Atherosclerosis is a disease that causes plaque to form on the walls of the arteries, usually in the elderly.

When blood flow is reduced due to narrowing of the arteries, the person may experience symptoms. 
For example, obstruction of the coronary arteries (the arteries that carry oxygenated blood to the heart) more than 75% of the artery section causes chest pain ( angina ).

Treatment of severe arteriosclerosis for the coronary artery also includes coronary angioplasty.

Percutaneous transluminal coronary angioplasty Percutaneous transluminal coronary angioplasty is a procedure performed to open the blocked coronary arteries, that is, those that carry the blood to the heart muscle. 
This causes a reduced blood supply to the heart muscle that can cause:

  1. Chest pain ,
  2. A  heart attack .

The purpose of this procedure is to allow blood flow to flow. 
It is called percutaneous because it reaches the artery through a small incision in the skin. 
It is called transluminal coronary angioplasty because an inflatable catheter is inserted into the lumen (internal section) of a coronary artery to restore blood flow.

To diagnose atherosclerosis, the physician prescribes coronary angiography, this examination consists of the radiological visualization of an artery where a contrast medium has been injected. 
In the case of stable ischemic coronary artery disease (in which the cholesterol plaques in the coronary arteries have a fibrous capsule and calcifications ), angiopathy can be programmed without urgency.

Primary Angioplasty Primary
angioplasty means that fibrinolysis (treatment with drugs that degrade fibrin) is not performed during or after angioplasty. 
When this can be done quickly, it is the treatment of choice to allow blood to flow through the obstructed artery that caused the heart attack. 
In comparison to fibrinolysis, primary angioplasty has some advantages:

  1. Almost always allows to “open” the artery, regardless of the time that passed after the infarct,
  2. It allows treating any residual stenosis at the site of thrombosis, reducing the risk of a new short-term obstruction,
  3. There is no risk of intracranial hemorrhage .

 

Differences between revascularization and angioplasty

When deciding the procedure there are many things to consider.

Questions for the doctor

    1. Is there a non-operation solution?
    2. The patient should always ask his doctor if there are other therapies to solve the problem.
    3. What are the chances of survival with both procedures?
    4. In the long run, which procedure allows the best quality of life?
    5. How long is the hospital stay? How soon can I get back to work?
    6. What are the complications in the short and long term?
    7. What activities should be avoided?
    8. Is it necessary to follow a specific diet to avoid other blocks?
    9. Is there any kind of medicine that should be taken forever?
    10. What urgent actions should be taken in case of sudden pain at the point of the operation?
    11. The patient should ask the doctor if he has enough experience in this type of interventions and the success rate.

We can usually say that angioplasty is a quick fix, but this does not last long, while revascularization is a surgical operation that gives longer lasting results.

If angioplasty is one of the most widely used treatment methods for coronary heart disease, the reason is simply the advantage it has over coronary artery bypass grafting. 
For example:

  1. The recovery time after angioplasty is short because it is not invasive like revascularization.
  2. The risks and contraindications of angioplasty are few, in fact almost everyone can undergo this surgery.

According to a study by Chuntao Wu, MD, PhD et al. (Long-Term Mortality of Coronary Artery Bypass Graft Surgery and Stenting with Drug-Eluting Stents) patients with severe stenosis (≥ 70%) in at least 2 coronary arteries, with the exception of the main left coronary artery, have a lower mortality risk with myocardial revascularization surgery compared to the drug-eluting stent.

Technique Survival rate 
(in 5 years)
Pharmacological stent 73,6%
Revascularization 
of the myocardium
 80,4%

When to do coronary angioplasty? The indications

Indications for coronary angioplasty are:

  1. Acute myocardial infarction with ST segment elevation (AMI), urgent angioplasty is indicated,
  2. Acute coronary syndrome without supradication of ST,
  3. Unstable angina ,
  4. Stable angina,
  5. Stress test results showing a high risk.

In an asymptomatic or mildly symptomatic patient , evidence of moderate to severe ischemia confirmed by noninvasive tests is an indication for angioplasty.

 

Contraindications of coronary angioplasty

Contraindications include:

  1. Intolerance to long-term antiplatelet therapy,
  2. The presence of other serious diseases that reduce the life expectancy of the patient (relative contraindication).

An assessment of a team of specialists (cardiologists and cardiac surgeons) is critical for patients:

  1. With diabetes and coronary artery disease in different blood vessels,
  2. In patients with severe obstruction of the left coronary artery and a high score of  syntax score .

Relative contraindications include:

  1. Arteries <1.5 mm in diameter,
  2. Diffuse saphenous vein grafts.

 

Coronary angioplasty technique

Coronary angioplasty is performed under local anesthesia . 
During surgery, a thin, flexible tube called a catheter is inserted into the artery through an incision in the groin, wrist, or arm. 
To guide the catheter to the affected coronary artery (right or left), the physician injects a dye and performs some  x-rays . 
When the catheter is in place, a thin wire descends to the affected coronary artery, carrying a small balloon to the blocked area.

The surgeon inflates the balloon to increase the artery and crush the fat deposits in the artery wall, so blood can circulate freely when the balloon is removed.

The balloon inflates repeatedly to increase the lumen (internal cavity) of the artery. 
This is done in all locked areas.

