What is Coronary Angiography and Coronary Angioplasty?

A coronary angiography is a procedure where X-ray imaging and a special contrast dye are used to determine how blood flows through the arteries in your heart to detect any narrowing or blockages.

This is done by inserting a catheter through an artery in the groin or wrist leading to the heart and openings of the coronary arteries. The contrast dye is then injected through the catheter, while a live X-ray displays images that help your cardiologist discern the location and severity of the blockages.

A coronary angioplasty is a minimally invasive procedure used to widen coronary arteries that are blocked or narrowed — usually as a result of coronary artery disease — in order to restore normal blood flow to the heart. The procedure is also known as a Percutaneous Coronary Intervention (PCI) and it eliminates the need for open-heart surgery. During a coronary angioplasty, a stent is often inserted into the affected artery to maintain healthy blood flow even after the procedure.

Heart Stents

A heart stent — also known as a coronary stent — is a small, inflatable wire mesh tube that is inserted into a narrowed or blocked artery during a coronary angioplasty. It helps widen the artery so that healthy blood flow to the heart can be restored. Several types of heart stents exist, and your cardiologist will discuss your options with you if a stent placement has been deemed necessary. The 3 main types of heart stents are:

• Drug-eluting stents (DESs)
  A drug-eluting stent is a metal stent that is coated in medicine that works to prevent the formation of scar tissue within the artery after the stent has been inserted. This reduces the risk of restenosis, which is when the recently-widened artery becomes narrow again. However, DESs have sometimes been known to lead to stent thrombosis, where blood clots form inside the stent. This can have dangerous consequences, such as strokes. To reduce the likelihood of developing such complications, patients with DESs will be prescribed a prolonged course of antiplatelets — a type of medicine that prevents blood from clotting.
  
• Bioresorbable vascular scaffolds (BRSs)
  Bioresorbable vascular scaffolds are similar to drug-eluting stents in that they are also coated in drugs that prevent tissue formation. Unlike drug-eluting stents, however, they are made of polymers or metals that the body can slowly absorb over time. As a result, there is a smaller risk of both restenosis and stent thrombosis when BRSs are used during stent placement. The use of antiplatelets will still be needed in the period immediately following the stent replacement until the BRS has been fully absorbed by the body.
  
• Bare metal stents
  As its name suggests, a bare-metal stent is a stainless steel stent that does not have any type of coating. While this is associated with a higher risk of restenosis, bare-metal stents do not call for the prolonged use of antiplatelet therapy. As such, bare-metal stents are most suitable for patients who are at high risk of excessive bleeding or are unable to take antiplatelets for a prolonged period of time due to other health conditions.

Who would need an Angioplasty?

Angioplasties are most often performed in cases of coronary artery disease (CAD), which is a condition where atherosclerosis affects the arteries supplying blood to the heart, known as the coronary arteries. Atherosclerosis is the narrowing or hardening of arteries due to a build-up of fatty cholesterol deposits, or plaque. CAD can sometimes be treated with medication, especially in its early stages. However, in more severe cases, medication alone is not a viable treatment option. In such cases, angioplasties are a necessary intervention because severe CAD leads to reduced blood flow to the heart, which can cause symptoms like angina, or even heart attacks.

In cases of CAD, a cardiologist will first determine the extent and severity of the condition through various blood and diagnostic imaging tests. However, an angioplasty is generally necessary if a patient is experiencing any of the following symptoms:

• Chest pain
• Shortness of breath
• Severely narrowed arteries
• Heart attack

Unfortunately, coronary angioplasties may not be suitable for all cases of CAD. Highly severe or complex instances of CAD — such as the presence of multiple severe artery blockages — are more likely to call for a bypass graft surgery, which is a type of open-heart surgery. In addition, some patients with weak heart muscles might benefit more from a bypass graft surgery than a coronary angioplasty.

Outside of CAD, coronary angioplasties are also performed as emergency treatment after a heart attack, which is a serious medical emergency. A heart attack occurs when blood flow to the heart has been interrupted, resulting in a lack of oxygen in the heart that disrupts its ability to function normally.

What happens during an Angioplasty?

An angioplasty is performed under local anaesthesia and can take between 30 minutes and 2 hours to complete, depending on the complexity of the case. You will most likely stay in the hospital overnight before being discharged the next day.

During a coronary angioplasty, a catheter — which is a long, thin tube tipped with a small balloon — will be inserted into a blood vessel through an incision in either the wrist, arm, or groin. Under X-ray guidance, the catheter is then led to the blocked or narrowed coronary artery. Once in place, the balloon at the end of the catheter will be inflated, flattening any plaque in the artery against the artery wall. This, in effect, widens the coronary artery, restoring healthy blood flow to the heart through the artery.

If stent placement is required, a stent would have been put around the balloon prior to the procedure. It expands along with the balloon and is left in place after the balloon is deflated and the catheter is removed. The stent will help to maintain normal blood flow to the heart for a longer period of time.

Some common side effects of undergoing an angioplasty include bruising and swelling at the site of incision, as well as the formation of blood clots. There are also some risks linked to the use of sedation, local anaesthesia, and the contrast dyes needed for X-ray imaging. Your cardiologist will go through these risks with you extensively prior to the procedure.

In addition, there are some uncommon major risks associated with angioplasty, including:

• Excessive bleeding
• Weakened kidney function
• Ruptured arteries
• Arrhythmia
• Heart attack
• Stroke

These types of complications are very rare. However, the likelihood of developing any of them depends on the severity and complexity of each case, as well as the presence of any underlying medical conditions.

How to prepare for an Angioplasty?

Prior to your procedure, there are some pieces of information that your cardiologist will require in order to minimise any of the possible risks associated with coronary angioplasties. Please provide your cardiologist with the following information to the best of your ability:

• Any drug or other allergies
• Any underlying medical conditions you may have
• A list of medications you are currently taking
• Any surgeries you may have planned or scheduled
• If you are pregnant, nursing, or trying to conceive

In addition, you will most likely have to abstain from food and drink for at least 6 hours before the procedure. If you are taking any regular medications, you may have to skip a dose the day of or even for a few days before your procedure.

What to expect post-procedure?

Immediately after the procedure, you will be returned to your hospital ward, where you will most likely have to stay the night. Barring the development of any complications, you will be discharged the following day. Please be sure to make travel arrangements for your journey home, as you will not be allowed to drive for at least 24 hours after the procedure.

In the week following the procedure, you should avoid heavy lifting and any strenuous activities. Please check in with your cardiologist before returning to your usual routine.

It is important to note that coronary angioplasties are not a cure for CAD. Rather, they simply counter the effects of the disease. To prevent restenosis and maintain a healthy heart, you should take steps to lead a healthier lifestyle. Some suggestions for doing this include:

• Eat a heart-healthy diet
• Exercise regularly
• Reduce stress levels
• Stop smoking, if you are a smoker

Summary

Angioplasties are an effective way to counter the effects of CAD. However, it is still important to make sure that you lead a heart-healthy lifestyle. If you are experiencing any symptoms of CAD, or would like some advice on how to maintain a healthy heart, please do not hesitate to see a cardiologist who will be able to manage your heart condition and provide advice on how to keep your heart as healthy as possible.