Balloon angioplasty, often combined with stent placement, is a minimally invasive procedure designed to open arteries narrowed by plaque buildup (atherosclerosis) without major surgery. A thin catheter is guided to the blockage, a balloon is inflated to compress the plaque, and a small metal mesh tube called a stent is left permanently in place to ensure the artery remains open. This procedure is critical for treating chest pain (angina) and is life-saving during heart attacks. While recovery is fast—most patients return to normal activity within a week—long-term success depends entirely on consistent use of antiplatelet medications (like aspirin and a secondary drug) and commitment to aggressive cardiovascular risk management.
Overview
Balloon angioplasty, formally known as Percutaneous Coronary Intervention (PCI) when performed on the heart, is a procedure that opens narrowed or blocked blood vessels without requiring open surgery. A thin, flexible tube called a catheter is inserted into a blood vessel—usually in your wrist or groin—and guided to the narrowed area using advanced X-ray imaging. Once positioned correctly, a small balloon at the catheter’s tip inflates, pushing plaque against the artery walls and widening the passage.
Most angioplasties now include stent placement. A stent is a small, expandable metal mesh tube that acts as a permanent scaffold inside the artery, preventing it from collapsing or narrowing again. The stent is mounted on the balloon catheter and expands when the balloon inflates, remaining securely in place once the balloon is deflated and removed.
Two main types of stents are used:
- Bare-metal stents (BMS) are simple metal mesh tubes.
- Drug-eluting stents (DES) are coated with medications that slowly release over months; this medication prevents scar tissue from growing inside the stent, significantly reducing the chance of re-narrowing (restenosis) and making DES the most common type used today.
The entire procedure is minimally invasive, usually taking 1–2 hours. It is most frequently performed in coronary arteries to treat heart disease, but it is also highly effective for opening arteries in the legs (Peripheral Artery Disease), kidneys, and neck.
Why You Might Need This Procedure
Angioplasty and stenting are recommended in several critical situations to restore blood flow and prevent severe cardiac events.
- Chest pain (Angina) from coronary artery disease is the most common reason; if medications don’t control symptoms, opening the narrowed arteries relieves pain and improves exercise capacity.
- Heart attacks require emergency angioplasty (called primary angioplasty); the blocked artery must be opened as quickly as possible, ideally within 90 minutes of arrival at the hospital, to save heart muscle.
- Abnormal stress test results indicating a significant blood flow problem to the heart muscle often lead to elective angioplasty to prevent a future heart attack.
- Leg pain when walking (Claudication) caused by narrowed leg arteries restricting blood flow can be relieved by angioplasty, significantly improving walking distance.
- Critical limb ischemia, where severe leg artery blockages cause pain at rest or non-healing wounds, requires urgent angioplasty to restore blood flow and save the limb from potential amputation.
Preparing for the Procedure
Proper preparation is necessary to ensure safety, minimize complications, and optimize the procedure’s success.
- Medication review is critical; blood thinners like warfarin are usually paused, and specific instructions are given regarding diabetes and blood pressure medications; never stop prescribed medications without explicit guidance from your physician.
- Fasting is required; you must not eat or drink for at least 6–8 hours before the procedure, as you will receive sedation.
- Kidney function tests are necessary because the contrast dye used during the procedure can stress the kidneys, especially in patients with pre-existing impairment.
- Allergy information, especially regarding iodine, shellfish, or contrast dye, must be provided to allow the doctor to use special medications to prevent allergic reactions.
- Arrange transportation and plan for an overnight hospital stay, as you will receive sedation and cannot drive immediately after the procedure.
- Bring a complete list of all your medications, doses, and any existing medical devices.
What Happens During the Procedure
The procedure takes place in a specialized room called the cardiac catheterization lab.
- Monitoring equipment tracks your heart rhythm (ECG), blood pressure, and oxygen levels throughout the procedure.
- Sedation is administered intravenously; you will be relaxed and drowsy but able to respond to instructions.
- The access site (wrist or groin) is numbed with local anesthetic, and a small puncture allows the doctor to insert a short tube called a sheath, which serves as a working portal.
- Catheters are guided through your blood vessels using X-ray guidance (fluoroscopy); you do not feel the catheters moving.
- Contrast dye is injected, which you may feel as warmth or flushing, allowing the doctor to see the exact location and severity of the narrowings on the screen.
