Coronary Angioplasty and Stenting

Angioplasty is a non-surgical treatment designed to open clogged arteries. This procedure is done after the doctor has seen the angiogram (picture) that shows where the arteries are blocked. Angioplasty, with or without stenting, opens the arteries to restore blood flow to areas of you heart that are at risk. Stenting involves implanting a metal tube (stent) into an artery during an angioplasty. The stent provides scaffolding to hold the vessel open to improve the flow of blood to the heart.

Patient Preparation

• Do not eat or drink anything after midnight the night before your procedure because you need to be fasting for at least 8 hours.
• Medications should be taken as scheduled with a sip of water unless special instructions are given to stop your meds. Your doctor may advise you to stop taking certain medications before your EP study to obtain more accurate test results.
• Be sure to mention to the doctor or nurse if you have any allergies
• Make arrangements with a family member or friend to drive you home after the procedure - you probably will not be permitted to drive. Family members and friends can wait in an assigned area.
• Pack a small bag in case your doctor decides to keep you overnight in the hospital. You may want to include a robe, slippers, toiletries, and a book / word games (something to pass the time).
• Leave money, jewelry, and valuables at home unless a family member or friend can hold them for you during the procedure.
• Bring a list of all medications you are currently taking. Your doctor may want to continue them while you recover from your procedure.
• Tell your doctor if you take aspirin or a blood thinner because they may need to be stopped several days before the procedure.
• Be sure to mention allergies if you are allergic to x-ray dyes or shellfish or medications.

Several routine tests are done before the Angioplasty:

• EKG (electrocardiogram)
• Blood tests
• Medical history and exam
• Chest x-ray

Should I take my medications the day of the test?

Take your medications as directed by your physician unless specifically requested to hold them prior to procedure.

Where is the catheterization performed and who performs it?

Cardiac catheterizations are performed in the Cardiac Catheterization Laboratory. Catheterizations are performed by specially trained cardiologists and they are assisted by highly skilled registered technologists and registered nurses.

What happens the day of the angioplasty?

The procedure is done in a catheterization laboratory (cath lab). It begins with a thin, flexible tube (the catheter) that the physician inserts through a sheath (previously inserted) in your arm or leg and maneuvers toward your heart.

A non-toxic dye is injected to make it possible for the physician to visualize the coronary arteries. In addition, blood pressure recordings may be made in the various chambers of your heart, and valve function can be examined. Pictures will be taken with specialized cameras.

When the blockage is located, a balloon catheter is placed in the narrowed artery and slowly inflated to press the fatty deposits or clot against the artery walls. Once the artery is open, the balloon catheter is removed. Then, x-ray dye is injected into the artery to ensure it is open enough for blood to flow more freely to the heart muscle.

A few stitches may be used to close the insertion site if an arm artery or vein is used. If a groin site is used, the sheath is left in place for several hours to keep the site from bleeding and to allow the doctor to check the artery if needed. Once the sheath is removed, pressure is applied to the site for 10-20 minutes and a pressure bandage is applied.

In many cases, better results can be obtained if the cardiologist inserts a stent into the area of the blockage and expands it with the balloon. A stent is an expandable wire mesh tube, sized to fit your artery. Once in place, a stent can provide a better channel for blood flow through the artery, with a better long-term result.

What happens after the angioplasty/stent?

You will be asked to drink plenty of fluids to help flush the dye contrast out of your system. Later, when the sheath is removed, a sandbag or pressure bandage will be placed on the insertion site to prevent bleeding. You will remain lying down for several hours and will likely remain hospitalized overnight.

What can I do when I return home?

Avoid heavy lifting and do only light activities for a few days.

Call your doctor if:

• The insertion site bleeds
• You feel chest pain or discomfort
• Your arm or leg (at the insertion site) feels numb or cold.
• The bruising or swelling gets worse or increases
• If you have a fever, or signs of infection (redness or oozing) appear at the insertion site
• Any other unusual symptoms

How will I feel after the angioplasty?

Your doctor will talk to you about the amount of improvement in the artery opening and the possibility of your symptoms returning, medications, restrictions, and changes in daily habits to reduce the risk of more arteries narrowing. You'll also be told when to return for follow-up visits.