Coronary angioplasty, also called percutaneous coronary intervention, is a procedure used to open clogged heart arteries. Angioplasty involves temporarily inserting and inflating a tiny balloon where your artery is clogged to help widen the artery. It is often combined with the permanent placement of a small wire mesh tube called a stent to help keep the artery open and decrease its chance of narrowing again. Some stents are coated with medication to help keep your artery open (drug-eluting stents), while others are not (bare-metal stents).
Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath and can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to the heart. Learn more.
This is a procedure that uses X-ray imaging to view your heart’s blood vessels to find out if there is a restriction to the blood flow to the heart. During the procedure, a dye that is visible in an X-ray is injected into your artery to allow the vessels in the heart to become visible on X-ray.
LEFT MAIN STENTING
The left main is the main artery that gives rise to two main branches of the heart artery. If the left main is blocked, about 2/3 of the heart muscle will lose its blood supply. The conventional treatment is bypass surgery, although angioplasty is an alternative treatment option if a bypass is not possible.
IVUS or intravascular ultrasound is a miniaturised ultrasound probe that can be placed into the heart arteries. This can help your cardiologist determine the severity of narrowing and the amount of cholesterol deposits within the wall of the artery. The results from an IVUS can give very specific information on the diameter and size of the artery, and can also be used to see if a stent is well placed and expanded within the artery. A well-placed and appropriately sized stent reduces the longer-term problems of renarrowing and clots.
Some artery narrowings have large deposits of calcium. In such cases, a device known as a rotablator may be required. This miniature “drill” is slowly advanced through the narrowing. Its metal tip coated with small diamond chips rotates at 160,000 rpm and reduces the calcium deposits to powder. Once the calcium is removed, stenting can be successfully carried out.
ACUTE OR EMERGENCY ANGIOPLASTY
Acute angioplasty is performed to reduce damage to the heart muscle following a heart attack caused when a clot chokes up a pre-existing narrowing resulting in no blood flow to the heart muscle. It is the ideal treatment as it is able to restore blood flow in more than 90% of cases and can be done in a timely fashion. Factors such as age and the size of the heart attack can influence the risk during this procedure.
This is a wire the thickness of a hair that features a miniature pressure probe at its tip. It can help determine if the narrowing in an artery is compromising blood flow. It is placed before the narrowing in the artery and the pressure at this point is compared to a point in the artery beyond the narrowing to assess the pressure drop caused by the narrowing. If the pressure drop is greater than 20%, your cardiologist will recommend an angioplasty.
SAPHENOUS VEIN GRAFT
In bypass surgery, veins are often taken from the leg to be used as new pipes to supply blood to the heart muscle. These veins can become narrowed or blocked after initial successful surgery and, unlike the heart arteries, they degenerate over time and soft cheese-like material can accumulate in the walls of the veins. If angioplasty were performed, there is a high risk that these soft materials would dislodge into smaller particles and flow downstream to the smaller arteries in the heart muscles, causing a total blockage. Special techniques are needed to prevent this downstream flow of debris and ensure a successful result. These include the use of filters and balloons to catch the debris during angioplasty and to remove them from the body so that they can do no harm.
CHRONIC TOTAL OCCLUSIONS
Chronic total occlusions (CTOs) are narrowings that are totally occluded and have been present for some time. They are different from the total occlusions that occur in the acute setting of a heart attack. The blockages in the CTOs are sometimes very resistant to penetration and dilation, and the success rate of treatment can vary between 50-90%. Predictors of success include the age of the CTO, the amount of calcium deposits in the artery, the length of the total blockage and position of the blockage. A CTO can take many hours to successfully unblock. Occasionally, a special X-ray called a CT angiogram done before angioplasty can help in developing a strategy to successfully overcome a CTO.