Angioplasty & Atherectomy

Q: What happens during angioplasty?

A: First, a cardiac catheterization is performed. You will receive medication for relaxation, and then the doctor will numb the site with local anesthesia.

Next, a sheath (a thin plastic tube) is inserted into an artery — usually in your groin, but sometimes in the arm. A long, narrow, hollow tube, called a catheter, is passed through the sheath and guided up the blood vessel to the arteries surrounding the heart.

A small amount of contrast material is injected through the catheter and is photographed as it moves through the heart’s chambers, valves, and major vessels. From the digital pictures of the contrast material, the doctors can tell whether the heart valves are working correctly.

Once the catheter engages the artery with the blockage, the doctor will perform one of the interventional procedures described below.

The procedure usually lasts about 1 to 2 hours, but the preparation and recovery time add several hours. You may stay in the hospital overnight to be observed by the medical staff.

Q: What types of interventional procedures are used in angioplasty?

A: There are several types of interventional procedures which your doctor may use when performing angioplasty. They include:

  • Balloon angioplasty. During this procedure, a specially designed catheter with a small balloon tip is guided to the point of narrowing in the artery. Once in place, the balloon is inflated to compress the fatty matter into the artery wall and stretch the artery open to increase blood flow to the heart.
  • Stent. A stent is a small metal mesh tube that acts as a scaffold to provide support inside your coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed coronary artery. Once in place, the balloon tip is inflated, and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed while the stent stays in place permanently. Over a several-week period, your artery heals around the stent. Stents are commonly placed during interventional procedures such as angioplasty to help keep the coronary artery open. Some stents contain medicine and are designed to reduce the risk of reblockage (restenosis). The interventional doctor will determine if this type of stent is appropriate for your type of blockage.
  • Rotoblation. A special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of narrowing in your coronary artery. The tip spins around at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed safely away in your blood stream and filtered out by your liver and spleen. This process is repeated as needed to allow for better blood flow. This procedure is rarely used today because balloon angioplasty and stenting have much better results and are technically easier for the cardiologist to perform.
  • Atherectomy. The catheter used in this procedure has a hollow cylinder on the tip with an open window on one side and a balloon on the other. When the catheter is inserted into the narrowed artery, the balloon is inflated, pushing the window against the fatty matter. A blade (cutter) within the cylinder rotates and shaves off any fat that protruded into the window. The shavings are caught in a chamber within the catheter and removed. This process is repeated as needed to allow for better blood flow. Like rotoblation, this procedure is rarely used today.
  • Cutting Balloon. The cutting ballon catheter has a special balloon tip with small blades. When the balloon is inflated, the blades are activated. The small blades score the plaque, then the balloon compresses the fatty matter into the artery wall.

Q: What can I expect before the procedure?

A: Most people will need to have a routine chest X-ray, blood test, electrocardiogram and urinalysis before the procedure. These tests may require separate appointments and are usually scheduled the day before the procedure.

You will not be able to eat or drink after midnight the evening before the procedure.

If you normally wear dentures or a hearing assistive device, plan to wear them during the procedure to help with communication. If you wear glasses, bring them also.

Please tell your doctor or nurse if you are taking Coumadin (warfarin), diuretics (water pills) or insulin. Also let them know if you are allergic to anything, especially iodine, shellfish, X-ray dye, latex or rubber products (such as rubber gloves or balloons) or penicillin-type medications.

You will need to take aspirin before the procedure. Please tell your doctor or nurse if you did not take aspirin.

You will remain awake during the procedure, but you are given medication to help you relax.

Q: What happens after the procedure?

A: You will have to lay flat (without bending your legs) while the groin sheath is in place. A sheet may be placed across your leg with the sheath to remind you to keep it straight.

After the groin sheath is removed, you must lay flat for about six hours to prevent bleeding, but your nurse can raise your head (about two pillows high) after two hours. Your nurse will tell you when you can get out of bed with assistance six to eight hours after the groin sheath is removed (or sooner if a collagen “plug” was placed in your artery).

You should not eat or drink anything except clear liquids until the groin sheath is removed because nausea can occur during this time. Once you are allowed to eat, you will be advised to follow a low-cholesterol and low-sodium diet. You may be admitted to the hospital overnight for observation after the procedure.

Notify your doctor or nurse immediately if you have a fever or experience chest pain, swelling or pain in your groin or leg. If you have bleeding from your groin site after you return home, and lie down immediately. Remove the dressing and push down on your pulse in the affected area.

If a stent was placed during the angioplasty procedure, you will need to take platelet-blocking medications to reduce the possibility of a blood clot forming near the newly implanted stent.

When you have recovered sufficiently from the procedure and have talked with your doctor about your follow-up care, you will be able to go home.

You will need to take it easy for a few days after the procedure. You may climb stairs, but use a slower pace. Do not strain during bowel movements.

Gradually increase your activities until you reach your normal activity level by the end of the week.

Q: Can this procedure cure coronary artery disease?

A: While the procedures performed during coronary angioplasty will open a blocked artery, they will not cure coronary artery disease. Lifestyle factors that can worsen coronary artery disease, such as smoking and diet, will still need to be modified. An exercise program will also be prescribed to improve your cardiac health.