Royal Sussex County Hospital. Princes Royal Hospital. Hove Polyclinic. Sussex Universities

Coronary Balloon Angioplasty or PCI and PTCI

What is balloon angioplastyAngioplasty-scheme
A procedure in which a catheter equipped with a tiny balloon at the tip is inserted into an artery that has been narrowed by the accumulation of fatty deposits. The balloon is then inflated to clear the blockage and widen the artery. This treatment helps improve the blood supply to your heart muscle by widening narrowed coronary arteries and inserting a small tube called a stent. Angioplasty can help to relieve angina symptoms and is also used as an emergency treatment for people who've had a heart attack.

Prior to performing PTCA, the location and type of blockage plus the shape andsize the coronary arteries have to be defined. This helps your cardiologist decide whether it is appropriate to proceed with angioplasty or to consider other treatment options such as stenting, balloon angioplasty is the technique of mechanically widening a narrowed or obstructed 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crushes the fatty deposits, so opening up the blood vessel to improved flow, and the balloon is then collapsed and withdrawn.
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What happens during an angioplasty?
An angioplasty normally takes between 30 minutes and two hours, but may take longer.

  • You will be given a local anaesthetic at the beginning of the procedure to numb the area in either your groin or your arm. Then a catheter (a thin flexable tube) with a small inflatable balloon at its tip is passed into an artery.
  • Once the cathere is in position some contrast (dye) is then injected into the catheter which shows up the arteries on an x-ray screen. It's normal to feel a hot flushing sensation when the dye is injected.
  • The doctor then directs the catheter up to the heart and into a coronary artery until its tip reaches a narrow or blocked section.
  • The balloon is then gently inflated so that it squeezes the fatty deposits against the wall of the artery, widening the artery which allows the blood to flow more easily.
  • As the balloon is inflates, a stent - a small tube of stainless steel mesh - which is sitting on the end of the balloon expands, this keeps the narrowed artery open.
  • The balloon is then deflated and take out and the stent is left in place.

After the procedure
Sometimes there might be a small amount of bleeding in the are of the groin or arm. To stop the bleeding a nurse will press on the area for a few minutes or put in a plug called an angioseal to stop any bleeding.
You will then be taken to the ward where you will be monitored until you go home.
Tell the nurse on the ward if you experience any chest pain or bleeding.
Before you leave hospital, you will be given advice by the staff on what you can and can’t do. Before you leave hospital, you should be given advice on:

  • any medication you need to take (see below)
  • improving your diet and lifestyle
  • wound care and hygiene advice during your recovery

Leaving hospital after an angioplasty
Most people are able to leave hospital and go home the same day or the next day. If there have been any complications you mey need to stay overnight.
Regularly check the area where the catheter was inserted when you get home. There usually is some bruising and tenderness, but if you get any redness or swelling, or if the bruising worsens, contact your doctor. It is common to feel lethargic but that is normal and you should feel better in a few days.
You should also be invited to go on a cardiac rehabilitation programme, a course of exercise and information sessions that help you to recover as quickly as possible. A member of the cardiac rehabilitation team will visit you in hospital and provide detailed information about:

  • your state of health
  • the type of treatment you received
  • what medications you'll need when you leave hospital
  • what specific risk factors are thought to have contributed to needing the operation
  • what lifestyle changes you can make to address those risk factors

Do's and Dont's
In most cases, you'll be advised to avoid heavy lifting and strenuous activities for about a week, or until the wound has healed.

Driving: You shouldn't drive a car for a week after having a coronary angioplasty. If you drive a heavy vehicle for a living, such as a lorry or a bus, you must inform the DVLA that you've had a coronary angioplasty. They'll arrange further testing before you can return to work. You should be able to drive again as long as you meet the requirements of an exercise/function test and you don't have another disqualifying health condition.
GOV.UK has more information on coronary angioplasty anddriving.

Work: If you had a planned (non-emergency) coronary angioplasty, you should be able to return to work after a week. However, if you've had an emergency angioplasty following a heart attack, it may be several weeks or months before you recover fully and are able to return to work.

Sex:If your sex life was previously affected by angina, you may be able to have a more active sex life as soon as you feel ready after a coronary angioplasty.
If you have any concerns, speak to your GP. According to experts, having sex is the equivalent of climbing a couple of flights of stairs in terms of the strain it puts on your heart.

What should I do if I get chest pain after I get home?
If you get chest pain, stop and rest and take your GTN as prescribed. If the pain doesn't ease, call 999 immediately. You could be having a heart attack.

How successful is coronary angioplasty?
In most cases the blood flow through the artery is improved. Many people find that their symptoms get better and they’re able to do more.
Sometimes the artery can become narrowed again, causing angina to return. But advances in stent technology mean that the risk of this happening is getting lower. Many people are now symptom-free for a long time.
A small number of people have complications. The risk varies depending on your overall health and your individual heart condition. Have a chat with your doctor about the benefits and possible risks of having an angioplasty and any concerns you may have.