Angioplasty for Heart Attack and Unstable Angina
Angioplasty gets blood flowing back to the heart. It opens a coronary artery that was narrowed or blocked during a heart attack. The coronary artery might be blocked by a blood clot and fat and calcium from a ruptured plaque that caused the heart attack.
Doctors try to do angioplasty as soon as possible after a heart attack. But angioplasty is not available in all hospitals. If a person is at a hospital that does not do angioplasty, he or she might be moved to another hospital where angioplasty can be done.
Angioplasty is also called percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA).
How is angioplasty done?
Angioplasty is done using a thin, soft tube called a catheter. A doctor inserts the catheter into a blood vessel in the groin or wrist. The doctor carefully guides the catheter through blood vessels until it reaches coronary arteries on the heart.
Cardiac catheterization, also called coronary angiogram. Your doctor first uses the catheter to find narrowing or blockages in the coronary arteries. This is done by injecting a dye that contains iodine into the arteries. The dye makes the coronary arteries visible on a digital X-ray screen. This testing is also called a coronary angiogram.
Balloon with or without a stent. If there is a blockage, the catheter is moved to the narrowed part of the artery. A tiny balloon is moved through the catheter and is used to open the artery. The balloon is inflated for a short time. Then it is deflated and removed. The pressure from the inflated balloon makes more room for the blood to flow, because the balloon presses the plaque against the wall of the artery. The doctor can also use the balloon to place a stent in the artery to keep it open.
In some cases, the doctor might remove loose pieces of blood clots from the artery. This is done with a small device that is like a vacuum. The doctor moves the device up through the catheter to the blocked artery and removes the clot pieces. This is a newer procedure that can be used during angioplasty.
See a picture of a balloon angioplasty.
See a picture of stent placement.
View the slideshow on angioplasty to see how an angioplasty is done.
What is a stent?
A stent is a small, expandable tube. It is permanently inserted into the artery during angioplasty. The stent keeps the artery open.
During angioplasty, the balloon is placed inside the stent and inflated, which opens the stent and pushes it into place against the artery wall to keep the narrowed artery open. Because the stent is like woven mesh, the cells lining the blood vessel grow through and around the stent to help secure it. Your doctor may use a bare metal stent or a drug-eluting stent.
Drug-eluting stents. All stents have a risk that scar tissue will form and narrow the artery again. This scar tissue can block blood flow. To help prevent this blockage, drug-eluting stents are coated with drugs that prevent the scar tissue from growing into the artery. Drug-eluting stents may lower the chance that you will need a second procedure (angioplasty or surgery) to open the artery again.
A stent is designed to:
- Press the plaque against the artery walls and open up the artery, thereby improving blood flow.
- Keep the artery open after the balloon is deflated and removed.
- Seal any tears in the artery wall.
- Prevent the artery wall from collapsing or closing off again (restenosis).
- Prevent small pieces of plaque from breaking off, which might cause a heart attack.
What To Expect After Treatment
After angioplasty, you will be moved to a recovery room or to the coronary care unit. Your heart rate, pulse, and blood pressure will be closely watched. You will have a large bandage or a compression device at the catheter insertion site to prevent bleeding.
An angioplasty may take 30 to 90 minutes. But you need time to get ready for it and time to recover. It can take several hours total. The average hospital stay is 1 to 2 days for uncomplicated procedures.
Do not do strenuous exercise and do not lift anything heavy until your doctor says it is okay. This may be for a day or two. You may resume exercise and driving after several days.
After angioplasty, you will take antiplatelet medicines to help prevent another heart attack or a stroke. You will probably take aspirin plus another antiplatelet such as clopidogrel. If you get a drug-eluting stent, you will probably take both of these medicines for at least 1 year. If you get a bare metal stent, you will take both medicines for at least 1 month but maybe up to 1 year. Then you will likely take daily aspirin long-term. If you have a high risk of bleeding, your doctor may shorten the time you take these medicines.
After your procedure, you might attend a cardiac rehabilitation (rehab) program. In cardiac rehab, a team of health professionals provides education and support to help you recover and start new, healthy habits, such as eating right and getting more exercise. To keep your heart healthy and your arteries open, making these changes is just as important as getting treatment. If your doctor hasn't already suggested it, ask if cardiac rehab is right for you.
Why It Is Done
Emergency angioplasty with or without stenting is typically the first choice of treatment for a heart attack.
Although many things are involved, angioplasty might be done if you:1
- Are having a heart attack.
- Have frequent or severe angina that is not responding to medicine and lifestyle changes.
- Have evidence of severely reduced blood flow (ischemia) to an area of heart muscle caused by one or more narrowed coronary arteries.
- Have a narrowed or blocked artery that is likely to be treated successfully with angioplasty.
- Are in good enough health to have the procedure.
Angioplasty may not be a reasonable treatment option when:
- There is no evidence of reduced blood flow to the heart muscle.
- Only small areas of the heart are at risk, and you do not have disabling angina symptoms.
- You are at risk for having complications or dying during angioplasty due to other health problems.
- You cannot take blood thinner medicines, aspirin and another antiplatelet, after getting a stent.
- The affected artery cannot be reached during angioplasty.
How Well It Works
Angioplasty works well to open a blocked artery after a heart attack. How well it works depends on the type of blockage. But angioplasty can open blocked arteries in about 9 out of 10 people.2
Angioplasty relieves angina symptoms (such as chest pain or pressure) and improves blood flow to the heart. If the artery narrows again, another angioplasty or a bypass surgery may be needed. The artery is less likely to narrow again if a stent, especially a drug-eluting stent is used.1
The benefits of angioplasty are much greater if you don't smoke. If you smoke, quit smoking.
Risks of angioplasty include:
- Bleeding at the puncture site.
- Damage to the blood vessel at the puncture site.
- Sudden closure of the coronary artery.
- Small tear in the inner lining of the artery.
- Heart attack.
- Need for additional procedures. Angioplasty may increase the risk of needing urgent bypass surgery. Also, the repaired artery can get narrow again (restenosis) and a repeat angioplasty may need to be done.
- Reclosure of the dilated blood vessel (restenosis).
- Death. The risk of death is higher when more than one artery is involved.
What To Think About
After a heart attack, bypass surgery is sometimes a better option than angioplasty. For example, surgery may be better for people who have many blocked arteries or blockages that cannot be reached during angioplasty.
- Levine GN, et al. (2011). 2011 ACC/AHA/SCAI Guideline for percutaneous coronary intervention: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation, 124(23): e574–e651.
- Hass EE, et al. (2011). ST-segmented elevation myocardial infarction. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1354–1385. New York: McGraw-Hill.
Current as of: March 12, 2014
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