What Is an Angioplasty? A Step-by-Step Explanation

Angioplasty is a common, minimally invasive procedure used to treat narrowed or blocked blood vessels in the heart, typically due to coronary artery disease (CAD). Also known as percutaneous coronary intervention (PCI), angioplasty is often used to improve blood flow to the heart muscle and can alleviate symptoms such as chest pain (angina) or shortness of breath. For many, it reduces the risk of a heart attack and can restore a more active lifestyle.

Here’s a step-by-step explanation of what angioplasty involves:

Step 1: Preparation and Assessment

Before the procedure, several assessments ensure angioplasty is the right treatment. Preparations include:

Imaging Tests: These tests, such as coronary angiography (an X-ray of the heart’s blood vessels), help determine the location and severity of artery blockages.

Physical Prep: Patients typically avoid eating and drinking a few hours before the procedure. Necessary medications may also be adjusted as advised by the doctor.

Step 2: Insertion of the Catheter

Angioplasty begins with the insertion of a thin, flexible tube called a catheter:

Local Anesthetic: A local anesthetic is applied to numb the insertion site, usually in the wrist or groin.

Catheter Insertion: The doctor makes a small puncture and inserts the catheter into the artery, guiding it through the blood vessels up to the blockage in the coronary artery.

Dye Injection: A contrast dye is injected through the catheter to help visualize the blockage using X-ray imaging (fluoroscopy). This shows the exact location and severity of the narrowing.

Step 3: Balloon Inflation

Once the catheter is in place, the next step is to open the narrowed artery:

Balloon Catheter Placement: Another catheter, with a small balloon on its tip, is guided to the blocked section of the artery.

Balloon Inflation: The balloon is inflated at the site of the blockage. This process pushes the plaque (a buildup of fat, cholesterol, and other substances) against the artery walls, widening the artery to improve blood flow.

Balloon Deflation and Removal: After a few seconds, the balloon is deflated and may be inflated again a few times as needed. Once the artery is sufficiently widened, the balloon catheter is removed.

Step 4: Stent Placement (if needed)

In many cases, a stent—a small, mesh-like tube—is used to keep the artery open after the angioplasty:

Stent Delivery: The stent is often placed around the balloon on the catheter. When the balloon inflates, the stent expands against the artery walls, acting as a scaffold.

Stent Placement: Once in position, the balloon is deflated and removed, leaving the stent in place. The stent remains in the artery permanently to keep it open and reduce the risk of future narrowing or blockages.

Types of Stents: Drug-eluting stents (DES), which release medication over time to prevent scar tissue formation, are commonly used to help prevent re-narrowing. Some patients may receive bare-metal stents, which do not release medication.

Step 5: Completion and Recovery

Once the angioplasty is complete, the doctor will remove the catheter and close the puncture site.

Bandaging and Observation: A bandage or a pressure device is applied to the insertion site to stop bleeding. Patients are monitored for a few hours in a recovery room.

Medication and Monitoring: Post-procedure medications, including blood thinners like aspirin, help prevent clot formation around the stent.

Recovery and Rest: Most people are encouraged to rest and avoid heavy activities for a few days after the procedure. Recovery time can vary, but many patients return to their regular routines within a week.

Benefits and Risks of Angioplasty

Benefits:

Improved Blood Flow: Angioplasty restores blood flow, reducing symptoms of chest pain and shortness of breath.

Reduced Risk of Heart Attack: By addressing blockages, angioplasty can lower the chance of a heart attack in the future.

Quick Recovery: As a minimally invasive procedure, it generally involves less recovery time than open-heart surgery.

Risks:

Bleeding or Blood Clots: The insertion site can bleed, and clots can form within the stent if blood thinners are not properly managed.

Restenosis: In some cases, arteries may narrow again, particularly if a stent is not used.

Heart Attack or Stroke: While rare, there is a risk of heart attack, stroke, or vessel damage during the procedure.

Follow-Up Care and Lifestyle Adjustments

After angioplasty, lifestyle changes and medical management are essential to maintain heart health. Regular exercise, a balanced diet, medication adherence, and routine check-ups with a cardiologist can all contribute to long-term success.