Balloon Angioplasty and Stent: Procedures, and Benefits

Balloon angioplasty and stent are modern and effective treatment methods used to open narrowed or blocked heart vessels (coronary arteries). These procedures are used when plaques formed due to atherosclerosis (arterial hardening) block blood flow. While balloon angioplasty opens the narrowing in your vessel, stent placement prevents re-narrowing (restenosis) of the vessel and restores normal blood flow to your heart.

In this article, we will comprehensively discuss what balloon angioplasty and stent are, when they are applied, pre- and post-procedural processes, their benefits, and possible risks.

What are Balloon Angioplasty and Stent?

Balloon angioplasty and stent are interventional treatment methods applied to open and keep open narrowed heart vessels. Balloon angioplasty involves inflating a balloon at the tip of a special catheter in the narrowed vessel area to press the plaque against the vessel wall and widen the vessel. A stent is a small, cage-like metal mesh placed inside the vessel after this procedure.

The balloon angioplasty procedure temporarily removes the narrowing. However, since the probability of the vessel narrowing again is high, today balloon angioplasty is almost always performed together with stent placement. The stent acts as a scaffold, supporting the vessel wall and ensuring the inner diameter of the vessel remains open. Modern stents may also have drug-eluting properties to help the vessel’s healing process.

What are the Types of Stents?

Stents have different technologies used to prevent re-narrowing of the vessel wall. Today, there are two main types of stents most commonly used. These are bare metal stents and drug-eluting stents. Drug-eluting stents have become the first choice in suitable patients because they significantly reduce the risk of vessel re-narrowing. Your doctor will determine the most suitable stent type for you based on your vessel characteristics and health condition.

The most commonly used stent types are:

Bare Metal Stents (BMS):

These are stents made from metal alloys such as stainless steel or cobalt-chromium that do not contain drugs. They are relatively cheaper and quickly integrate with the vessel wall after placement. The risk of re-narrowing (restenosis) inside the stented vessel is higher compared to drug-eluting stents while the stent becomes covered with tissue.

Drug-Eluting Stents (DES):

These are bare metal stents whose surface is coated with a special drug that prevents excessive growth of vessel tissue. They significantly reduce the risk of vessel re-narrowing compared to bare metal stents. Since the healing process is longer, longer-term use of blood-thinning medication (usually one year and above) is required.

Why are These Procedures Needed?

Balloon angioplasty and stent application are needed when there are significant narrowings or blockages in the vessels feeding the heart. These narrowings can cause symptoms such as chest pain (angina) and shortness of breath. Additionally, they are urgently applied in patients who have had a heart attack to quickly open the blocked vessel and minimize damage to the heart muscle. These procedures restore blood flow to your heart, control your symptoms, and improve your quality of life.

What is the Pre-Procedure Preparation Process?

Before the procedure, your doctor performs a detailed examination to evaluate your general health condition. You may need to adjust or temporarily stop using your blood-thinning medications before the procedure. Additionally, you may be asked to stop eating and drinking water the night before the procedure. Your doctor will give you specific instructions and answer all your questions about the procedure.

What you need to do during the pre-procedure preparation process:

• Blood Tests: Blood tests are performed to check your kidney functions and blood clotting parameters.
• Medication Adjustments: Your doctor gives you clear instructions about when and how to use your medications, especially blood thinners (such as aspirin, clopidogrel). You must strictly follow these instructions.
• Fasting: You will be asked not to eat or drink water after a certain time the night before the procedure. This is to reduce the risk of possible nausea and vomiting during the procedure.
• Information: You will be informed in detail by your doctor about how the procedure will be performed, its possible risks and benefits.

How are Balloon Angioplasty and Stent Procedures Performed?

The procedure is usually performed by entering through an artery in your wrist or groin. After local anesthesia is applied, your doctor inserts a thin catheter into your vessel and advances it to your heart under X-ray imaging guidance. When the blocked area is reached, the balloon at the tip of the catheter is inflated to compress the plaque and widen the vessel. After the balloon is deflated, a stent is placed through the same catheter to ensure the vessel remains permanently open. The procedure usually takes between 30 minutes and several hours.

The procedure stages are:

• Entry Site Preparation: The wrist or groin area where the procedure will be performed is numbed with local anesthesia and made sterile.
• Catheter Placement: A thin sheath is placed in the artery, and a catheter is advanced through it along with a guide wire.
• Imaging (Coronary Angiography): When the catheter reaches the heart, contrast agent is given into the vessel and narrowed or blocked areas are imaged with an X-ray device.
• Balloon Angioplasty: A special balloon catheter is placed in the blocked area. The balloon is inflated to ensure the plaque adheres to the vessel wall. You may feel brief chest pain during this time.
• Stent Placement: After the balloon is deflated, the stent mounted on it is left inside the vessel, ensuring the vessel remains open.
• Closing the Incision: After the catheter is removed, the entry site is closed by applying pressure to stop bleeding or using a special closure device.

What Do You Feel Afterwards?

You can stand up within a few hours after the procedure. There may be mild pain or bruising at the entry site. You are usually kept under observation in the hospital for one night and discharged the next day. After discharge, it is very important to use the medications prescribed by your doctor regularly and limit your physical activities. You will feel that symptoms such as chest pain decrease as blood flow to your heart improves.

What you need to pay attention to during the post-procedure recovery process:

• Medication Use: You must regularly use the blood-thinning medications (dual anti-platelet therapy) recommended by your doctor to prevent stent blockage.
• Entry Site Care: You should take care to keep the entry site dry and clean for the first few days.
• Physical Activity: You should avoid heavy lifting and strenuous exercises for a few days. Your doctor will inform you about when you can return to your normal activities.
• Follow-up Appointments: You will have regular appointments with your doctor to monitor your recovery process.

What are the Benefits of Balloon Angioplasty and Stent?

Balloon angioplasty and stent improve your quality of life with the many advantages they offer in treating coronary artery disease. They quickly improve blood flow to your heart, relieving symptoms such as chest pain and increasing your exercise capacity. Since these procedures are less invasive than open heart surgery, your hospital stay is shorter and your recovery process is faster. Most importantly, they reduce your risk of heart attack and related mortality rates.

What are the Risks of the Procedure?

As with any medical procedure, balloon angioplasty and stent procedures also have some risks. The most common risks are bleeding or bruising at the entry site. Although rare, more serious complications such as stent blockage, vessel damage, heart attack, or stroke can also occur. Your doctor takes all necessary precautions to minimize these risks and evaluates the risk-benefit balance according to your condition.

• Detailed Explanation: The potential risks of balloon angioplasty and stent procedures are:
• Bleeding or Bruising at Entry Site: Bleeding or bruising may occur after the procedure.
• Stent Blockage (Stent Thrombosis): Although very rare, especially when blood-thinning medications are not used regularly, a clot may form inside the stent and the vessel may become blocked again.
• Vessel Damage: Damage to the vessel wall or perforation of the vessel by the catheter or balloon is a rarely seen risk.
• Heart Attack or Stroke: The risk of heart attack or stroke as a result of a clot formed during the procedure blocking another vessel is very low but exists.
• Kidney Damage: Contrast agent may cause temporary kidney damage, especially in individuals with kidney disease.

When Should You See a Doctor?

After the procedure, while at home, if you notice symptoms such as severe pain, swelling, or bleeding at the entry site, increased chest pain, shortness of breath, dizziness, or fainting, you should consult your doctor or the nearest emergency room without delay. These symptoms may be a sign of a rarely seen but emergency intervention-requiring complication.

Reference: Angioplasty