Angioplasty is a surgical procedure used to widen the arteries that are narrowed due to atherosclerotic plaque deposits.
Atherosclerosis is a condition that leads to hardening of the arteries and forms plaques in the artery walls. As a rule, this occurs in the elderly.
The problems arise when blood flow decreases due to arterial constrictions.
For example, narrowing of the coronaries (arteries that carry oxygenated blood to the heart) causes chest pain (angina) and other symptoms.
The treatment of high-grade atherosclerosis of the coronary arteries also provides for coronary angioplasty.
Percutaneous transluminal coronary angioplasty
PTCA is used to open occluded coronary arteries, i.e. the arteries that carry blood to the heart muscle.
This leads to reduced blood flow to the heart muscle, which could lead to chest pain, heart attack or infarction.
The goal of treatment is to allow undisturbed blood flow.
It is called percutaneous because the artery is reached through the skin.
It is called transluminal coronary angioplasty because an inflatable balloon catheter is inserted into the interior of a coronary artery to restore blood flow.
To diagnose atherosclerosis, the doctor prescribes coronary angiography. This examination consists of the radiographic visualization of an artery into which a contrast agent is injected.
Stable ischemic coronary disease is called elective angiopathy because it is not an emergency measure and can be scheduled for scheduling.
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Difference between Bypass and Angioplasty
There are many aspects to consider when deciding on the procedure.
Questions for the doctor:
- Is there a solution without surgery?
- The patient should always ask his doctor if there are other therapies to solve the disorder
- What are the life expectancies in both procedures?
- Which process offers the best quality of life in the long term?
- How long is the hospital stay? After what time can you resume your work?
- What are the short- and long-term complications?
- What activities should be avoided?
- Should you follow a special diet to prevent further closure?
- What medications need to be taken permanently?
- What urgent measures need to be taken if suddenly there is pain in the area where the operation took place?
- The patient should ask the doctor if he has enough experience with this type of surgery and what his success rates are.
The indications for these two procedures may be the same, but therapy depends on the severity of the disease, medical history and general health of the person.
In general, angioplasty is a quick fix, but does not last long, while bypass is a comprehensive procedure that brings long-lasting results.
The reason why angioplasty is the most widely used treatment method for coronary artery disease is the advantage it has over coronary bypass surgery.
For example, the recovery time after angioplasty is short because it is not as invasive as bypass surgery.
Risks and contraindications are low, almost anyone can undergo this procedure.
How is a PTCA performed?
Execution of a coronary angioplasty
Coronary angioplasty is performed under local anesthesia.
In the procedure, a thin and movable tube, also called a catheter, is inserted into the artery through a skin incision in the groin, wrist or arm.
To trace the catheter into the coronary artery in question, the doctor injects a dye and takes X-rays.
Once the catheter has reached the right place, a thin wire is used to guide a balloon into the affected artery to the site of the occlusion.
The balloon is inflated to widen the artery and push the fatty deposits against the artery wall. Thus, the blood can flow freely again after the balloon has been removed.
The balloon is inflated several times to expand the inside of the artery. This procedure is used in all closed areas.
One can perform angioplasty with an excimer laser, which emits an energy beam to dissolve the atherosclerotic plaque.
What is angioplastic surgery with a stent?
Stents are made of fine meshes and are made of metal wires (stainless steel) that are very rigid and serve to keep the arteries open.
Cardiac surgery with a stent is an advanced technique that can prolong the lives of many patients.
Angiography is performed by inserting a very thin guide wire into the femoral artery (arteria femoralis) at the level of the groin. From here it is advanced to the coronary arteries of the heart.
After that, a catheter is inserted along the guide wire and an X-ray dye is injected.
This substance spreads along the artery and follows the bloodstream.
The X-rays provide detailed images and can determine the closure.
Then the catheter is removed, but the guide wire remains in its position.
The cardiologist again inserts a catheter with a balloon at the tip to the site of the narrowing to restore the normal width of the artery.
Once the catheter has reached the position of the arterial occlusion, the balloon is inflated and the stent expands.
In this way, the stent is safely inserted at the point of constriction.
The cardiologist may recommend a stent that releases a drug to prevent proliferation of the artery wall (drug-eluting stent).
How long does a stent last in the heart?
There is no fixed shelf life for a stent. This depends on the body’s reaction to its presence, diet, medical history and lifestyle.
Sometimes they last 15 years.
How long does angioplasty take?
Usually, coronary angioplasty lasts between 15 minutes and two hours.
The hospital stay is short, usually you are discharged home the same or the following day.
Risks and complications
With the advanced technology and cardiology professionals, the probability of death during surgery is extremely low (less than 1%).
In about 2-3 cases out of a thousand, emergency bypass surgery is required.
Even though PTCA is relatively safe, some complications are possible.
Complications of this operation:
- Infection or bleeding in the area of the inserted catheter
- Allergic reaction to contrast agent
- Cardiac arrhythmia or cardiac arrhythmias
- Perforation of the artery
- Stroke
- Infarct
- Kidney problems
With the rupture of a coronary artery, the patient must be treated by open surgery.
Patients with blood clotting problems have a greater risk of developing complications than others.
Likewise, individuals who suffer from kidney disease or diabetes need other precautions to prevent deterioration of kidney function.
If the angioplasty is not successful, the operation can be repeated.
The likelihood of recurrence is higher in people with chronic (long-standing) atherosclerosis.
After angioplasty: convalescence and recovery times
In the hospital
In most cases, recovery times after angioplasty are about one or two days, meaning the person is discharged the same day or the following day.
To avoid bleeding, a bandage is applied over the insertion site of the catheter and the cardiologist asks the patient to keep his arms and legs stretched.
Also, doctors may order medications to prevent blood clots from forming. The patient begins to walk again after 12-24 hours.
If the doctor is convinced that the postoperative course is good, the patient is discharged from the hospital.
Upon discharge, the patient is given special instructions that he must follow at home in order to recover quickly.
At home
If a person has received a simple coronary angioplasty, the recovery time is about a week. After that, he can return to his normal everyday life.
If, on the other hand, the procedure was performed as a result of a heart attack, the recovery period is extended by a few days.
During the recovery period, the patient should visit the doctor at regular intervals for follow-up.
After the operation, you are not allowed to lift weights, do sports or drive for a week.
If fever occurs, it is necessary to consult the cardiologist to rule out infection.
After the procedure, the patient notices a hematoma on the leg, where the catheter was inserted.
The patient must ensure that the area is well protected and dry to prevent infection.
If there are signs of infection, the doctor must be informed as soon as possible.
Due to the high risk of thrombosis, it is recommended to avoid traveling by plane until two weeks after the procedure. Furthermore, it is recommended to quit smoking permanently.
The doctor may recommend a cardiac rehabilitation program specifically designed to help patients recover.
A study published in the Journal of the American Heart Association found that the chances of survival are improved by 47 percent when a person completes the rehabilitation program.
In atherosclerosis, it is important to change the diet to lower cholesterol in the blood.
It is advisable to avoid cheese and meat, and in their place eat legumes and fish.
- Ischemic or hemorrhagic stroke – rehabilitation
- Coronary artery bypass
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