Harrison’s interventional cardiologists perform minimally invasive procedures—angioplasty (also known as balloon angioplasty or percutaneous transluminal coronary angioplasty (PTCA)—to open narrowed coronary arteries and improve blood flow. Nearly 90-95% of our angioplasty procedures also include stent placement.
Angioplasty is one of three therapies for coronary artery disease and angina (chest pain). Medications are the first line of treatment, but when the disease can’t be well controlled, or the patient is in critical need because of an impending or actual heart attack, then an angioplasty is performed. When all three major arteries are blocked, coronary artery bypass graft surgery is generally the preferred procedure.
What to expect
The procedure is performed in the cardiac catheterization laboratory (cath lab). A local anesthetic is used to numb the area—the doctor decides which artery to use—in the groin, bend of the elbow or through the wrist.
A small nick is made in the skin and a catheter, (a thin, plastic tube) is inserted. The catheter is threaded through the artery. When the blocked artery is reached, a dye is injected and a picture of the coronary arteries (coronary angiogram) is taken so the doctor can see the size and location of the blockage.
With the exact site pinpointed, a guide wire is threaded through the same artery past the blockage. Then the balloon-tipped catheter is slipped over the guide wire and advanced to the blockage. The balloon is inflated at the blockage site to scaffold the plaque against the artery wall, then deflated and removed. Expanding the balloon helps to restore blood flow by stretching the arterial wall, which increases the inner diameter of the artery.
Stent placement calls for placement over a balloon-tipped catheter, which is expanded, pushing the stent in place against the artery wall. When the balloon is deflated and removed, the stent remains permanently in place, acting as a scaffold for the artery. Most patients receive either bare metal or drug coated stents (wire mesh devices that keep arteries open).
Other angioplasty procedures are used when needed. Harrison offers heart assist devices percutaneously (Impella support) for high-risk angioplasty/stent procedures in patients with severe congestive heart failure. Atherectomy, a procedure that is used to pulverize and remove hardened plaque, is offered in selected cases, when the plaque is severely calcified and resistant to balloons or stent delivery.
Timing is everything
Angioplasty is available on an emergency basis all day, every day, 365 days a year at Harrison. Our ‘door to balloon time’ is consistently less than the 90 minute national standard - one of the lowest in the state. The time has consistently improved by streamlining the emergency room process, and we continue our efforts to make it even faster, resulting in more lives saved.
Life after angioplasty
In most cases, patients stay in the hospital for one to two days after an angioplasty. You’ll be given care instructions for the incision, and discharge instructions for driving, activity level, medication, and any other restrictions and asked to avoid physical exertion or strenuous activity for one to two weeks.
Patients usually feel relief of chest discomfort and shortness of breath. Stamina might also improve. The number of heart-related medications can sometimes be decreased.
Monitoring is important because there is always a small chance of renarrowing of the artery at the stented site. In rare circumstances, a stented site may form a clot. Most commonly, this happens if the patient stops the “blood thinners” too early. The resultant heart attack (with severe symptoms) is a medical emergency that requires immediate re-opening of the blocked artery.
Angioplasty isn’t a cure—it is a way to improve symptoms, and improves prognosis when used in case of a heart attack. The real answer to better heart health is to focus on reducing risk with lifestyle changes that include lowering cholesterol, treating hypertension and diabetes—and by not smoking.
“Harrison’s door to balloon time is consistently less than the 90 minute national standard, and one of the lowest in the state. The time has consistently improved by streamlining the emergency room process.”
- Satyavardhan Pulukurthy, MD
Board Certified Interventional Cardiologist