- The balloon and stent are positioned across the blockage, and the balloon inflates for 10–30 seconds, expanding the stent; you may feel temporary chest pressure during this inflation in coronary procedures.
- The balloon is removed, leaving the stent permanently in place to hold the artery open.
- Pressure is applied to the puncture site for 10–30 minutes to stop bleeding before you are moved to the recovery area.
After the Procedure
Recovery begins immediately after angioplasty, with close monitoring for complications.
- Monitoring is intense in the recovery area; if the groin was used, you must lie flat for 4–6 hours to prevent bleeding, while wrist access allows more immediate movement.
- Chest discomfort is common immediately after coronary angioplasty but should resolve quickly; severe or persistent chest pain requires immediate medical attention.
- Hospital stay typically involves one overnight stay for monitoring, and discharge usually occurs the next morning.
- Medications after stenting are critical; you will take aspirin indefinitely (probably for life) and a second antiplatelet medication (like clopidogrel, prasugrel, or ticagrelor) for at least one year.
- Never stop antiplatelet medications without explicit consultation with your cardiologist; stopping prematurely can cause sudden, potentially fatal blood clots (stent thrombosis) inside the new stent.
Recovery at Home
Recovery is generally rapid, but adherence to physical restrictions is important for puncture site healing.
- Avoid heavy lifting, straining, or vigorous exercise for about one week to allow the puncture site to heal (do not lift anything heavier than 10 pounds).
- The puncture site will likely bruise; keep the area clean and dry, but you can shower after 24 hours.
- Watch for complications; report any large or growing swelling, persistent bleeding, increased pain, or signs of infection (redness, warmth) at the puncture site immediately.
- Return to work is usually possible within a few days to a week, depending on the job’s physical demands.
- Exercise can gradually resume after the first week; Cardiac rehabilitation programs provide supervised exercise and education and are strongly recommended after the procedure.
Potential Complications
While angioplasty is safe, especially for elective procedures, potential complications must be understood.
- Bleeding at the puncture site is the most common complication, ranging from minor bruising to larger collections of blood that sometimes require repair.
- Kidney damage from contrast dye can occur, particularly in people with pre-existing kidney disease or diabetes; adequate hydration before and after helps minimize this risk.
- Stent thrombosis (a blood clot inside the stent) is rare but very serious, causing sudden heart attacks; consistent use of dual antiplatelet medication prevents this complication.
- Restenosis, the re-narrowing of the artery inside the stent, is uncommon with modern drug-eluting stents but can be fixed with repeat procedures if it occurs.
- Heart attack or stroke during the procedure is rare but possible if plaque fragments break loose or the artery closes suddenly.
Long-Term Outlook
Angioplasty provides immediate symptomatic relief and improves survival after heart attacks, but it does not cure the underlying disease.
- Symptom relief is typically dramatic; chest pain often disappears, and leg pain during walking improves significantly.
- Angioplasty treats the blockage but Atherosclerosis (plaque buildup) continues throughout your body; therefore, continued medications and lifestyle changes are essential for long-term success.
- Secondary prevention is critical; this involves taking all prescribed medications (statins, antiplatelet drugs, blood pressure medications) and maintaining a heart-healthy lifestyle, including absolute smoking cessation.
- The stent is permanent; after about 6–12 months, it is covered by a layer of your own tissue, becoming a permanent part of your artery wall.
- Regular follow-up appointments allow your cardiologist to monitor your condition and adjust treatments, sometimes requiring additional stress tests to check for new blockages in other arteries.
Key Points
To assist in quickly recalling the most critical information and steps, here are the key points about Angioplasty and Stenting:
- Angioplasty and stenting is a minimally invasive procedure that permanently opens blocked arteries using a balloon and a metal mesh scaffold (stent).
- The procedure is life-saving during acute heart attacks (primary angioplasty) and highly effective for relieving chronic chest pain.
- Recovery is fast; most patients return to normal activity within a week.
- Adherence to medication is critical; you must take aspirin and a second antiplatelet drug for at least one year to prevent a potentially fatal blood clot in the stent (stent thrombosis).
- The long-term outlook is excellent but depends entirely on aggressive secondary prevention—taking statins, managing blood pressure, and making dedicated lifestyle changes—as the underlying disease is not cured.
- Work closely with your cardiologist to optimize medications and monitor for any signs of new blockages or complications.
Reference: Angioplasty
