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Angiogram, Angioplasty & Stents

Angiograms and angioplasties have become common events among the public at large. There are always a lot of misconceptions and confusions regarding the terminology as well as the procedures themselves.

Coronary Angiogram

Coronary Angiogram is a diagnostic procedure performed to identify any narrowing or block in the arteries that supply blood to the heart. Coronary Angiogram is done by injecting a specific kind of dye to the blood vessels, the dye is observable by taking a continuous X-ray video. The images from X-ray are analysed to identify blockage or narrowing present in blood vessels carrying blood to the heart.

Your doctor may prescribe a Coronary Angiogram if you experience following conditions

  • Radiating pain in your chest, jaw, neck or arms
  • Abnormal results seen in a heart stress test, ECG
  • Problems related to blood vessel
  • Injury to your chest
  • Problems with valves of your heart which may require surgical intervention

A Coronary Angiogram is a relatively safe procedure, but it has some complications such as:

  • Stroke and cardiac arrest
  • Damage to the catheterized blood vessel
  • Cardiac arrhythmias
  • Adverse reactions to the dye used for angiogram
  • Kidney impairment
  • Bleeding and Infection

General guidelines for patients preparing for Coronary angiogram

The patient is advised to avoid food and water intake after a specific time depending on the timing of the angiogram.

Do confirm with the doctor about the routine morning medication.

Certain blood investigations are required to be done to identify any problems in the clotting of the blood, kidney function, haemoglobin status, and the presence of any past/present viral infections.

Intravenous access is taken and IV fluids are started before the procedure usually.

Before the coronary angiogram, the patient is recommended to empty the bladder and remove wearables, contact lenses, spectacles, jewellery etc.

About the procedure

The procedure may take anywhere from 15 minutes to one hour or more, depending on other combined cardiac catheterization procedures. The patient is asked to lie on her/his back on an X-ray table. After cleaning and draping, local anesthetic is infiltrated under the skin at the site of the puncture. Radial angiograms involve a puncture of the radial artery at the wrist while a femoral angiogram involves a puncture below the left or right groin, high on the thigh. A sheath is inserted into the artery of choice and the catheter(s) are threaded over a wire to reach the beginning of the aorta where the coronary arteries arise. Each artery is engaged selectively and dye injected under fluoroscopic video recording. The X-ray images taken at the Cath lab is analysed by the specialist doctor for any blockage or narrowing of blood vessels. Upon removing the catheter, the puncture site is closed by manual pressure, a clamp or a small plug.

The images are discussed with the patient and/or relatives, so that a decision on further management of the problem can be taken. This might be continuation of medical management, coronary angioplasty or coronary artery bypass surgery for significant blockages as seen on the angiogram (depending on the number, nature, severity, location and significance of the blockages in addition to patient related factors).

After a radial Coronary Angiogram, the patient can rest a while and can walk, if required. He is observed for a period of time and can then be discharged with specific advice on further follow up.

After the femoral angiogram, the patient is required to lie flat for at least 4 hours to avoid any local bleeding. The patient might need to spend the night in the hospital under observation and get discharged the next day.

It is recommended to increase the fluid intake as it helps to remove the dye used during coronary angiogram.

Coronary Angioplasty

Coronary angioplasty involves dilating a balloon at the site of the blockage to enlarge the passage for blood flow in the coronary arteries. Most of the time, a stent will need to be implanted as a scaffold to keep the artery open. A drug eluting stent will deliver a drug locally to the vessel wall to prevent the blockage from coming back (restenosis). Primary angioplasty is done at the time of an acute heart attack as a life-saving procedure to open an artery blocked with blood clots.

Your doctor may suggest Coronary Angioplasty if you have

  • Significant Blockage or narrowing of the coronary artery due to fatty plaque deposition when medication and lifestyle changes do not improve angina
  • Severe chest pain and acute heart attack

Complex Coronary angioplasty may be required

  • When the blockages are extremely severe,
  • where the vessels are tortuous,
  • where there are blockages at the branching points or of the Left Main artery
  • Where there are chronic total occlusions
  • Where there is reduced pumping of the heart
  • When there are other major co-existing diseases
  • When the patient is frail/elderly/malnourished
  • When coronary artery bypass surgery is not feasible due to major diseases of the lungs, liver, kidney, brain, etc, Or, if the patient is unwilling for a surgical procedure.

