Angioplasty and stents

Angioplasty opens a heart artery (coronary artery) that is narrow or blocked by fatty deposits. A thin tube called a catheter is passed through an artery in the wrist or groin up to the heart. A balloon on its tip is inflated to widen the artery. A stent, a small mesh tube, is usually left in place to keep it open. It is also called PCI.

Angioplasty is used when narrowed arteries cause angina (chest pain on effort) that medicines do not control. It is also an emergency treatment during a heart attack, to reopen the blocked artery quickly. Some people need only medicines, and some are advised bypass surgery instead, for example when many arteries are narrowed. The heart specialist decides, usually after an angiogram, an X-ray of the heart's arteries.

Angioplasty is often an emergency, with no time to prepare. If it is planned, the team will give you instructions.

A planned angioplasty goes like this:

1. You lie on a table in an X-ray room, connected to monitors. A sedative may be offered.
2. The wrist or groin is numbed. You stay awake and should feel no pain.
3. The catheter is guided to the heart on a live X-ray picture, and dye shows up the arteries.
4. A balloon is inflated at the narrowing, and a stent is usually placed.
5. The tube is removed. After a groin entry you lie flat for some hours.

It usually takes 30 minutes to 2 hours. Tell the staff at once if you feel unwell or have chest pain.

Most people having a planned angioplasty go home the same day or the next. After a heart attack you may stay several days. Bruising and soreness where the tube went in are common. You will take medicines that stop clots forming in the stent, often aspirin and a second medicine, exactly as prescribed, which can mean a year or longer. People are usually told to avoid heavy lifting and driving for at least a week, and longer after a heart attack. Contact your doctor for pain, redness, swelling or worsening bruising at the site, or a fever. Chest pain that does not go away needs emergency care.

Angioplasty is generally safe, but serious problems can happen. Common ones are bleeding, bruising or infection where the tube went in, and a clot in the stent, which is why the medicines matter. Less often there can be an allergic reaction to the dye, kidney damage (more likely if the kidneys are already weak), an irregular heartbeat, damage to an artery or valve, a heart attack or a stroke. The artery can also narrow again inside the stent.

For most people blood flow in the treated artery improves, and chest pain and breathlessness often ease. Angioplasty does not cure the disease behind the narrowing, and arteries can narrow again. Healthy eating, regular activity, not smoking and your medicines lower that risk. Follow-up and cardiac rehabilitation (exercise and support) may be offered. Bypass surgery is the main alternative.