Coronary Angioplasty And Stents Risk Factors & Treatment

Coronary angioplasty, also known as percutaneous coronary intervention, is a technique used to clear blocked heart arteries. A small balloon catheter is placed during an angioplasty procedure to assist the expansion of a blood artery that has narrowed and enhanced blood flow to the heart.

A thin wire mesh tube known as a stent is frequently inserted in addition to an angioplasty. The stent aids in keeping the artery open, reducing the likelihood of further constriction. Drug-eluting stents, which are common, are coated with medicine to help keep the artery open. Bare-metal stents are seldom used.

Chest discomfort and shortness of breath are examples of symptoms of clogged arteries that can be improved by an angioplasty. Another frequent application of angioplasty after a heart attack is to rapidly unblock an artery and lessen the quantity of the heart that has been harmed.

Why is it done ?

Angioplasties are used to address fatty plaque buildup in the heart's blood vessels. This buildup is a type of heart disease called atherosclerosis.

You may benefit from angioplasty as a kind of therapy if:

• You have tried many drugs and lifestyle modifications, but nothing has helped your heart health.
• Your angina (chest discomfort) is becoming worse.
• Your heart stops beating. A clogged artery can be promptly opened with an angioplasty, minimising cardiac damage.
• Not everyone should get an angioplasty. Your doctor may decide that coronary artery bypass surgery is a better course of treatment for you than angioplasty depending on the severity of your heart disease and your general health.

Having a coronary artery bypass may be necessary if you have any of the following:

• The principal blood vessel in the left
• Your heart's left side is constrained in size.
• Your heart's muscles are frail.
• You have diabetes and several, serious artery blockages.
• A healthy blood vessel from another part of your body is utilized to circumvent the blocked piece of your artery during coronary artery bypass surgery.

Risk Factors

Although bypass surgery is a more intrusive method of opening blocked arteries, angioplasty still has significant hazards.

The most typical angioplasty risks are as follows:

Your artery has to be re-narrowed. There is a slight possibility that the treated artery will recur following angioplasty and drug-eluting stent implantation. The use of bare-metal stents increases the chance of the artery re-narrowing.

Clots of blood. Stents are susceptible to blood clot formation even after the surgery. A heart attack may result from these clots closing the artery. To lessen the possibility of blood clots forming in your stent, it is crucial to take aspirin together with clopidogrel (Plavix), prasugrel (Effient), or another drug precisely as directed. Ask your doctor how long you will need to take these drugs. Never discontinue using these drugs without first seeing your doctor.

Bleeding. Where a catheter was implanted in your leg or arm, there may be bleeding. Most of the time, this just causes a bruise, but occasionally, significant bleeding happens and you may need surgery or a blood transfusion.

The following are uncommon hazards of angioplasty:

Chest pains. Although extremely unlikely, you might get a heart attack while having the surgery.

Arterial damage in the heart. During the surgery, the coronary artery might be ripped or burst. These issues could necessitate urgent bypass surgery.

Kidney issues. For those who already have renal issues, the dye used during angioplasty and stent implantation might harm the kidneys. 

During the operation, your doctor may take precautions to attempt to protect your kidneys, such as minimizing the quantity of contrast dye and making sure you are well-hydrated.

Stroke. If plaques come free while the catheters are being put through the aorta during angioplasty, a stroke might result. Additionally, blood clots can develop in catheters and, should they come free, go to the brain. Stroke is a very uncommon side effect of coronary angioplasty. To lower the danger, blood thinners are given during the surgery.

Irregular heartbeats. The heart might beat too rapidly or too slowly during the process. Although these cardiac rhythm issues are often transient, sometimes medicine or a transient pacemaker are required.

Preparation

Before scheduling the angioplasty, the doctor will do a physical examination and review your medical history.  Before your operation, you might need to undergo a few tests, such as a chest X-ray, an electrocardiogram, and blood work. In order to determine whether the arteries leading to your heart are clogged and whether they can be opened up with angioplasty, your doctor will also do an imaging test known as a coronary angiography.

Your doctor may decide to do angioplasty and stenting while your heart is still catheterised if a blockage is found during your coronary angiography.

You will get preparation-related instructions from your doctor.

• Before having angioplasty, your doctor may advise you to change or stop taking certain medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) or anticoagulants. 
• Tell your doctor about all of your prescription and non-prescription drugs, including herbal supplements.
• Usually, six to eight hours prior to an angiography, you must refrain from eating or drinking.
• On the morning of your procedure, take just tiny sips of water with any permitted drugs.
• Bring all of your medications, including nitroglycerin if you take it, to the hospital.
• Make plans for home transportation. You will not be able to drive yourself home the following day after an angioplasty since it often necessitates an overnight hospital stay.

