Coronary Balloon Angioplasty is also known as Percutaneous Coronary Intervention. This is a surgical procedure which is commonly used to open clogged arteries of the heart. Coronary angioplasty involves temporarily inserting & inflating a tiny balloon into the artery at the place where it is clogged in order to help widen the passage. Most often, balloon angioplasty is also combined with permanent placement of small wire mesh tube which is called a stent so as to help prop open the artery & thereby decrease chances of narrowing once again. Some of these stents (drug-eluting stents) are also coated with medications so as to help keep arteries open, while other bare-metal stents do not. Balloon angioplasty can effectively improve symptoms of blocked arteries like chest pain & shortness of breath. Balloon angioplasty can also be ideally used during heart attacks for quickly opening a blocked artery & reducing amount of damage it can cause to the heart.
Balloon angioplasty is most commonly used to treat a type of heart disease which is known as atherosclerosis. Atherosclerosis is caused due to slow buildup of fatty plaques within the blood vessels of the heart. Doctors may therefore suggest balloon angioplasty as an ideal treatment option when lifestyle changes or medications have not been able to improve heart health, worsening of chest pain (angina), in case of heart attack or various other coronary symptoms.
However, balloon angioplasty is not for everyone. Coronary Artery Bypass Surgery or CABG may be a better option in case the main artery which brings blood to left side of the heart is narrow, the patient is having multiple diseased blood vessels or in cases where the heart muscle itself is weak. CABG is more suitable in such cases because the blocked part of the coronary artery is eventually bypassed by using another blood vessel from a different part of the patient’s body. Moreover, doctors may invariably suggest coronary artery bypass surgery in case the patient is having diabetes & multiple blockages. However, decision of CABG or balloon angioplasty will extensively depend upon the extent of heart disease & overall medical condition of the heart patient.
Although balloon angioplasty is a less invasive procedure designed to open clogged arteries than CABG, it still carries some amount of risks. Most common risks of balloon angioplasty include the following.
Other types of rare risks of balloon angioplasty include the following.
Doctors will invariably review the patient’s medical history & conduct a physical examination before a scheduled balloon angioplasty procedure. They will also perform an imaging test which is called a coronary angiogram in order to see if blockages can be effectively treated with balloon angioplasty. Coronary angiograms also help doctors determine if arteries to heart are narrowed or blocked. Liquid dye is also injected into arteries of heart through a catheter. Catheters are long & thin tubes which are fed through an artery from the wrist, arm or groin & which travel to arteries in the heart. As dyes fill arteries, they become visible on video & X-ray so that doctors can see where the arteries are blocked. In case doctors find a blockage during coronary angiogram, it is possible that they decide to perform balloon angioplasty & stent procedures immediate following the coronary angiogram while the heart is still catheterized. Balloon angioplasty patients will also receive instructions about drinking & eating instructions prior to undergoing the procedure. Typically, they will have to stop drinking & eating about 6 – 8 hours prior to the scheduled time of balloon angioplasty procedure. However, preparations may differ in case the patient is already staying at the hospital facility before commencement of the procedure.
Whether balloon angioplasty is pre-scheduled or performed as an emergency procedure, patients will most likely have to undergo some routine tests before surgery, including electrocardiogram, a chest X-ray & blood tests. Balloon angioplasty patients should also take the following instructions into account on the night before the procedure.
Patient’s body does not require to be cut open during balloon angioplasty procedure, except for a very small incision in skin over a blood vessel located in the wrist, arm or leg through which a small & thin tube (catheter) is threaded as prelude to performing the procedure. Balloon angioplasty procedure can take anywhere between 30 minutes to several hours depending upon the difficulty & number of blockages which need to be removed & whether any complications arise during the operation. Balloon angioplasty is normally performed by heart specialists (cardiologist) along with a team of specialized cardiovascular technicians & nurses in special operating rooms called cardiac catheterization laboratory or cath lab.
Balloon angioplasty operation is commonly executed through the femoral artery which is located in the groin region. Less commonly balloon angioplasty is also performed by using an artery located in the wrist or arm area. This area is prepared with an antiseptic solution & a sterile sheet is placed over the patient’s body. Local anesthetic is subsequently injected so as to numb the area where catheter is to be inserted. Small electrode pads are then placed on the patient’s chest in order to monitor the heart during operation. General anesthesia is not required for balloon angioplasty procedure. Patients will however receive fluids & medications to relax & anticoagulants through an IV catheter.
Most people undergoing balloon angioplasty also undergo stent placement within their blocked arteries which have just been opened. Stents are usually inserted in arteries once they are widened by the inflated balloon. Stents are meant to support walls of arteries so as to help prevent them from re-narrowing after balloon angioplasty procedure. Stents basically look like tiny coils of wire mesh.
Balloon angioplasty patients may need prolonged treatment with medications after stent placement. These medications include clopidogrel (Plavix) or aspirin in order to reduce chances of blood clot formations on the stent.
Balloon angioplasty patients will most probably remain hospitalized for one day while their hearts will be closely monitored & medications adjusted. They should however be able to return to work or to normal routine within a week following balloon angioplasty procedure. However, when these patients return home for recovery, they should drink plenty of fluids which will help flush their bodies of contrast dye that was injected during the procedure. They should also avoid strenuous exercise & lifting of heavy objects for several days following the procedure. It would therefore be sensible of them to check with the nurse or surgeon about any other restrictions in their activities.
Calling the surgeon immediately is recommended in the following circumstances.
It is very important that balloon angioplasty patients closely follow surgeon’s recommendations concerning treatment with blood-thinning medications like clopidogrel, aspirin or other similar medications. As it is, most people who have undergone balloon angioplasty with or without stent placement are most likely to need aspirin for life. However, those patients who have also undergone stent placement will additionally need other blood-thinning medications like clopidogrel for a year or longer in some cases. Patients who are having any questions or are in need of non-cardiac surgery must essentially talk to their cardiologists before stopping any of these blood-thinning medications.
Coronary balloon angioplasty greatly increases flow of blood through previously narrowed or blocked coronary arteries. Chest pain would also decrease following this procedure & patients may also be better able to exercise. Undergoing balloon angioplasty & stent placement does not mean that heart disease will go away. Patients will however need to continue with healthy lifestyle habits & take prescribed medications as instructed by cardiologists. In case symptoms like chest pain or shortness of breath return or if some other symptoms which are similar to those which patients have had before undergoing balloon angioplasty occur, they must immediately consult the doctor. In case patients have chest pain during rest or pain which does not respond to nitroglycerin, they must essentially seek emergency medical care.
Successful balloon angioplasty effectively means that patients will not have to undergo another surgical intervention called coronary artery bypass surgery. An artery or vein is removed from another part of the body in CABG & sewn to the surface of the heart so as to take over for the blocked coronary artery. CABG however requires an incision in chest & recovery from this procedure is usually much longer & more uncomfortable. Nevertheless, doctors may recommend CABG surgery instead of balloon angioplasty & stent placement for some patients who are having many blockages or narrowing of main artery leading to heart, reduction in heart function and/or diabetes. Additionally, some coronary blockages are better treated with coronary bypass surgery.
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