Angioplasty and Stents
Percutaneous transluminal coronary angioplasty (PTCA), usually simply called angioplasty, involves opening the blocked artery.
 | Click the icon to see an animation about percutaneous transluminal coronary angioplasty. |
A typical angioplasty procedure follows these steps:
- The surgeon threads a narrow catheter (a tube) containing a fiber optic camera directly to the blocked vessel.
- The doctor opens the blocked vessel using balloon angioplasty, in which the surgeon passes a tiny deflated balloon through the catheter to the vessel.
- The balloon is inflated to compress the plaque against the walls of the artery, flattening it out so that blood can once again flow through the blood vessel freely.
- In order to keep the artery open afterwards, surgeons use a device called a coronary stent, an expandable metal mesh tube that is implanted during angioplasty at the site of the blockage. (In some cases, a stent may be used as the initial opening device instead of balloon angioplasty.)
- Once in place, the stent pushes against the wall of the artery to keep it open.
 | Click the icon to see an animation about percutaneous transluminal coronary angioplasty. |
Complications occur in about 10% of patients (about 80% within the first day). Outcomes are better in hospital settings with experienced teams and backup.
 | Click the icon to see an illustrated series detailing coronary artery balloon angioplasty surgery. |
The most important long-term complication is reclosure (restenosis), which can lead to heart attack if not treated with a repeat procedure. Stenting and other advances have helped significantly in preventing reclosure and reducing heart attack rates. Nevertheless, a repeat procedure is still needed to restore the opening in 10 - 15% of procedures that use stents. Radiation therapies and stents coated with immunosuppressive drugs may significantly reduce these rates.
Recuperation
Angioplasty is less invasive than bypass surgery, requiring only one night in the hospital. Recuperation takes about a week. Chest pain after the procedure is very common and usually due to problems other than ischemia. Mild chest pain is even more common when a stent is used, possibly because the artery is stretched.
Preventing Reclosure and Blockage During or Shortly after Angioplasty
Reclosure of the artery during or shortly after angioplasty often occurs. A number of anti-clotting drugs are used to help prevent this.
- Aspirin and the anti-platelet drug clopidogrel are often used to prevent reclosure during the procedure.
- A high dose of the anticoagulant heparin is typically given before the operation.
- Intravenous glycoprotein IIb/IIIa inhibitors, powerful drugs that block platelets, also prevent reclosure after stenting in many high-risk patients, and evidence now strongly suggests that they reduce rates of heart attack and death. Eptifibatide (Integrilin) and tirofiban (Aggrastat) are the standard drugs used during angioplasty. They may be most effective if administered during angioplasty, rather than beforehand.
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