Coronary angioplasty and stent insertion
What happens before the procedure?Before the procedure is performed, your cardiologist will do a thorough physical assessment. A cardiac catheterization and coronary angiogram will be conducted in order to check that the procedure is a viable option. During this assessment, your cardiologist will insert a catheter into a blood vessel in your groin or arm, which will be guided to the heart. X-rays will show images of the heart, so that your cardiologist can examine your arteries. Besides a cardiac catheterization and coronary angiography, blood tests and a health check may be required. After a full assessment, and once you have been approved for surgery, you will be advised to not eat or drink for four to six hours before the procedure. Your doctor will also let you know about any medications you should not take at this time.
What happens during the procedure?
The procedure will take place in a catheterization laboratory, which is equipped with X-ray apparatus. This equipment allows your cardiologist to monitor the procedure throughout the process.
The angioplasty procedure takes place as follows:
- You will be connected to a heart monitor and an IV line.
- Your skin will be anaesthetized.
- Your cardiologist will make an incision over an artery (either in your groin, wrist or arm). The incision will be kept open by a small tube or sheath throughout the procedure.
- A catheter is inserted through the artery and into the opening of either your left or right coronary artery.
- Your cardiologist will insert a wire into the catheter.
- A small balloon will then be positioned over the wire and inflated. This helps to widen the walls of the artery. If a stent is inserted, it will already be fitted with a balloon. It is normal to feel some discomfort or pain when the balloon is inflated.
- After the procedure your cardiologist will place some contrast dye into the artery to check that it is wide enough to allow blood to flow easily.
- All of the equipment (balloon, wire, catheter and sheath) will be removed.
- Your doctor will ensure that bleeding is stopped by either applying firm pressure or inserting a dissolvable plug.
What is a stent?A heart stent is a tube that helps to keep the artery open. There are two types of stent. These are:
- Bare metal (uncoated) stent An uncoated stent does not contain any medication. In some cases, the arteries narrow again after the use of an uncoated stent. This occurs when the immune system identifies the stent as a foreign body and attacks it. This can lead to swelling and tissue growth around the stent.
- Drug-eluting stent This kind of stent is covered in medicine, which helps to decrease the risk of a blocked artery. Medication is released into the areas most likely to block. The medicine hinders tissue growth around the stent. Drug-eluting stents are used in most stent procedures, but they can delay the healing process. If your doctor uses a drug-eluting stent, it is important to take blood-thinning medication after the procedure to reduce the risk of blood clotting and heart attack.
What happens after the procedure?
It is likely that you may be required to spend the night in hospital after your procedure, although your doctor may allow you to go home on the same day, depending on your condition. You will be advised to not drive for up to a week. If you have had a stent inserted, your doctor will advise you to take aspirin everyday for the rest of your life and a medicine such as clopidogrel, prasugrel or ticagrelor for up to a year after the procedure.