Introduction

In human body organs plays a crucial role for the optimum performance of all systems. Circulatory system which primarily comprises of heart and blood vessels is one of the very important organ systems. In the body the blood flows through arteries and veins and provide necessary oxygen and nutrition to various parts of our body. Sometimes due to some malfunctioning the blood vessels (arteries or veins) around the heart are obstructed or narrowed hence affecting the natural flow of blood. This condition is called CHD coronary heart disease. Angioplasty is a surgical procedure that used to widen obstructed or narrowed blood vessels (arteries and veins) around the heart in order to restore the natural flow of blood. In pathological terms, angioplasty is called PCI i.e. percutaneous coronary intervention.

Angioplasty can be defined in two simple terms ‘Angio’ and ‘plasty’. The term ‘angio’ means anything related to blood vessels whereas ‘plasty’, in medical terms refers to the molding or grafting of any body part. Angioplasty is a procedure which helps to restore blood flow through the artery. Angioplasty helps to relieve symptoms of blocked and clogged arteries and is often performed immediately after a heart stroke. Angioplasty is of many types and is always performed as per the requirement depending upon the condition and problem the person is having. Mainly in the angioplasty two procedures is widely used. One is Coronary angioplasty procedure in this a small balloon catheter is used to open up the clogged heart arteries and helps in improving the blood flow to the heart. The doctor inserts a thin tube with a balloon on the other end through a blood vessel in the arm or groin up to the blocked site in the artery. Second is when coronary angioplasty process is clubbed with the placement of a metal stent in the artery to help keep the coronary artery wall open.

Angioplasty is a widely used procedure to cure blocked artery. It is a safe and effective way to get relief from the symptoms.

Types of Angioplasty

Angioplasty is a very selective procedure which is not same for all conditions. There are several types of procedures of angioplasty which is chosen as per the type of the condition that the patient is suffering from. These procedures include:

  1. Coronary Angioplasty: Coronary angioplasty is a medical procedure in which a balloon is used to open a blockage in a coronary (heart) artery narrowed by atherosclerosis. This procedure improves blood flow to the heart. When the plaque builds up on the inner walls of the arteries this condition is called atherosclerosis. For Coronary angioplasty procedure, the doctors insert a small catheter with a balloon in heart arteries. The deflated balloon is fixed at the tip of the catheter and it is placed close to the plaque or the blockage in the blood vessel. The doctors then inflate the balloon to gradually open up the obstruction and hence, boost blood flow into the heart.
  2. Peripheral Angioplasty: Peripheral angioplasty is used to cure Peripheral artery disease, also referred to as peripheral arterial disease which is a common circulatory problem in which narrowed arteries reduce blood flow to the lower body parts (legs). In Peripheral Angioplasty a medicated balloon is used to open narrowed or blocked blood vessels that supply blood to the legs. The balloon after insertion presses the inside wall of the artery to open the space and improve blood flow. In some cases a metal stent is placed across the artery wall to keep the artery from narrowing again.

When a person develops peripheral artery disease (PAD), the legs don’t receive enough blood flow to keep up with the body’s needs. The patients with PAD generally have notably leg pain when walking. In such condition Peripheral angioplasty is done. A catheter is inserted into a blood vessel in the upper thigh (groin). Using high-resolution fluoroscopic (X-ray) video, the catheter is guided through to the peripheral artery that is being treated. Once the catheter reaches the affected place the balloon is inflated and the narrowed peripheral artery is stretched open. After widening the blocked area of the peripheral artery the balloon is deflated and removed and blood flow through the peripheral artery is increased.

  • Carotid Angioplasty: Carotid angioplasty is a procedure that opens clogged arteries to restore blood flow to the brain. This procedure often helps in treatment or prevention of strokes. In the body the carotid arteries are located on each side of the neck. These are the main arteries supplying blood to the brain. The arteries can be clogged with fatty deposits that slow or block blood flow to the brain. This condition is known as carotid artery disease which can lead to a stroke. The carotid angioplasty procedure involves temporarily inserting and inflating a tiny balloon into the clogged artery to widen the area so that blood can flow freely to your brain.

In some cases Carotid angioplasty is combined with another procedure called stenting. In stenting a small metal coil (stent) is paced in the clogged artery. The stent helps the artery to remain open and decreases the chance of it blocked again.

