When having a coronary angioplasty and stenting, you may have a pre-assessment of your health a few days before the operation.
This gives you an opportunity to discuss any concerns with your surgeon.
Your coronary arteries also need to be assessed to make sure the operation is technically possible. This is done using a test called coronary angiography.
You may be asked not to eat or drink anything for four hours before a coronary angioplasty.
You will usually be able to take most medications as normal up to the day of the procedure, with the exception of blood-thinning medication (anticoagulants), such as warfarin. You may also need to alter the timing of any diabetes medication you take. Your medical team can give you more information about this.
Where it takes place
A coronary angioplasty usually takes place in a room called a catheterisation laboratory, rather than in an operating theatre.
A catheterisation laboratory is a room that is fitted with X-ray video to allow the doctor to monitor the procedure on a screen.
How long it takes
Coronary angioplasty usually takes about 30 minutes, although it may take longer depending on how many sections of your artery need to be treated.
What you can expect to happen
You'll be asked to lie on your back on an X-ray table.
You'll then be linked up to a heart monitor and given a local anaesthetic to numb your skin.
An intravenous (IV) line will also be inserted into a vein, in case you need to have painkillers or a sedative. The cardiologist (heart specialist) will make a small incision in the skin of your groin or wrist and will insert a catheter. They will guide the catheter through the artery in your groin or arm, passing it through the main artery in your body (the aorta) and into the opening of your left or right coronary artery.
A thin, flexible wire is then passed down the inside of the blood vessel being treated to beyond the narrowed area.
A small balloon is passed over the wire to the narrowed area and inflated for up to 60 seconds. This squashes the fatty material on the inside walls of the artery to widen it. This may be done several times.
While the balloon is inflated, the artery will be completely blocked and you may have some chest pain. However, this is normal and is nothing to worry about. The pain should go away when the balloon is deflated. Ask your cardiologist for pain medication if you find it uncomfortable.
You shouldn't feel anything else as the catheter moves through the artery, but you may feel an occasional missed or extra heartbeat. This is nothing to worry about and is completely normal.
If you are having a stent inserted, it will open up as the balloon is inflated and will be left inside your artery.
Types of stent
A stent is a short, wire-mesh tube that acts like a scaffold to help keep your artery open.
There are 2 main types of stent:
- bare metal (uncoated) stent
- drug-eluting stent, which is coated with medication that reduces the risk of the artery becoming blocked again
The biggest drawback of using bare metal stents is that, in around 30% of cases, the arteries begin to narrow again. This is because in some cases the healing response of the coronary vessel leads excessive tissue growth around the stent.
This problem can be much reduced by using drug-eluting stents. These are coated with medication that reduces the tendency to excessive tissue growth.
If you have a stent, you’ll also need to take certain anti-platelet drugs to help reduce the risk of blood clots forming around the stent.
- aspirin - taken every morning for life
- clopidogrel - taken for up to 12 months depending on whether you have had a bare metal or drug-eluting stent, or whether you have had a heart attack
- prasugrel and ticagrelor - sometimes used as alternatives to clopidogrel
At the end of the operation
When the operation is finished, the cardiologist will check that your artery is wide enough to allow blood to flow through more easily.
The balloon, wire and catheter are then removed and any bleeding is stopped with a dissolvable plug or firm pressure.