Percutaneous Coronary Angioplasty

Percutaneous Coronary Angioplasty (PTCA or PCI)

Coronary angioplasty is the technique of mechanically widening a narrowed or obstructed coronary blood vessel; typically as a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres). The balloon crushes the fatty deposits, so opening up the blood vessel to improved flow, and the balloon is then collapsed and withdrawn. Angioplasty has come to include all manner of vascular interventions typically performed in a minimally invasive or percutaneous method.

After angioplasty, most of the patients are monitored overnight in the hospital but if there are no complications, the next day, patients are sent home.

The catheter site is checked for bleeding and swelling and the heart rate and blood pressure are monitored. Usually, patients receive medication that will relax them to protect the arteries against spasms. Patients are typically able to walk within two to six hours following the procedure and return to their normal routine by the following week.

Angioplasty recovery consists in avoiding physical activity for several days after the procedure. Patients are advised to avoid any type of lifting or other strenuous physical activity for a week. Patients will need to avoid physical stress or prolonged sport activities for a maximum of two weeks after a delicate balloon angioplasty.

Patients with stents are usually prescribed a blood thinner medication, clopidogrel which is taken at the same time with acetylsalicylic acid. These medications are intended to prevent blood clots and they are usually taken for at least the first months after the procedure is performed. In most cases, patients are administrated this type of medication for 1 year. Also, patients who are doing dental work are advised to cancel it because there is a risk of endocarditis, an infection of the heart.

Patients who experience swelling, bleeding or pain at the insertion site, develop fever, feel faint or weak, notice a change in temperature or color in the arm or leg that was used or have shortness of breath or chest pain should immediately contact their doctors.

Angioplasties are safer than bypass surgeries and according to statistics less than 1% of people die from complications after this procedure. Complications that may occur after or during an angioplasty are the following:

• Tearing of the artery resulting in total blockage and possible myocardial infarction – this can usually be repaired with a stent
• A dislodged clot may cause a stroke in some circumstances (in less than 1% of patients who undergo angioplasties);
• Bleeding or bruising where the catheters were inserted;
• Kidney problems, especially in people with underlying kidney disease and diabetes – this is caused by the iodine contrast dye used for the X-ray; intravenous fluids and medications can be given before and after the procedure to try to reduce this risk.
• Arrhythmia (irregular heartbeat);
• Allergic reaction to the dye given during the angioplasty;
• Myocardial infarction happens in 3 to 5% of the cases;
• The need for emergency coronary artery bypass grafting during the procedure (2-4 percent of people). This may occur if an artery closes down instead of opening up;
• Restenosis is one of the most common complications of angioplasties and it consists in the gradual re-narrowing of the blood vessels within the next several weeks after the procedure. The cause of restenosis is not known but specialists think that it may be caused by blood clots occurring at or near the site of the treatment. There are however certain conditions that increase the risk of developing this complication and these are hypertension, diabetes, angina or kidney disease. Often, doctors prescribe anti-clotting drugs to prevent the re-narrowing of the arteries on long term;
• Blot clots can form within stents weeks or months after angioplasty and they may cause myocardial infarction.

The risks carried by angioplasty are greater in patients older than 75 years, patients who suffer from diabetes or kidney disease or who have extensive heart disease or blot clots in the heart arteries. Also, patients with poor pumping function in their hearts and women are considered to have an increased risk for complications.

Complications such as myocardial infarction, stroke or kidney problems are however among the rarest. The death rate among patients who have angioplasty is very small, about 0.1% (compared to 1% to 2% for routine bypass surgery).

All in all, the risks are relatively low and acceptable in most cases when one balances the potential benefit against the expected risk (risk-benefit ratio)