  • Renal Artery Angioplasty: Renal artery Angioplasty is used in patients with renal issues. Renal artery angioplasty is a very delicate procedure. In Renal artery angioplasty a small flexible tube called a catheter with a tiny balloon attached to the end can be positioned inside the renal artery. The angioplasty balloon is inflated inside the artery and presses the walls of the vessel and widen it.

In some cases in addition to percutaneous angioplasty, a blood vessel may require stent placement. A stent is a mesh metal tube that is pressed into the sides of the blood vessel in order to hold the vessel open. An un-deployed stent is wrapped around an angioplasty balloon at the end of the catheter. The balloon and stent combination are positioned at the effected place inside the vessel. When the balloon is inflated it helps in deploying the stent, pressing it against the inside of the vessel wall. After the stent is fully expanded, the balloon is deflated and removed from the vessel. The stent remains inside of the lumen to hold the vessel open.

  • Venous Angioplasty: Our blood circulation system has arteries and veins. Sometime the major veins carrying blood also get blocked. Venous angioplasty is a procedure used to treat vein blockages. Large veins that are narrowed or blocked can cause severe swelling and pain in effected part of the body. In the venous angioplasty procedure sometimes a metal mesh tube called a stent may also be placed into the vein to hold it open. Venous angioplasty is a minimal invasive surgery procedure which is image-guided procedures to diagnose and treat diseases.
  • Chronic limb-threatening ischemia : The Chronic limb threatening ischemia (CLTI), also known as critical limb ischemia (CLI), is an advanced stage of peripheral artery disease (PAD). Ischemia is a serious condition in which there is inadequate blood flow and oxygen to a specific part of the body. It can occur at any part where blood flows including the limbs, heart, brain, or intestines. It is caused by a narrowing or blockage of an artery. Ischemia is a severe condition that can cause tissue damage resulting in loss of limbs. This condition requires appropriate medical attention. In comparison to the other manifestation of PAD, intermittent claudication, CLI has a negative prognosis within a year after the initial diagnosis. CLI was conceived to identify patients at high-risk for major amputation. Doctor always suggest treatment of ischemia as per the location of the ischemia and its severity. Its treatment includes mainly medication, exercise and surgery.

In some patients an endovascular procedure may be performed within the artery using clot-busting drugs to dissolve clots (thrombolysis), a balloon to widen the artery (angioplasty), and/or a wire reinforced stent to keep it open. In some cases, a bypass of the affected artery may be performed. In this procedure a segment of leg vein or an artificial tube is attached surgically above or below the blockage to detour blood flow around the blocked area which allow the blood to reach the area of ischemia beyond the blockage. Examples of bypass procedures are leg artery bypass or coronary artery bypass grafting. Severe blockages in the carotid arteries that causes ischemia may be treated with a surgical procedure known as carotid endarterectomy in which severe plaque is removed from the artery.

Facts to be discussed with your doctor before angioplasty

Before angioplasty the patients should discuss many facts about their disease and the procedure with the doctor. Angioplasty is a life saving procedure with certain benefits and risk. The Patient should know the facts about angioplasty and Coronary heart disease (CHD). Coronary artery disease, is caused due to blocked or narrowed coronary arteries. The coronary arteries are the main source to supply oxygen and blood to the heart. CHD develop when cholesterol builds up on the artery walls, creating plaques. The arteries become narrow, reducing blood flow to the heart. Such a blood clot can sometimes obstruct the blood flow, causing serious health problems.

There are many options available of angioplasty the right option according to the condition of the patient should be opted like only balloon therapy is required or stent is must if yes what kind of stent. The patients should discuss the condition of the blockage and it consequences which is helpful to understand about the health risk. The patient should also know about the risk and benefits of the procedure. The pre and post procedure way of living is a must to be discussed which is helpful for the success of the surgery.

Preparation of Angioplasty

Angioplasty is a very sensitive procedure which required thorough preparation before, during and after the procedure. Before a scheduled angioplasty, the doctor will review the medical history and do a physical examination of the patient. The patient may need to have some routine tests, including a chest X-ray, electrocardiogram and blood tests, before the procedure. The doctor will also perform an imaging test called a coronary angiogram to see if the arteries of the heart are blocked and if they can be treated with angioplasty. This thorough investigation is very useful for the doctor to take care of the patient during and after the surgery.

