Angioplasty with stents

ANGIOPLASTY is the insertion of a small balloon to open a blocked artery near the heart.

ANGIOPLASTY is the insertion of a small balloon to open a blocked artery near the heart.In Australia, most of these operations now also use a small metal tube called a “stent” that acts as scaffolding to keep the artery open.WHY MIGHT I NEED IT?Angioplasty is used to treat coronary artery disease, which is caused by a build-up of fatty deposits (plaque) inside blood vessels. This plaque blocks the flow of blood from the heart muscle, leading to chest pain or angina.Angioplasty is most commonly used to treat people with a partial blockage in one artery, but it is increasingly being used as an alternative to heart bypass surgery.Some doctors are even using it instead of clot-dissolving drugs in people who have just had a heart attack.HOW IS IT DONE?Before surgery, your doctor will perform a cardiac catheterisation (coronary angiography) to diagnose the extent of coronary artery disease. You will also have a chest X-ray, blood tests and an electrocardiogram (ECG).On the day of surgery, your blood pressure and weight will be checked and the sides of your groin may be shaved. (Most procedures are done via the femural artery in the upper thigh but some are via the arm.)Your doctor will insert an IV drip and give a sedative tablet before you are taken on a stretcher to a cardiac catheter theatre.Here you will be placed on an X-ray table and be connected to a heart monitor, before having your groin cleaned with sterilising agents and receiving a local anesthetic.A tube with a balloon at its tip will be threaded up through an artery to the heart area via your groin or arm. Once it arrives at the spot where your artery has narrowed, it is inflated to expand the blood vessel. This pushes the plaque against the wall of the artery, allowing the blood to flow more easily. A stent, usually made of stainless steel, is then inserted to hold the artery open.Once the blockage has been adequately opened, the catheters and balloon are removed.WHAT ARE THE RISKS?Your artery may be damaged or close completely during this procedure.This can require an emergency heart bypass operation or cause a heart attack. Death occurs in four out of every 1000 patients who experience this complication of surgery.Most patients who undergo angioplasty are aged between 65 to 79 years, which raises their risk of complications, including from the anesthesia.The chance of an artery narrowing again after a stent is inserted is about 9 per cent, compared with about 30 per cent in standard balloon angioplasty.RECOVERYYou will be taken to the coronary care unit where you will be given bed rest with a sheath covering the puncture site. The nurses will check your ECG and you will be placed on a heart monitor. Your pulse, blood pressure, puncture site and limb will be checked regularly.The tube in your groin will be removed once the effects of the blood-thinning drugs given during surgery have worn off.A small dressing will then be put over the incision site.Painkillers will be used to relieve any post-operative pain.You may be discharged the next day if your angina has subsided but some patients remain in hospital for three days.(Source: The Australian, By Louise Pemble, March 29, 2003)