It is possible to perform angioplasty with the excimer laserthat sends a beam of energy to melt the atherosclerotic plaque. 
In addition, according to a scientific study published in the PUBMED ( Effect of low-intensity coronary endovascular therapy during angioplasty on the release of endothelin-1 and nitric oxide ), a low-power laser beam applied during angioplasty may reduce the likelihood recurrence of stenosis because it changes the concentrations of:

  1. Nitric oxide,
  2. Endothelin-1

 

Angioplasty with stent implantation

A stent is a tiny, expandable, knitted tube made up of thin strands of metal (stainless steel) that are very stiff and are used to keep the arteries open. 
Cardiac surgery with the stent is an advanced technology used to prolong the lives of many patients.

Angiography is performed by inserting a very tight guidewire into the femoral artery at the level of the thigh that reaches the coronary artery. 
Thereafter, a long catheter is placed over the guidewire to inject an opaque dye into the x-rays. 
This substance spreads along the arterial blood stream. 
With the radiography we obtain the detailed image and identify the block. 
The catheter is then removed, but the guide wire remains in place.

The cardiologist inserts the catheter again  with a balloon attached to the tip and transports it to the point of obstruction to restore the normal width of the artery. 
When the catheter reaches the position of the arterial obstruction:

  1. The balloon inflates,
  2. A stent expands.

In this way it is possible to position the stent at the point where the artery is blocked. 
The cardiologist may recommend a stent that releases a drug to prevent proliferation of the arterial wall (drug-eluting stent).

 

How long does a heart stent take?

There is no fixed duration of stenting. It depends on how the body responds to your presence, diet, medical history and lifestyle. 
Sometimes it lasts for up to 15 years. 
In case of restenosis (narrowing of the artery after stent implantation), the most appropriate treatment is the insertion of a new drug-eluting stent of the new generation.

 

How long does coronary angioplasty surgery last?

Usually, coronary angioplasty lasts between 15 minutes and two hours. 
Hospitalization (hospitalization) is short, usually returning home the same day or the next day.

 

Risks and complications of coronary angioplasty

With advanced technologies and a good cardiologist, the probability of death during surgery is very low (less than 1 percent). 
Approximately 2/3 cases out of 1,000 serve an urgent revascularization operation.

Although PTCA is relatively safe, there are some possible complications.

The complications of this operation are:

  1. Infection or bleeding where the catheter is inserted,
  2. Allergic reaction to contrast liquid,
  3. Cardiac arrhythmia or dysrhythmia,
  4. Formation of thrombi ,
  5. Perforation of the artery,
  6. Stroke ,
  7. Heart attack ,
  8. Kidney problems due to contrast fluid.

In case of rupture of the coronary artery, the patient should perform the surgery in the open.

Patients with blood clotting problems are at greater risk of complications than the other. 
Similarly, people who have kidney disease or diabetes need other precautions to avoid worsening kidney function.

If the angioplasty is not successful, the surgeon may recommend a bypass. 
The likelihood of recurrence is higher among people with chronic (longstanding) atherosclerosis.

 

After angioplasty, convalescence and recovery time

In the hospital
In most cases, the recovery time after angioplasty is one or two days, ie the patient is discharged on the same day or the next day. 
To prevent bleeding, a dressing is made at the catheter insertion site and the cardiologist asks the patient to keep their legs and arms extended.

In addition, doctors may prescribe medications to prevent blood clots. Usually the patient starts walking after 12 to 24 hours. 
If the doctor believes that the postoperative course is good, the patient is released from the hospital. 
At discharge, specific instructions are provided to the patient to follow at home for a fast recovery.

At home
If the person has had a simple angioplasty, the recovery time is about a week, after which one can  return to normal daily life. 
On the other hand, if the person suffered the procedure after a heart attack, the recovery period may last for a few days.

The patient must visit the doctor regularly for postoperative follow-up. 
According to the guidelines of the German National Disease Management, after the intervention, the patient needs regular medical visits every 3 to 6 months of the family doctor.

Symptoms and after effects
In case of fever , it is necessary to consult the cardiologist to exclude an infection. 
The patient may have mild chest pain after angioplasty, usually disappear after a few days of rest. 
After surgery, the patient noticed a hematoma in the leg where the catheter was inserted. 
The patient should check that the area is well protected and dry to avoid infections. 
If there are signs of infection, it is necessary to seek the doctor as soon as possible.

Physical activity after coronary angioplasty
After angioplasty with stent implantation, the physician recommends avoiding excessive movements of the limb where the puncture was performed on the following two days. 
To prevent bleeding at the femoral artery incision, patients should avoid:

  1. Transport heavy objects,
  2. Making long trips by car or bike
  3. Sightseeing,
  4. Sport.

If the stent was inserted through the radial artery, patients should rest the affected hand for a few days (Source: Schwalm T. Transcarpal cardiac catheterization. Dtsch Arztebl Int. 2009; 106 (42): 685-691).

Due to the high risk of blood clots, you should avoid air travel for two weeks after surgery, you should also stop smoking forever. 
Your doctor may recommend a cardiac rehabilitation program designed specifically to help patients recover.

Mayo Clinic study published in the American Heart Association journal showed that the chances of survival increase from 45-47 percent when a person performs the rehab program.

Diet and Food
In case of atherosclerosis, it is important to change the diet to lower blood cholesterol. 
We recommend that you avoid cheese, cereals and meat, instead you can eat vegetables and fish. 
Every day you have to eat fruits and vegetables, nuts are also important because they are rich in substances that prevent the formation of atherosclerotic plaques:

  1. Unsaturated fats,
  2. Omega 3,
  3. Omega-6,
  4. Antioxidants

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