If the doctor finds a blockage during your coronary angiogram, it’s possible he or she may decide to perform angioplasty and stenting immediately after the angiogram while the heart is still catheterized. The doctor instruct the patient about certain medications before angioplasty, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners. The patient should be sure to tell the doctor about all medications including herbal supplements and any allergic tendency with any medicine or anything if any. The patient should be in complete fasting before the Angioplasty procedure. The patient is instructed to stop eating or drinking minimum six to eight hours before an angiography. The patient should take approved medications with only small sips of water on the morning of the procedure.

The better preparation helps in getting the best desired results. We can say that the success of the procedure depends on the thorough preparation of it.     

Angioplasty Procedure

Heart is the main organ of our blood circulation system. Coronary heart disease is called silent killer. Every year a huge number of death worldwide caused by coronary heart disease. It is one of the factors responsible for the largest death in the world. Since very long coronary heart disease is proved to be a challenge to the whole medical research community. Angiography is a very revolutionary discovery in the history of medical history. The first coronary stent was approved in 1993. In the due course of time these procedure and devices have gained revolutionary development. Angioplasty is successfully adopted throughout the world now days.

Coronary heart disease (CHD) caused when the coronary arteries become blocked or narrowed. The coronary arteries function is to supply oxygen and blood to the heart. CHD tends to develop when cholesterol builds up plaques on the artery walls. These plaques cause the arteries to become narrow, reducing blood flow to the heart. Serious health problems occurs sometimes when the blood flow is reduced. If these arteries are narrow, the heart may not receive enough oxygen rich blood and effect the physical activity of the body.

The fatty deposits of plaque a buildup at the artery wall. This buildup is called atherosclerosis. This plaque can block the artery and reduce or block blood flow, which may lead to a heart attack. Angioplasty is found to be an ultimate remedy in such cases. Angioplasty gives almost a perfect remedy to the coronary artery or vein blockage. Angioplasty procedure is a minimally invasive procedure used to widen narrowed or obstructed arteries or veins. In this procedure a deflated balloon attached to a catheter (a balloon catheter) is passed over a guide-wire into the narrowed blood vessel and then inflated to a fixed size. The balloon forces the blood vessel and the surrounding muscular wall, allowing an improved blood flow. A stent is inserted at the time of ballooning to ensure the vessel remains open, and the balloon is then deflated and withdrawn. 

Today medical science has many less invasive diagnostic test, technologies that improve stent placement, and more patient-friendly angiography done via the wrist. Before the angioplasty procedure begins, the patients will be given some pain medicine and blood-thinning medicines to prevent a blood clot from forming. The doctor will insert a flexible tube (catheter) into an artery. Sometimes the catheter will be placed in the arm or in the upper leg (groin) area. The patient is given local anesthesia and remains awake during the procedure.

The doctor will use live x-ray pictures to carefully guide the catheter up into the arteries. Liquid contrast (sometimes) called “dye,” will be injected into the body to highlight blood flow through the arteries. The doctor can see any blockages in the blood vessels that lead to your heart with this color liquid in blood. A balloon catheter is pushed into the blockage. The balloon on the end is blown up (inflated). This widens the blocked vessel and restores proper blood flow to the heart.

Stent placement: Angioplasty helps in widen the blocked area and helps to restore blood flow.But in some cases the artery gets blocked again very soon. To overcome this stent are proven to be a very important tool in angioplasty. Stents are small, expandable, metal devices inserted by a catheter into a narrowed artery after the angioplasty procedure is complete. Stents are implanted in the effected artery to keep it from closing again. Stents are now used in combination with balloon angioplasty an estimated 60% to 70% of the time. In some cases direct coronary stenting, which is done without balloon angioplasty, is also an option, but is not used as frequently. Stents have improved the outcome of patients who have angioplasty. In very few cases a patient can develop blood clots associated with the use of stents. The blood clot occurs mostly in people with weak hearts, and after the use of more than one stent, or different types of stents. A stent is a small, metal mesh tube that expands inside a coronary artery after it is paced. A stent is put during or immediately after angioplasty. It is used to avoid the complication of the artery get narrowed again. A drug-eluting stent has medicine coated in it to prevent the artery from closing for long. During angioplasty procedure the stent is inserted along with the balloon catheter. It expands when the balloon is inflated. The stent is left there to help keep the artery open.