Risks Associated with Coronary Angioplasty

Coronary angioplasty is less risky compared to coronary artery bypass surgery, However, some complications are:

  • Formation of blood clots after the procedure
  • Bleeding at the catheter insertion site.
  • Rare chance of heart attack.
  • Damage to the coronary artery
  • Kidney impairment due to the dye used for coronary angioplasty
  • Stroke
  • Cardiac arrhythmias

General guidelines for patients preparing for Coronary angioplasty

  • Do NOT stop essential cardiac medicines, antihypertensives, medicines for blood sugar, etc
  • Avoid food and water intake before 3-4 hours of coronary angioplasty
  • Be prepared for an overnight hospital stay; try to arrange transportation as you are not advised to drive on the following day of the procedure.

About the procedure

Coronary Angioplasty is performed under local anesthesia usually. Sedation is not usually required. It is commonly done from a radial artery approach (wrist) or from a femoral artery approach (groin). A catheter is threaded over a wire till the concerned coronary artery is reached and selectively engaged. Dye injections are made under fluoroscopy to delineate the blockages. The blockage is crossed with a wire. A balloon is tracked over the wire and inflated at the site of the blockage. A stent (wire mesh, often coated with a drug) is then implanted at the site and fixed with balloon inflation. Further balloon dilatations may be needed to ensure that the correct expansion of the stent is reached and the blockage is totally relieved. After confirmation of good flows, the wires and catheters are removed. The sheath is removed when it can be safely done without excessive bleeding.

The average angioplasty can get over in less than an hour, but complex procedures can last 4-6 hours.

After the procedure

Be prepared for an overnight hospital stay.

The expert cardiac team at Aster Medcity, Kochi will closely monitor your vital signs as well as heart’s functioning. Cardiac drugs are optimized and the patient is made to walk. Diet and exercise advice are given at the time of discharge, along with a detailed summary listing the procedure, and the drugs that need to be continued.

You will be able to return to normal life within one or two weeks. It is recommended to increase the fluid intake as it helps to remove the dye used during coronary angioplasty. Patients are also advised to avoid heavy exercise and lifting of hefty objects.

Frequently Asked Questions

What is Angiogram?

Angiogram is a diagnostic procedure performed to identify any narrowing or block in the blood vessels.

What is Angioplasty?

Angioplasty is a minimally invasive procedure used to treat blockages / narrowing of blood vessels.

What is a stent in Angioplasty?

Stent is a small, metal mesh tube placed in blood vessels during angioplasty to act as a scaffold and to reduce the chances of developing blocks in the future.

Why do I need Angiogram & Angioplasty?

An angiogram & angioplasty is suggested to a patient if you experience,

  • Radiating pain in your chest, jaw, neck or arms
  • Abnormal results of a of heart stress test, ECG
  • Problems related to blood vessel
  • Injury to your chest
  • Problems with valves of your heart which may require surgical intervention.

How Angioplasty is performed?

A small balloon catheter is inflated at the site of the blockage in the coronary artery to remove the block and improve the blood flow to the heart.

Does Angioplasty hurt?

There is no significant pain except for the discomfort at the time of the needle puncturing the artery and again, at the time of removal of the sheath when pressure has to be applied at the site of puncture to prevent bleeding.

How long does it take to complete Angioplasty procedure?

The whole process could take 1-4 hours depending on the number of blocks and potential complication.

How long do you stay in hospital after Angioplasty?

Be prepared for 2 days’ hospital stay, try to arrange transportation as you are not advised to drive on the following day of the procedure.

How long does it take to recover from Angioplasty?

You will be able to return to normal life within one/two weeks, depending on the recovery.

How is life after Angioplasty?

Do follow a healthy diet and lifestyle to reduce the risk of developing block in your arteries again. It is recommended to start less intensive exercise such as walking on plain ground. Patient can gradually increase the intensity of the exercise. Regular drugs are needed lifelong including blood thinning antiplatelet drugs to prevent reblockage and blood clotting within the stents.

How long will a heart stent last?

In most of the patients the stents will stay open forever, only 4-9% patients may have chance of narrowing occurring again.

It should be remembered that angioplasty/surgery, stents, etc tackle the existing blocks. Only some of the primary risk factors that caused the blockage can be treated/controlled. Hence, new blockages can occur again. A healthy diet and lifestyle with avoidance of smoking, good control of sugar/pressure/cholesterol are essential.

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