressure—but not much pain. You will remain awake during the procedure, although you may be given something to help you relax. The area where the catheter was inserted may be bruised and painful to the touch after angioplasty— this is normal. Inform your doctor if there is any bleeding or swelling after the procedure.

Before you go in for angioplasty, it is likely that your doctor will order an x-ray, an electrocardiogram, and blood tests to make sure you are a good candidate for this procedure. You will most likely be instructed to fast for 6-8 hours before the procedure. Let your doctor know about any medications you are taking—especially diabetes medication, which you may need to stop taking before the angioplasty. A cardiologist does the procedure with the help of a specialized cardiovascular team in a cardiac catheterization laboratory—or a cath lab.

Once the catheter is removed from the blood vessel, pressure will be applied for 15-20 minutes to stop the bleeding. If the catheter was inserted through the groin, you would need to lie down for several hours while you are monitored for bleeding or chest pain. Angioplasty patients are usually required to stay in the hospital for one night following the procedure to ensure smooth recovery. Most angioplasty patients will be put on aspirin indefinitely follow insertion of a stent. Your doctor may put you on blood thinners as well for 6-12 months to minimize the risk of a blood clot forming in the stent.

After the procedure, your doctor and nurses will encourage you to drink a lot of water. This is because your blood vessels were pumped with iodine contrast dye to make them more visible in the x-rays during the angioplasty. The water your drink after the procedure will help to flush the iodine contrast dye from your system.

If you have atherosclerosis, you are in danger of having a heart attack. Angioplasty is used to improve the prognosis of patients with angina, minimize the risk of heart attack, and avoid doing open heart coronary artery bypass graft (CABG) surgery, which can be risky. In CABG, blood vessels from another part of the body are taken and used to repair damaged arteries or to create a new route for blood to flow around damaged arteries. Complications of open heart surgery could include bleeding, arrhythmia, blood clots, infection, kidney failure, fever, memory loss, and heart attack or stroke.

Angioplasty is successful in 90-95% of patients. The other 5-10% experience complications which may be due to technical difficulties during the procedure, or due to abrupt coronary artery closure during or after the procedure. Sudden closure can happen for many reasons and may be the result of tearing of the inner lining of the blood vessel, blood clotting, or constriction or elastic recoil of the artery— or a combination of these things. Rarely, a person may have a heart attack during the procedure.

Immediately following angioplasty, you should not be doing any strenuous activity or lifting heavy items. Your doctor will tell you when you may return to full physical activity. If you had angina before the procedure, you should feel relief. You may be able to exercise better than before because you will be free from chest pain. Even though your artery may be expanded, it does not mean you are free from heart disease. Keep taking your medication as instructed by your doctor, and stick to the following healthy lifestyle choices:

• Maintain a healthy weight
• Keep cholesterol levels down
• Quit smoking
• Take control of your diabetes
• Check your blood pressure often
• Exercise

After angioplasty, you will probably have a few follow-ups, and you may need to visit your doctor regularly for checkups. Don’t skip out on these important appointments. If you experience chest pain, shortness of breath, or any other symptoms that may indicate angina or a heart attack, seek immediate medical attention.