What is Angioplasty Surgery?

Coronary angioplasty or percutaneous coronary intervention, is used to open clogged

heart arteries. It involves temporary insertion and inflation of a tiny balloon where an
artery is clogged for widening it. Upon suffering from a heart attack, ideally the patient
needs to be subjected to an angioplasty within the first 1 to 1.5 hours. This time is
known as golden hour. Beyond this time frame, heart muscle cells get irreversibly
damaged.

This type of angioplasty is known as primary angioplasty. In cases where angioplasty is

not possible, an intravenous clot buster is given as an alternative. Even though using
this clot buster is an easy option, it is less effective than angioplasty.

Why is Angioplasty Surgery Required?

Angioplasty surgery helps in improving symptoms of blocked arteries. These symptoms
include shortness of breath and chest pain. It is useful during a heart attack for quick
opening of a blocked artery. It helps in reducing the heart damage. It also helps in
clearing of plaque from coronary arteries. Angioplasty surgery is beneficial as the artery
returns back to normal size without need of major surgery.

Indications for Angioplasty Surgery

An emergency angioplasty with or without stenting is carried out normally as the first
treatment of choice for the patients of heart attack. Given below are the cases where an
angioplasty is required to be carried out

 Severe angina on frequent basis with no response to medications

 Ischemia of heart muscles
 Narrowed or blocked artery

Pre-operative Preparation
Prior to angioplasty, following tests are required to be done.

 Medical history and basic examinations, such as blood pressure, heart rate and
weight
 Blood tests
 EKG (electrocardiagram)
 Chest X-ray

Specific instructions will be given by the surgeon prior to the surgery procedure. Few hours
before surgery, patients are not allowed to eat or drink anything.
Day Before Surgery
In case of emergency angioplasty, the patient cannot be made to wait for a day to
undergo the procedure. But in case of planned angioplasty, the patient should follow
certain restrictions since a day prior to surgery. It is not advisable to consume food
since midnight prior to surgery. The patient may consume liquids depending on the
surgeon's instructions. The patient should avoid undergoing physical stress prior to
surgery.

Procedure Day
An angioplasty is carried out in a catheterization laboratory. It starts with an insertion
of catheter through previously inserted sheath into an artery of the arm or the leg. For
better visibility of coronary arteries, a radio-opaque dye is given through injection to
the patients. Blood pressure from the various parts of the heart is recorded. Functioning
of valves is also examined. Using specialized cameras, images of the heart can be
captured during the process. A balloon catheter is placed at the location of blockage and
slowly used for inflation of fatty plaque deposits. This helps in free flow of the blood to
the heart muscle.
Stent insertion by a cardiologist into the blockage site and expansion of the same with
the help of balloon gives better results. Stent provides better medium for blood flow via
artery. This gives long-term better results.

Methods/Techniques of Angioplasty
Surgery
Angioplasty is one of the minor surgeries used for treatment of clogged blood vessels
which help in restoring normal blood flow to the heart and throughout the body of the
patient. For patients who are at the risk of heart disease or stroke, surgeon may
recommend to go for an angioplasty instead of bypass surgery. Based on the patient's
condition, type of angioplasty is decided. Given below are the main types used for
angioplasty surgery.

 Balloon Angioplasty
 Laser Angioplasty
 Atherectomy

Balloon Angioplasty
Balloon angioplasty is a commonly used angioplasty method. It involves passing of a
thin and long tube called catheter into an artery (obstructed) via a small incision in the
arm or the thigh of the patient. With the help of X-ray, guidance is provided to the
catheter so that it can travel smoothly through the blood vessels into an artery. Upon
entry into the narrowed artery, balloon attached to the catheter tip is inflated. The
balloon in expanded state presses and flattens the plaque and widens the artery. Once
the artery gets clear, blood flow is restored back.

After insertion of balloon, it is normal to experience discomfort in the chest by the

patient. Stents are commonly used during balloon angioplasty. These are small devices
made up of metal which can be placed with the help of catheter after completion of
angioplasty process. It remains inside the artery under treatment for preventing
narrowing of the artery.
Most of the times, patients with stent insertion, find it beneficial. Sometimes, patients
with weak heart may develop blood clots as a result of stent insertion. In most cases,
stents have proven to be beneficial for those who receive them, but in rare cases, when
someone has a weak heart, blood clots can develop due to the stent.