Advantage or benefits of Angioplasty

Angioplasty and stenting are proved to be a revolution in the treatment of coronary heart disease. Angioplasty offers life-enhancing and life-saving – treatment for many conditions. A blocked artery can cause serious health problems because it prevent the body’s most critical organs (the heart, brain or kidneys) from getting the oxygenated blood needed to keep it alive and functioning. Angioplasty helps to remove the blockage and allow the natural blood flow.

Angioplasty with stenting has been found to be very effective in treating very threatening condition. It is a well known fact that heart attacks and strokes are such emergencies that should be treated as promptly as possible to avoid the damage of heart muscle or brain tissue, which can lead to death. A patient who is having a medical emergency due to coronary heart disease has very little time to explore treatment options. The patients having such emergencies the angioplasty procedure can be life saving. Angioplasty and stenting give relief by reducing angina and other symptoms of CHD.

The Angioplasty can save your life and reduce heart muscle damage during a heart attack by restoring blood flow to the heart. It may immediately relieve or at least reduce symptoms, such as chest pain, shortness of breath and fatigue. It can reduce the risk of stroke. It can improve functioning of the kidneys. It can restore blood flow to the legs to prevent gangrene and eliminate the need for amputation.

In some cases of blockage in the heart arteries clearly benefited more from open-heart surgery to restore blood flow to the heart. The patients have blockage in all three major arteries. In comparison to open-heart surgery, angioplasty and stenting is less invasive than surgery as from a tiny incision in the upper leg or the wrist the blocked artery is accessed. Angioplasty and stenting may allow to recover more quickly than from the surgery, which can also mean less time in the hospital and returning to your regular activities more quickly.

Risk and complication

Angioplasty is a better choice to get relief from many Coronary Heart Disease related symptoms and problems but like any medical procedure, angioplasty and stenting has risks and complication. It’s important to take the time to weigh the benefits and risks to decide if they are the right treatment. One should always discuss with the doctor about the risks of angioplasty and stenting. Many risks can be managed if taken care of. The doctor sometime may implant a drug-eluting stent rather than a bare metal stent to help prevent scar tissue from forming blood clot that could cause the blockage of the artery again. And one can greatly reduce the risk of blood clots by taking medication exactly as prescribed by the doctor. The level of risk also depends on the personal circumstances, but it can result in an artery collapsing or closing again, especially when stenting is not an option. It can cause bleeding or damage to the blood vessel where the catheter is inserted or in the inner lining of the artery. Sometimes it causes an allergic reaction to the dye or to the stent. The scar tissue can grow within a stent (restenosis), requiring a repeat procedure. A blood clot can be formed inside the stent (stent thrombosis), which may require immediate medical treatment.

Proper care of the stent requires taking the medications on regular basis. It could be a great risk when the patients do not take medications as prescribed on regular basis. If one has a bare metal stent, then it is necessary to take medications for at least one month to prevent blood clots from forming in the stent. In case the patient is implanted drug-eluting stents, medication will be required for at least a year. With either type of stent one should take aspirin for the rest of the life which can cause other serious health issues.

Recovery after angioplasty

Angioplasty procedure gives relief from the symptoms of coronary heart disease and patient is kept under observation in the hospital. In most cases the angioplasty procedure is done with local anesthesia and the the patient is awake during the procedure. After angioplasty and stenting, the heart stent recovery time is almost 12-24 hours after the catheter is removed. Patients can return to normal life within a few days or a week after the angioplasty procedure. Coronary artery disease status post Angioplasty is that chest pain decreases significantly and patients regain the ability to physical activity. After the restoration of the normal blood flow with high oxygen the body restores it’s narmal pace.This occurs because the healthy blood flow into the heart has been restored and the body is capable of functioning normally and with more energy.

