Following a cardiac catheterization, your cardiologist may determine that there is a significant cholesterol blockage in one or more of the arteries that feed the heart. If the amount of disease cannot be treated with medication alone, then the blockage can be opened mechanically with a balloon (angioplasty) or stent.

An angioplasty is performed by a similar procedure to a diagnostic cardiac catheterization but may take 1 to 2 hours. The same small hollow tubes are used and dye is injected into the arteries that feed the heart. Once a blockage is identified, a small narrow wire, the width of a hair, is inserted past the blockage and a deflated cigar-shaped balloon is guided over the wire. The balloon is then placed in the location of the blockage and is inflated under high pressure to push the cholesterol plaque into the walls of the artery allowing blood to again flow freely through the artery. Depending on the blockage, multiple inflations may be necessary to restore blood flow. After the procedure, the wire and balloon are both removed from the body.

If the anatomy of the artery is appropriate, a stent is often used to buttress the artery after the narrowed portion of the artery is opened. Similar to an angioplasty, a balloon is placed over the site of the blockage, but in this case, a stent covers the balloon and is expands into the wall of the artery when the balloon is inflated. The wire and balloon are then both removed as in an angioplasty, but the stent is left behind. In the right patient, it is often more effective than angioplasty in helping to keep the artery open. It eventually becomes embedded in the artery and cannot be removed after it is placed. The stent is made of metal but certain conditions may benefit from a drug impregnated onto the stent to prevent the blockage from growing back. These drug-coated stents are not for every patient, and your cardiologist can help decide which is best for you. In either situation the patient will need to take both aspirin and clopidogrel (Plavix®) for at least a month and with drug coated stents, for at least a year.

With both balloon angioplasty and stent procedures, a plug is often placed in the artery to stop the bleeding or otherwise the site is compressed for about 10 or 15 minutes until the artery clots. There is a mandatory bed rest period after the procedure lasting from 2 – 6 hours. The patient is observed overnight and usually discharged the following day.

Traditionally MVC has performed the angioplasty procedures at the Lahey Clinic where backup bypass heart surgery is available. However as technology has improved, the need for surgical backup has proved to be rarely used. In 2004 MVC started doing emergency angioplasty in the community hospitals, LGH and SMC for patients having a heart attack. Subsequently in 2005 we started doing angioplasty in stable patients electively, but only as part of a statewide study called MASSCOMM required by the Department of Public Health and directed by Harvard University. Patients who need an angioplasty or stent and choose to participate in this study will have a 3 to 1 chance of having their angioplasty/stent procedure done at the local hospital where they had cardiac catheterization performed, often times immediately following diagnostic procedure. For the other 25% patients, the procedure will be performed at Lahey Clinic, usually the same day and by the same interventional cardiologist.

Alternatively, some patients prefer to have the diagnostic cardiac catheterization at the Lahey Clinic so that if they need an angioplasty it can be performed right away and avoid being in the study. Although we are happy to make these arrangements, we like to encourage patients to take part in our study at the local hospitals so that we can soon provide this service to all patients in the Lowell area.

What to expect before the procedure:

1. If you have had a reaction to contrast, shellfish or iodine in the past, please let your cardiologist know immediately
2. Nothing to eat after the midnight before the procedure.

3. You may bring a CD of your favorite music to help you relax

What to expect after the procedure:

1. There may be soreness at the incision site and possibly some swelling and bruising.

2. Avoid any significant physical activity or heavy lifting for the first few days after the procedure
3. The patient may resume driving the day following the procedure
4. Avoid taking a bath for a few days; showers may be taken within 24 hrs

When to call your physician or 911:

1. Bleeding at the access site

2. Severe tenderness, discharge or fever 

Complications:
Complications of the procedure are rare but could include a blood vessel tear or bleeding, reaction/allergy to medication or contrast, kidney complications or very rarely stroke or heart attack.

To learn more about angioplasty and stenting, click here or here.