During the Procedure

• A cardiac catheterization laboratory is a specialised operating room where angioplasties are carried out by a team of nurses and technicians with specialised cardiovascular training.
• An artery in your groin, arm, or wrist is used to do an angioplasty. There is no need for general anaesthesia. You will be given a sedative to help you unwind, but depending on how well you sleep, you could be awake for the process.
• Through an IV catheter in your hand or arm, you will receive fluids, sedatives, and blood-thinning (anticoagulant) drugs.
• Throughout the process, your heart rate, pulse, blood pressure, and oxygen level will be monitored.
• Your doctor will use an antiseptic solution to clean the region in your leg, arm, or wrist before covering it with a sterile sheet.
• A local anaesthetic will be used by your doctor to make the region where a very small incision will be made painless. The next step involves inserting a tiny, thin guidewire into the blood artery.
• Your doctor will insert a tiny tube (catheter) into your artery with the aid of live X-rays.
• Once the catheter is inserted, contrast dye is administered via it. As a result, angiograms, which are X-ray images that show the inside of your blood arteries, can be used by your doctor to determine the blockage.
• At the location of the obstruction, a tiny balloon with or without a stent is inflated to expand the obstructed artery. The balloon is deflated and the catheter is withdrawn once the artery has been stretched.

The following steps happen while inserting a stent:

• The stent is steered through the artery to the obstruction after collapsing around a balloon at the catheter's tip.
• The balloon is inflated near the obstruction, whereupon the spring-like stent expands and snaps into position inside the artery.
• To keep the artery open and increase blood flow to your heart, the stent remains in place forever. To clear a blockage, more than one stent may occasionally be required.
• The balloon catheter is inflated and withdrawn once the stent has been positioned.
• More X-ray pictures are obtained (angiograms) to examine the blood flow via your enlarged artery.
• The majority of stents placed during an angioplasty are coated with drugs. The stent's medicine releases gradually to aid in preventing future plaque formation and blood channel re-narrowing.
• To lessen the possibility of blood clots developing on the stent after the insertion of your stent, your doctor may give aspirin, clopidogrel (Plavix), ticagrelor (Brilinta), or prasugrel (Effient).

After the Procedure

If you underwent a non-emergency operation, you will likely spend the night in the hospital while your heart is watched and your medicines are changed. The week following angioplasty, you should be able to go back to work or your regular schedule.

Drink a lot of water when you get home to assist your body to rid itself of the contrast dye. For at least a day following, refrain from doing any vigorous activity or lifting anything heavy. Inquire with your doctor or nurse about any further activity limitations.

Call the personnel at the hospital or your doctor's office right away if:

• Your catheter's insertion site starts to bleed or bulge.
• You have pain or discomfort where your catheter was placed.
• You exhibit symptoms of infection, such as fever, redness, edoema, or discharge.
• The arm or limb that underwent the treatment has changed in temperature or colour.
• You feel weak or dizzy.
• You have shortness of breath or chest discomfort
• You should carefully adhere to your doctor's instructions for the use of blood-thinning medicines such as aspirin and clopidogrel (Plavix), prasugrel (Effient), or similar drugs.

Most patients who have had angioplasty—with or without the implantation of a stent—will require long-term aspirin use. A blood-thinning medicine, such as clopidogrel, will be required for six months to a year after stent installation. Before discontinuing any of these drugs, speak with your cardiologist if you have any concerns or if you require any other kind of surgery.

Results

Coronary angioplasty significantly improves blood flow via a coronary artery that was previously obstructed or constricted. In general, chest pain should lessen. You might be able to workout better.

Even after angioplasty and stenting, heart disease still exists. You must maintain a healthy lifestyle and take your medications exactly as your doctor has instructed.

Contact your doctor if you have symptoms like chest discomfort or shortness of breath that you did before coronary angioplasty.  Seek emergency medical attention if you have chest discomfort while at rest or pain that does not improve with nitroglycerin.

Immediately following angioplasty, you should:

• Stop smoking.
• Your cholesterol should be reduced.
• Consume a nutritious diet low in saturated fat.
• Keep a healthy weight.
• Manage various additional ailments, including diabetes and high blood pressure
• Exercise often.
• Take drugs as directed by your doctor. If angioplasty is successful, you may avoid coronary artery bypass surgery, which is more intrusive and has a longer recovery period.

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