After the angioplasty procedure is over, the patients can expect the occurrence of some common symptoms at home. The patient may have bruises or discoloration in the area where the catheter was inserted. Some patient feels excessive fatigue and lack of energy. In some cases extensive chest pains that the patients used to feel before the surgery continues. If the puncture wound at the area where the incision was made swells up and develops a lump. It can also become sore and may start leaking blood with Incidences of fever. If the patient experience any such symptoms should immediately contact the doctor.

Limitation of angioplasty

Although angioplasty has many advantages, it has its limitation also. In some cases too much scar tissue may develop in the treated area of the artery. This can result in again narrowing of the artery. Sometimes this happens within a matter of months. The problem, called restenosis, occurs in angioplasty patients when no stent is used. Also in angioplasty patients when any type of stent is used. Sometimes it cocurs in angioplasty patients who receive a drug-eluting stent—a type of stent that’s coated in medicine to reduce the growth of scar tissue. The area around a stent is treated with radiation to decrease this risk in some cases. If restenosis does occur, the artery can often be opened again with another angioplasty.

More serious concern is that a blood clot may form within the stent—a risk that seems to be higher with drug-eluting stents than with bare metal ones. After an angioplasty procedure doctors often prescribe aspirin plus another anti clotting medicine to reduce the risk but there is always a chance of unwanted side effects also like an allergic rash or excessive bleeding.

In most of the cases the positives of angioplasty far outweigh the negatives. However, bypass surgery may make more sense in some cases. In comparing the two treatments it can be concluded that both angioplasty and bypass surgery are “reasonable options” for treating advanced coronary heart disease depending on the conditions. In case of patient with diabetes, bypass surgery generally leads to better outcomes, including a lower risk of having a heart attack or dying prematurely. While in less complex cases and those for whom major surgery is deemed too dangerous, angioplasty is a good option.

Patients with more complex cases of coronary heart disease, bypass surgery may be a better choice.

Life after angioplasty  

Angioplasty is just temporary solution to the coronary heart disease. After angioplasty medication and lifestyle related precautions are must to follow for all the patients. After angioplasty the patient has to take extra care of his lifestyle and should lead a very careful life. The procedure can get blood flowing freely through the artery again. But it can’t fight the ongoing buildup of plaque in arteries around the body. For that, one may need a lifestyle makeover.
One should have a healthy Heart-Smart Diet. The patient recommends cutting saturated fat to no more than 5 to 6 percent of your total calories. Limit trans fat, sodium (salt), and added sugars, as well. Not all dietary fat is bad, compounds in omega-3 fatty acids—the kind of healthy fat found in many foods is recommend. One might take omega-3 supplements, as well one discussion with the doctor.
The patients should stay physically active. This helps in managing  high blood pressure, high cholesterol, diabetes, and obesity—all conditions that can make atherosclerosis worse. Always consult the doctor what types and amounts of exercise are safe.
Weight management is an important factor for the patient. If the patient is overweight, slimming down may improve the blood pressure, cholesterol, and blood sugar levels.
The patient should quit smoking. The cigarettes smoking can damage the blood vessels and raise the blood pressure and cholesterol levels.
The patient should avoid stress. Managing stress effectively can improve the overall health and well-being.

The patient should have good night’s sleep. It is found that angioplasty patients who slept poorly had an increased risk of needing another procedure over the next four years.

Conclusion 

Angioplasty is a very effective solution in case of emergency situations like heart attack and stroke. It is also a fact that it can even help to avoid the complications but at the same time has many disadvantages too. Angioplasty has many limitations in many cases where it is not possible to perform the procedure. It is very costly also which makes it difficult for all to afford. It is in our hand to avoid it as far as possible. We have a healthy body and we should try to keep our body healthy. Healthy body with a healthy heart is a must for a smooth healthy life. It is not very difficult to maintain it. The angioplasty procedure is a very effective way of getting a solution of coronary heart disease. It has many benefits and gives relief from the symptoms of coronary heart disease but on a temporary basis. It has many complication and limitations also which can even worsen the conditions if taken proper care.

The life after angioplasty procedure is full of precautions. We have to take medication almost throughout life. We have to take many other lifestyle majors to keep our body and heart healthy. One should understand the fact that even after going through the hardships of coronary heart disease, angioplasty, lot physical and mental trauma we have to lead a life full of precaution. If one lead a life with all such health precautions about diet and physical activity all will remain fit and will not require to go through all such procedures. Wish all a healthy heart and healthy body.     