Laser Angioplasty
In laser angioplasty, catheter is used, but instead of balloon, laser is used. The laser is
then moved to the plaque and blockage gets vaporized. It is common to use balloon and
laser angioplasty one after the other. While balloon is used first for the destruction of
hard plaque, remaining plaque is removed by the laser. Time interval between both
procedures is decided by the cardiologist.
Even though this is the case, laser angioplasty is not used frequently as compared to
other angioplasty methods.

Atherectomy
This procedure is done when the plaque is so hard that it cannot be removed with
balloon angioplasty or laser angioplasty. The plaque is then cut completely using a
surgical blade. The blade helps to shave off the plaque from the walls of the affected
artery.

Rotational Atherectomy
This type of atherectomy involves use of a diamond-tipped high speed drill for the
destruction of plaques deposits. Excessively hard plaque is removed by this method.

Extraction Atherectomy
For cutting the plaque deposits present inside the walls of artery, a small rotating blade
similar to that of food processor cutter is used in an extraction atherectomy.

Directional Atherectomy
In this method, balloon and shaving blade are used in combination for shaving the
plaque away.

Post Procedure
In case of non-emergency angioplasty surgery, patient remains hospitalized based on
the health condition. Usually, patients can return back to normal routine after a week
post angioplasty. In case of angioplasty and stenting during heart attack, hospitalization
period and recovery time can increase.
Recovery at Home
After returning home, patients need to drink plenty of fluids for flushing out the
contrast dye from the body. Strenuous exercise and heavy weight lifting needs to be
avoided post angioplasty surgery. Rest of the activities are required to be followed as
per recommendation of the surgeon. Post angioplasty, if following symptoms are
observed, patients need to inform to the surgeon immediately.

 Pain and discomfort at the site of catheter insertion

 Infection signs such as fever, redness or drainage
 Swelling or bleeding at the site of insertion of catheter
 Temperature fluctuations
 Fatigue or weakness
 Chest pain
 Shortness of breath

Use of Blood Thinners Post Angioplasty

It is very essential for patients to follow recommendations of surgeons regarding
medications after angioplasty. Most of the times, the angioplasty patients need to take
Aspirin indefinitely post surgery. Patients with stent placement will require a blood-
thinning medication. Clopidogrel is given in such cases for a period of an year or longer.
It is very essential to keep the heart healthy post angioplasty. Given below are the
guidelines required to be followed after angioplasty surgery.

 Avoid smoking
 Maintain cholesterol levels
 Maintain healthy weight
 Regular exercise

Risks and Complications

Factors increasing the risk of angioplasty complications are listed below.

 Age of the patient - With old age, risk increases.

 Type of treatment procedure - An emergency process is risky always since there
is less time for planning than well-planned procedure.
 Presence of kidney diseases - Kidney damage can happen as a result of contrast
agent used during angioplasty.
 Abnormal heart rhythms - During angioplasty procedure, the heart beats
increase or become slow. Heart rhythm problems are short-lived usually , while
in some cases a temporary pacemaker insertion or medications are required.

Complications
 Bruising or bleeding on the skin at the site of catheter insertion
 Damage to the artery at the site of sheath insertion
 Coronary artery rupture can take place during angioplasty which may need an
emergency bypass surgery.
 Allergic reactions to contrast agent used in angioplasty procedure - For allergic
patients, limited amount of contrast agent is used by surgeons and it is made
sure that patient is well-hydrated.
 Excessive bleeding can occur during angioplasty procedure.
 Heart attack - it is possible that patient going through an angioplasty may
experience a heart attack during the procedure in rare cases.
 Stroke - A stroke can be rarely experienced by the patient during angioplasty
procedure. This happens as a result of loosening of plaque while catheters are
inserted via aorta. In such cases, blood thinners are used for reducing the risk of
stroke.