Angioplasty

Coronary angioplasty is a medical procedure used to restore flow through a narrowed or blocked artery that supplies blood to the heart muscle. The coronary arteries can become narrowed and blocked due to buildup of a material called plaque on their inner walls. (Read about "Arteriosclerosis & Atherosclerosis") This narrowing reduces the flow of blood through the artery and can lead, over time, to coronary artery disease and heart attack. (Read about "Coronary Heart Disease" "Heart Attack")

In angioplasty (also called percutaneous coronary intervention or PCI), a thin tube with a balloon or other device on the end is first threaded through a blood vessel in the arm or groin (upper thigh) up to the site of a narrowing or blockage in a coronary artery. Once in place, the balloon or other device is used to widen the artery and restore the flow of blood through it.

The National Heart, Lung, and Blood Institute (NHLBI) says angioplasty is used to:

• Relieve chest pain caused by reduced blood flow to the heart. (Read about "Angina")
• Minimize damage to the heart muscle during a heart attack. This damage occurs when blood flow is cut off to an area of the heart.

Since angioplasty was first used in the 1970's, there have been several improvements. These include:

• Stents - A stent is a tiny mesh tube that looks like a small spring. The stent is inserted in the area where the artery is narrowed to keep it open. Some stents are "coated" with medication to help prevent the artery from closing again. Stents are used in most angioplasties except when an artery is too small for a stent to fit.
• Plaque removers - Many kinds of plaque removers exist. They are used to cut away plaque that narrows the inside of the arteries.
• Laser - A laser is used to dissolve or vaporize plaque. In laser angioplasty, a thin, flexible plastic tube called a catheter with a laser at its tip is inserted into an artery. It is then threaded through the artery to the blockage. The laser then emits pulsating beams of light which vaporize the plaque.

NHLBI calls angioplasty a common medical procedure. NHLBI says major complications are rare, but they can occur. During an angioplasty, you lie on a table with an intravenous (IV) line to give you fluids and medicines to help relax you and prevent blood clots. The area where the catheter will be inserted will be cleaned and numbed. (Read about "Anesthesia") A small cut will then be made in your arm or groin to find an artery. The doctor then threads a very thin wire through the artery up to the area of the coronary artery that is blocked. A small amount of dye may be injected through the tube into the blood stream to help show the blockage on an x-ray. (Read about "X-rays") If you are having a balloon angioplasty, the balloon at the tip of the catheter will be inflated to widen the artery. If you are having a laser angioplasty, the laser at the tip of the catheter will emit pulsing beams of light to dissolve the blockage. Plaque removers may be used to take away some of the plaque from the wall of the artery. A stent can be placed at the site to keep the artery open. The stent remains in place permanently.

Even with a stent, however, an artery can reclose, requiring either another angioplasty or bypass surgery. (Read about "Cornary Bypass Surgery") NHLBI says this is especially common for people with diabetes or unstable angina. (Read about "Diabetes" "Angina") The new re-narrowing is called in-stent restenosis. The American Heart Association (AHA) says the use of drug-coated stents has helped to reduce this risk. Brachytherapy can also be used for some patients, according to the Food and Drug Administration (FDA). This is a procedure in which radioactive material is placed into the body at the site of the in-stent restenosis. FDA says the radiation treatment can prevent an exaggerated healing response at the lesion site, which causes scarring, and a recurrence of a significant blockage. As with any surgery, there are risks and benefits to the use of stents, which you should discuss with your doctor. (Read "Learn About Your Procedure")

After the procedure, it is important to remember that angioplasty is not a cure for coronary heart disease. You should discuss with your doctor what led to CHD and the need for angioplasty, as well as ways to reduce your risk of future problems. You may be placed on some sort of blood thinner. (Read about "Heart Risks") It is also important that after any heart procedure, a patient adhere to a healthy lifestyle and rehabilitation. (Read about "Cardiac Rehabilitation")