Angioplasty and Stent Implantation
What to Expect
What Happens Next
Angioplasty is a widely used procedure that is performed for patients with cardiovascular disease. The procedure involves inserting a medical device, such as a balloon, into your heart to open the heart artery narrowed by plaque. It may involve placement of a stent (mesh tube) to help keep the vessel open. The stent may be coated with medicine.
Heart disease treated with angioplasty usually provides rapid relief of symptoms such as chest pain and/or shortness of breath. The majority of patients return to regular life activities without chest pain in a short time.
Angioplasty is used to:
- Restore blood flow to the affected area of the heart by treating narrowed coronary arteries
- Provide prompt relief of chest pain and/or shortness of breath after procedure
- Potentially reduce the risk of heart attack and prolong life compared to no treatment
Patients who may receive angioplasty include those with:
- Chest pain during exertion if medication has failed or is not selected
- Continual or increasing chest pain and/or shortness of breath
- Patients who are not candidates for cardiac bypass surgery
Stents are tiny, expandable tubes made of metal mesh designed to open a blood vessel that is blocked by plaque. The angioplasty procedure opens the artery, and stents are placed and expanded to fit the size, shape and bend of the artery. The stent remains in the artery after the procedure to help keep the artery open. Over time, the artery wall heals around the stent.
There are two kinds of coronary artery stents.
- Bare-metal stents help keep the cleared artery open after angioplasty by supporting the artery wall after angioplasty. Bare-metal stents help to prevent the artery from re-narrowing.
- Drug-coated stents are bare-metal stents with a special drug coating. These stents are also called drug-eluting stents, or DES. DES have the same support benefits as a bare-metal stent for keeping the artery open after angioplasty. In addition, the stent releases a drug over time to further reduce the chance of re-blockage.
- Arteries commonly become blocked again about 7% of the time with drug-coated stents, compared to 25% for bare-metal stents.¹
How to Prepare
Your healthcare provider will give you specific instructions about preparing for your angioplasty and stent implantation procedure prior to admission to the hospital. Follow the instructions carefully.
Your healthcare provider determines whether you should continue or stop certain medications, if you should avoid eating or drinking in the hours before the procedure and what to expect when you check into the hospital.
Tell your doctor if you:
- Are allergic to shellfish
- Have had a bad reaction to contrast material or iodine in the past
- Are taking Viagra
- Might be pregnant
It is important for you to tell your doctor if you cannot take aspirin or have a history of bleeding problems. Your doctor also needs to know if you are taking any other medications, have drug allergies, or are allergic to any metals or plastics.
What to Expect
Specially trained catheterization laboratory nurses and technicians work with your doctor as a team to provide care. You will be brought to the Cardiac Catheterization (Cath) Laboratory, a special room in the hospital with testing equipment and staff for the procedure.
An intravenous (IV) line will be started in your arm and you will be given medicine to help you relax and get sleepy. This is called conscious sedation, which means you remain aware of your surroundings and are able to talk to the staff, but you should not feel any pain.
Your healthcare provider will clean, shave and numb the site where catheters will be inserted into your veins. This is typically done in one or both sides of your groin, or your neck in order to access the heart.
Several thin tubes (catheters) are inserted into a vein in your leg, usually in your groin area (on the inside of your legs). Your doctor will gently push the catheters all the way into your heart.
An X-ray machine (fluoroscope) provides images of your heart during the procedure to help the doctor accurately position each catheter.
Your Angioplasty Procedure - Watch the Video [01:21]
Using the guiding catheter, a balloon catheter is then positioned precisely in the clogged area of the coronary artery. Once in place, the balloon is inflated, compressing the plaque buildup and widening the artery. At this time you may experience some chest pain. Although this is normal, let your doctor know if you are experiencing any pain.
After the artery has been widened, your doctor will then pass the stent, mounted on a delivery catheter, into the coronary artery where the balloon was inflated. Your doctor will again inflate the balloon to expand the stent. The stent will expand to shape itself to the size and contours of your vessel.
Once in place, the stent will remain as a permanent implant in your artery. If the stent is a coated, drug-eluting stent, a very small but effective dose of the medicine is released slowly over the time when restenosis (reclosing of the artery) is most likely to occur.
What Happens Next
Your doctor may prescribe a number of medications that you will need to take each day. This combination of drugs, called anti-clotting therapy (also referred to as blood thinners), reduces the risk of blood clots forming. Take the medication as instructed by your doctor.
Your cardiologist may prescribe aspirin and a second anti-clotting drug such as PLAVIX® (clopidogrel) or TICLID® (ticlopidine)*. Aspirin is usually taken long term, and the second anti-clotting medicine (PLAVIX or TICLID) is normally prescribed for a specific length of time by your cardiologist depending on individual needs.
Before leaving the hospital, make sure you understand the dosage and durations of all medications that your cardiologist instructs you to take.
Recovery from an angioplasty procedure is usually quick. Many people are able to resume most of their normal activities 24 hours after the procedure. As the insertion site heals, some people experience bruising and feel a small, hard lump. This is normal and will go away in a few days.
If any of the following are experienced, it is very important to call the healthcare provider.
- Bleeding at the insertion site
- Increased pain
- Any complaint of chest pain
- Shortness of breath
- Feeling cold, have swelling, or numbness on the arm or leg of the insertion site
- The bruising or lump at the insertion site gets larger
- Fever over 100° F
- Return of arrhythmia symptoms
Be sure to talk with your healthcare provider so that you thoroughly understand all of the risks and benefits associated with the implantation of a stent. As you recover from your implant surgery, you will find that your device may allow you to return to an active lifestyle.