FAQ

Q.1      What is angioplasty of the heart?

Ans.    Angioplasty of the heart is a minimally invasive surgical procedure that is performed to remove the obstruction or blockage formed by plaques in the coronary arteries. Angioplasty helps restore the normal blood flow in the body.

Q.2     What is the success rate of angioplasty surgery?

Ans.    The success rate of the angioplasty procedure is exceptional. The angioplasty is successful in opening blocked blood vessels near the heart in over 90 percent of the patients.

Q.3     How much rest is required after angioplasty?

Ans.    After angioplasty how many days rest should be taken depends on the procedure of angioplasty that was performed and the condition of the patient. Many patients can return back to normal life within a few days to a maximum of a week after the procedure was performed.

Q.4     What is the cost of angioplasty in India?

Ans.    Angioplasty surgery costs anywhere between one to three lakhs rupees in India and it varies from one hospital to another.

Q.5       What is double vessel coronary artery disease?

Ans.    Double vessel coronary artery disease is a type of coronary disorders, in this case, two important arteries near the heart have simultaneous formations of plaques that are restricting the blood flow. For this condition, angioplasty is not performed and doctors advise the more invasive coronary bypass surgery.

Q.6     Do stents have to be replaced after they have been placed in the coronary artery?

Ans.    Stents made of metal that can last for a lifetime as normal tissues start to form after the stent is placed inside the artery. Generally stents do not essentially need to be replaced.

Q.7     Can stents be removed after angioplasty?

Ans.    In some cases, if the stents close then the doctors can perform procedures to reopen the stent or even add new stents in the area, there is no option possible of stent removal as normal body tissue starts to form in and around the stent after it is placed in the artery.

Q.8        What is the difference between angioplasty and a stent?

Ans.    Angioplasty procedure is a process that opens narrow or blocked blood arteries or veins. The stent is a small, metal mesh tube that expands inside the coronary artery after palcement. The stent is often placed immediately after or during an angioplasty.

Q.9     What is PTCA?

Ans.    Percutaneous transluminal coronary angioplasty or PTCA is an alternative name for percutaneous coronary intervention or PCI (Coronary Angioplasty).

Q.10   Are there any serious complications with angioplasty?

Ans.    Just like any other major surgery, coronary angioplasty tends to carry some risk of complications. But, the risk is very minimal.

Q.11   What are the warning signs of clogged arteries?

Ans.    The symptoms of clogged arteries include-Chest pain, Trouble breathing or shortness of breath, Heart palpitations, Dizziness and fatigue,Nausea, Intense sweating.

Q.12   What does a blocked artery feel like?

Ans.    If a coronary artery is completely blocked then it will cause a heart attack. The signs of a blocked artery include a crushing pressure within the chest and shooting pain in your left shoulder and arm, it also includes shortness of breath and sweating.

Q.13   Which is safer, bypass or angioplasty surgery?

Ans.    Since the bypass is a more invasive procedure, it is generally recommended only for patients with a high risk of more than two narrow or blocked arteries. Angioplasty procedure is safe for patients who are at low risk of a heart attack but have one or two narrow arteries.

Q.14   How can one stay fit after getting an angioplasty?

Ans.    Once the patient recover from the angioplasty surgery, the doctor will recommend to start taking on more heart-healthy habits. Doctors usually tell their patients to have a healthy, nutritious diet that includes no smoking and limiting alcohol. It also includes plenty of exercise like cardiac rehabilitation.
While one may not indulge in high-intensity exercises, can perform light exercises like going for walks. The doctor might even refer to a cardiac rehabilitation centre which will help to set a healthy eating lifestyle.

Q.15    What are the benefits of angioplasty?

Ans.    Angioplasty treats narrow or blocked arteries with angioplasty and stents, gives several benefits. It increases the life span and reduce any damage to the heart muscles, which can occur during a heart attack, by restoring blood flow to the heart.It can relieve any heart disease symptoms like chest pains, shortness of breath. It reduces the risk of stroke in the future. It restores blood flow to the legs, this helps prevent gangrene and removes the need for amputation.

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