What is Coronary Angioplasty?

Coronary angioplasty, also known as percutaneous coronary intervention (PCI), is a non-surgical medical procedure used to open narrowed blood vessels to increase blood flow to the heart. The procedure is frequently employed as a treatment for individuals with coronary artery disease caused by atherosclerosis, a plaque-induced narrowing of the arteries. As with any medical procedure, there are serious risks associated with coronary angioplasty and these should be discussed with a health care professional prior to pursuing this treatment option.

First introduced in the 1970s, coronary angioplasty involves the insertion of a thin balloon catheter into an artery, either in the arm or groin, which advances to the location of the reduction in the coronary artery. Once the catheter reaches the area of the blockage, the balloon is inflated to enlarge the artery. The procedure does not require large incisions or the use of a general anesthetic. Angioplasty is a treatment option pursued to improve symptoms associated with coronary artery disease or to reduce damage to the heart muscle caused by a heart attack. When the treatment is successful, the prognosis for individuals with an unstable, chronic angina is improved, and periodic instances of angina, or chest discomfort, are alleviated.

Prior to performing PCI, the location, size, and type of blockage must be determined by employing a cardiac catheterization, also known as a heart cath. A hollow, flexible tube in inserted into the artery in either the groin or arm, and the catheter is guided to the heart with the assistance of x-ray visualization. An iodine-based contrast material is injected into the artery via the catheter, making the coronary arteries and any blockage visible.

After the size of the artery is determined, a balloon catheter and guide wire of appropriate size are chosen and a blood thinner is administered to prevent blood clotting. The patient is placed under local anesthesia and the balloon catheter is introduced into the artery. As the balloon is inflated, it presses the plaque against the artery walls, opening the passageway. Angioplasty frequently uses a balloon to widen the narrowed artery, but in more serious cases a small, wire-mesh tube, known as a stent, is utilized. Made of bare metal, the stent is placed in the artery during the angioplasty procedure and, when necessary, can be drug-eluting, meaning it releases a drug to prevent restenosis, or reblocking of the artery.

The most serious complication associated with coronary angioplasty is the abrupt closure of the dilated coronary artery following the procedure. A dissection, or tearing, of the inner lining of the artery, or a constriction, or spasm, of the artery at the balloon site can contribute to an abrupt closure of the artery. To prevent thrombosis, also known as blood clotting, aspirin is administered to prevent the blood platelets from forming clots which could also lead to the coronary artery closing abruptly.

Instances of major complications following coronary angioplasty are relatively uncommon. An individual's medical history and current condition should be discussed prior to treatment. In addition to vessel closure, risks associated with PCI include injury of the artery by catheter insertion and allergic reaction when contrast material is employed. In cases when a coronary artery cannot be kept open via a PCI or a stent, emergency open heart coronary artery bypass graft (CABG) surgery is usually conducted.