In coronary artery disease, cholesterol accumulates in the coronary arteries which supply the myocardium with oxygen and nutrients. Over time, the build-up of fatty substances narrows the vessels and as the condition progresses circulation in the myocardium is reduced. The symptoms of coronary artery disease are first detected under stress. During physical activity the heart needs more oxygen. If a stenosis of the coronary artery significantly restricts the blood flow, your myocardium becomes exposed to a lack of oxygen. This is called ischaemia. Symptoms typically include a vice-like chest pain which spreads to the neck or left arm. Other symptoms include shortness of breath associated with physical activity.
The primary methods for treating coronary artery disease include drug therapy and eliminating risk factors. Drug therapy is used to alleviate the symptoms, reduce the risk of myocardial infarction and improve the prognosis. Balloon angioplasty and bypass surgery are considered when the symptoms remain severe despite drug therapy. Invasive treatment methods are sometimes indicated in patients with only minor symptoms if critical stenoses are detected in the roots of the coronary arteries. The appropriate treatment method is selected based on the location, number and severity of the stenoses. Any associated diseases will also affect the decision between bypass surgery and balloon angioplasty. After an invasive operation, drug therapy is continued to improve the prognosis.
Often coronary angiography is immediately followed by balloon angioplasty. However, it is sometimes important to consider the available options and postpone the treatment. Acute coronary syndromes and myocardial infarctions require immediate treatment and in such cases coronary angiography is followed by balloon angioplasty or bypass surgery with consultative assistance from a heart surgeon.
Balloon angioplasty
Balloon angioplasty is similar to coronary angiography. It is performed under local anesthetic. A thin catheter is passed along your radial or femoral artery to the opening of the coronary artery under X-ray guidance. A guide wire is passed to the constricted vessel and it will act as a pathway for other intravascular equipment required during the operation.
A collapsed balloon at the tip of the catheter is inflated when it reaches the stenosis. A stent is usually placed at the time of ballooning to ensure the artery remains open by preventing the recurrence of a stenosis. After a few months, the internal layer of the vessel grows enough to protect the stent. Effective anticoagulants are administered during the recovery period.
The procedure takes between 30 minutes and two hours, depending on the number and characteristics of stenoses. Following balloon angioplasty, patients are monitored for two to six hours at rest. If the operation has been uncomplicated, you will be discharged the same day. An angioplasty indicated by myocardial infarction will require a longer stay in hospital, usually a couple of days.
Risks and results
The results of coronary angioplasty tend to be good. In less than 5 per cent of patients, the procedure needs to be repeated due to recurrent narrowing of the stent. In such cases, the vessel is dilated again. Coronary bypass surgery will be performed when a new angioplasty is not possible. Recurrent narrowing is reduced by using stents coated with specific medications or by manipulating the artery with a balloon which releases medication.
In coronary angioplasty, complications associated with the puncture sites are the same as in coronary angiography. Anticoagulants administered during the operation increase the risk of bleeding.
A ruptured artery is a rare complication of balloon angioplasty and can usually be treated by inserting a coated stent or surgically. A stent thrombosis is a serious complication which occurs when a blood clot forms on the surface of a stent. It is typically the result of discontinuing the anticoagulant therapy too early. The risk of stent thrombosis is less than 1 per cent during the first year after the operation. If your chest pains return or become worse after the operation, contact your treating physician. In emergencies, dial 112.
Avoid burdening the puncture site for approximately one week after the operation. It is recommended to avoid MRI scans for two months. After the two-month period, there are no contraindications for MRI scans. The stent will not show in airport security checks and you do not need to mention it.