During Angioplasty:
First, a cardiac catheterization is performed. You will receive medication
for relaxation and sedation, and then the doctor will numb the site with
local anesthesia. Next, a sheath (a thin plastic tube) is inserted into an
artery -- usually in your groin. A long, narrow, hollow tube, called a
catheter, is passed through the sheath and guided up the blood vessel to the
arteries in your heart. A small amount of contrast material is injected
through the catheter. This allows the doctor to see the blood vessels,
valves and chambers of the heart on a TV screen.
If you physician determined the need for interventional procedure, he make a
critical Decision in regards of what type of procedure your blockages need,
balloon angioplasty, stents, or atherectomy.
Balloon angioplasty:
During this procedure, a specially designed catheter with a small balloon
tip is guided to the point of narrowing in the artery. Once in place, the
balloon is inflated to compress the fatty matter into the artery wall and
stretch the artery open to increase blood flow to the heart.
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Balloon is compressing the fatty matters in the narrowed area of the artery
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Stent:
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A stent is a small stainless steel mesh tube that acts as a scaffold to provide support inside your coronary artery.
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A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed coronary artery. Once in place, the balloon tip is inflated, and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed, and the stent stays in place permanently.
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It is now standard for stents to be used in combination with other procedures, such as angioplasty, to help keep the coronary artery open.
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Stents also reduce the need for emergency open-heart surgery when blockages in medium- to large-sized arteries do not respond to balloon angioplasty.
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Over a several-week period, your artery heals around the stent
Pre-Admission and Evaluation:
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You will not be permitted any food or beverages after midnight to prevent nausea during the procedure.
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If you are a diabetic, you will be given special instructions.
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Your groin area will be washed and the hair clipped in preparation for the PCI.
Angioplasty Procedure:
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The length of the procedure depends on the complexity of each individual’s situation, but in general, the duration is 1 to 2 hours.
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An intravenous line will be started in your arm in the morning.
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You will receive various medications in the angioplasty laboratory through this line. To help you relax, you will be given medication prior to leaving for the lab. You will remain awake, but slightly drowsy.
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Upon your arrival in the lab, you will be placed on an X-ray table. It is the same type of room in which you had your cardiac catheterization. You will be covered by sterile sheets. Your groin (or arm) will be cleansed with an antiseptic (which might be cold) and then numbed with an anesthetic. You will feel the sting of the needle, but then your groin (or arm) will feel quite numb. Heart monitoring equipment will be placed on your arms and legs, and you may be given oxygen to breathe through a small tube near your nose. You will be given various medications through the intravenous line, including medication to relax you. You must still be able to talk and follow directions.
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The angioplasty catheter (balloon-tipped) is inserted at the numb area, and advanced to your heart, using X-ray to guide it. When the balloon is inflated at the point of the blockage, you may feel chest pressure, or discomfort, and this is normal. It will subside when the balloon is deflated. You may also feel your heart thump or skip, feel flushed, or have a headache. All these sensations are normal. Always let your doctor know how you feel during the entire procedure. You may be asked at times to hold your breath for a few seconds, or to cough.
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Then the angioplasty balloon is pulled out and the stent over another balloon is inserted and positioned in the blocked area and inflated to attach the stent to the wall of the vessel. This is called “STENT DEPLOYMENT”. Then all balloon pulled out and final angiography is taken to be sure about the outcome and no complications.
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If a stent was placed during the angioplasty procedure, you will need to take platelet-blocking medications to reduce the possibility of a blood clot forming near the newly implanted stent. This medicine will be continued for about 6-12 months.
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After the procedure, if the femoral approach was used, you will be moved to a recovery area for a short time, and then taken to the step down unit where your condition can be monitored closely. Nurses will periodically check the groin area and dressing.
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You will be able to eat as soon as you wish after the procedure.
Recuperation:
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The catheter will be removed and most of the times a closure device may be placed in the blood vessel if conditions are suitable (to allow early mobility). Some facilities still do manual catheters pull out and firm pressure applied for about 20 minutes. Then a pressure bandage is applied and a small sandbag may be placed over it. This is to assure proper healing of the artery. Pain medication is available to you every few hours after the procedure. Please let your nurse know of any pain or discomfort you may feel at any time.
Discharge:
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Most of the time you spend the night in the hospital for observation. The reason for that is safety of the patient.
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Your doctor could discharge you 4 to 48 hours after the procedure, depending on your condition.
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Your nurse will go over medications, activities, follow-up care and give you prescriptions for new medicines as needed. You may be scheduled for a stress test after your discharge. This stress test will help plan further treatment and rehabilitation.
POSSIBLE COMPLICATIONS AND RISK
No invasive procedure occurs without a certain
amount of potential risk and complications. You are followed closely by your
doctor and nurses, precisely for the reason that if any complications arise,
corrective action can be taken immediately. The incidence of complications
is low, but nonetheless, you need to be aware of what they can be:
Severe bruising / bleeding into the area of the procedure.
Changes in your heart rhythm.
Allergic reaction to the contrast (“dye”) or to other medications used.
A tear in the lining of the artery which is being dilated.
Possibility of a heart attack during or after the procedure (you are given blood thinners to minimize this risk).
Possibility of a blood clot in the artery in which the catheter is inserted which may require surgical removal.
Rupture of the artery requiring bypass grafting surgery.
Significant blood loss requiring use of blood products (blood or blood component transfusion).