Angioplasty and Stent placement - heart
Balloon angioplasty
Drug-eluting stents; PCI
Percutaneous coronary intervention
Coronary angioplasty
Coronary artery angioplasty
Cardiac angioplasty
Heart artery dilatation
PTCA
Percutaneous transluminal coronary angioplasty

What it is?

             Procedure to open narrowed or blocked coronary arteries to supply blood to the heart is called angioplasty. A coronary artery stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed after angioplasty. It helps prevent the artery from closing up again. A drug eluting stent has medicine in it that helps prevent closing of the artery.

             Cholesterol comes from two sources: our liver produces it, and we consume it in meat and dairy products. It is a waxy, fat-like material that is found in all parts of the body.


             Atherosclerosis is a disease of the arteries in which fatty material is deposited in the vessel wall, resulting in narrowing and eventual impairment of blood flow. Severely restricted blood flow in the arteries to the heart muscle leads to symptoms such as chest pain. Atherosclerosis shows no symptoms until a complication occurs.

Procedure
             Drugs to minimize blood clotting process are given. Anesthesia is given.
             You will lie down on a padded table. Your doctor will make a small cut (incision) on your body, usually near the groin. Then your doctor will insert a catheter (flexible tube) through the incision into an artery. Sometimes the catheter will be placed in your arm or wrist. You will be awake during the procedure.
             The doctor uses live x-ray pictures to carefully guide the catheter up into your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps the doctors see any blockages in the blood vessels that lead to your heart.
             A guide wire is moved into and across the blockage. A balloon catheter is pushed over the guide wire and into the blockage. The balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart.
             A stent (wire mesh tube) may then be placed in this blocked area. The stent is inserted along with the balloon catheter. It expands when the balloon is inflated. The stent is then left there to help keep the artery open.

Reasons the Procedure Is Performed
             Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis.
             Not every blockage can be treated with angioplasty. Some need coronary bypass (heart surgery).

Angioplasty may be used to treat:
1) Persistent chest pain (angina) that medicines do not control
2) Blockage of one or more coronary arteries that puts you at risk for a heart attack
3) Blockage in a coronary artery during or after a heart attack

Risks
             Angioplasty is generally safe, but ask your doctor about the possible complications. Risks of angioplasty and stent placement are:
1) Heart attack
2) Allergic reaction to the x-ray dye
3) Bleeding or clotting in the area where the catheter was inserted
4) Damage to a heart valve or blood vessel
5) Kidney failure (higher risk in people who already have kidney problems)
6) Irregular heart beats (arrhythmias)
7) Stroke (this is rare)
8) Clogging of the inside of the stent (in-stent restenosis Allergic reaction to the stent material
9) Allergic reaction to the drug used in a drug-eluting stent
10) Blood clot

Preoperative preparations
             Angioplasty is often performed when you go to the hospital or emergency room for chest pain, or after a heart attack. If you are admitted to the hospital for angioplasty when it is not an emergency:
             You will usually be asked not to drink or eat anything for 6 to 8 hours before the test.

Tell your doctor what drugs you are taking, even drugs or herbs you bought without a prescription.
             Take the drugs your doctor told you to take with a small sip of water.
             Tell your doctor if you are allergic to seafood, if you have had a bad reaction to contrast material or iodine in the past, if you are taking Viagra, or if you might be pregnant.



             Cardiac catheterization is used to study the various functions of the heart. Using different techniques, the coronary arteries can be viewed by injecting dye or opened using balloon angioplasty. The oxygen concentration can be measured across the valves and walls (septa) of the heart and pressures within each chamber of the heart and across the valves can be measured. The technique can even be performed in small, newborn infants.

After the Procedure
             Usually, the average hospital stay is 2 days or less. Some people may not even have to stay overnight in the hospital.
             In general, people who have angioplasty are able to walk around within 6 hours after the procedure. Complete recovery takes a week or less. Keep the area where the catheter was inserted dry for 24 to 48 hours.
             Most people take aspirin and another medicine called clopidogrel (Plavix) after this procedure. These medicines are blood thinners, and they keep your blood from forming clots in your arteries and stent. A blood clot can lead to a heart attack. Take the medicines exactly as your doctor tells you. Do not stop taking them before talking with your doctor first.

Outlook
             For most people, angioplasty greatly improves blood flow through the coronary arteries and the heart. It may remove the need for coronary artery bypass surgery (CABG).
             Angioplasty does not cure the cause of the blockage in your arteries. Your arteries may become narrow again. Follow your heart-healthy diet, exercise, stop smoking (if you smoke), and reduce stress to help lower your chances of having a blocked artery again. Your health care provider may prescribe medicine to help lower your cholesterol

Balloon Angioplasty





             The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.



             While the patient is awake and pain-free (local anesthesia), a catheter is inserted into an artery at the top of the leg (the femoral artery). The procedure begins with the doctor injecting some local anesthesia into the groin area and putting a needle into the femoral artery (the blood vessel that runs from the heart down the leg). Once the needle is inserted, a guide wire is placed through the needle, into the blood vessel. Following this step, the guide wire is left in the blood vessel and the needle is removed. A large needle called an introducer is then placed over the guide wire and the guide wire is removed.



             Next, a diagnostic catheter, which is a long narrow tube, is advanced through the introducer over a .035"guidewire, into the blood vessel. This catheter is then guided to the aorta and the guide wire is removed. Once the catheter is placed in the opening or ostium of one of the coronary arteries, the doctor injects dye and takes a series of X-rays (film of the images).



             The first catheter is exchanged out over the guide wire for a guiding catheter and the guide wire is removed. A smaller guide wire is advanced across the blocked section of the coronary artery and a balloon -tipped tube is positioned so the balloon part of the tube is beside the blockage. The balloon is then inflated for a few seconds to compress the blockage against the artery wall. Then the balloon is deflated. The doctor may repeat this a few times, each time pumping up the balloon a little more to widen the passage for the blood to flow through. This treatment may be repeated at each blocked site in the coronary arteries.



             A device called a stent may be placed. A stent is a latticed, metal scaffold that is placed within the coronary artery to keep the vessel open.
             Once the catheter has been positioned at the coronary artery origin, contrast media is injected and a series of X-rays (film) are taken to check for any change in the arteries. Following this, the catheter is removed and the procedure is completed



             This procedure can greatly improve the blood flow through the coronary arteries and to the heart tissue in about 90% of patients and may eliminate the need for coronary artery bypass surgery. The outcome is relief from chest pain symptoms and an improved exercise capacity. In 2 out of 3 cases, the procedure is considered successful with complete elimination of the narrowing or blockage. This procedure treats the condition but does not eliminate the cause and recurrences happen in 1 out of 3 to 5 cases. Patients should consider diet, exercise, and stress reduction measures. If adequate widening of the narrowing is not accomplished, heart surgery (coronary artery bypass graft surgery, also called a CABG) may be recommended



Immediately after the procedure, a ten-pound sandbag may be placed over the femoral artery puncture site in the leg and remain there for 6 hours. This is done to help the artery heal



Video

Reference:  MedlinePlus, OR-Live