THE BASICS: “What is it?”

Coronary artery angioplasty with stent (angioplasty with stent) is a minimally invasive treatment for opening coronary arteries—the blood vessels that supply blood to the heart—that are blocked or narrowed by fatty-plaque buildup from atherosclerosis (coronary heart disease, or CHD).

The procedure involves:

  • Temporarily inserting a tiny balloon and wire-mesh coil (stent) into the blocked or narrowed artery in your heart
  • Inflating the balloon to:
    • Break up and flatten the blockage against the artery wall, widening the artery
    • Expand the stent into a tube that helps keep the artery open after the balloon is deflated and removed

The benefits of angioplasty with stent could make a big difference in your life:

  • If you’re having a heart attack, it could save your life and lessen damage to your heart.
  • If you’ve been having CHD symptoms, such as chest pain and shortness of breath, it could:
    • Improve them right away (as it does for most people who have it)
    • Help you achieve a better quality of life
  • It involves only a small puncture or incision—making it much less invasive than coronary artery bypass surgery (CABG)—and recovery time is often much shorter.

Overall, the decision to treat CHD with angioplasty with stent is based on:

  • The patient’s age and medical history
  • The severity of the coronary artery blockage and/or damage

Your doctor may recommend angioplasty with stent if you have CHD and one or more of the following situations applies to you:

  • You’re still having CHD symptoms despite taking medications and/or making healthier lifestyle choices
  • You can’t take symptom-relieving medications because of their side-effects or interactions with other medications
  • You’re having a heart attack or symptoms of one
  • You have coronary artery blockage that could cause a heart attack or that occurs during or after you have one

In addition to improving blood flow, stents are designed to:

  • Seal tears, if any, in the artery wall
  • Prevent breakaway of small fatty-plaque pieces, which could cause a heart attack

The stent may be made of:

  • Bare metal—over time, as the artery heals from the procedure, tissue grows through and around the stent to hold it in place
  • Metal coated with a medicine (this is called a drug-eluting stent) to help prevent stent-related tissue overgrowth and artery re-narrowing

Although about 600,000 Americans a year have this procedure, some people with coronary artery narrowing or blockage do not have angioplasty with stent.

  • Some can be treated with lifestyle changes and medication, particularly if only one artery is affected.
  • Still others—for example, those whose main artery on the left side of the heart is blocked—may need CABG surgery.

Angioplasty with stent is generally safe. The complications that may occur include the following.

During the procedure:

  • Additional blockage(s) due to breakaway of fatty-plaque particles that travel to other arteries
  • Puncturing of the heart or a blood vessel
  • Blockage of the blood vessel where the balloon and stent were first inserted
  • Bleeding
  • Allergic reaction to the stent material, drug coating on the stent, or the X-ray dye used during the procedure
  • Rarely occurring complications, which include:
    • Heart attack from collapse of the artery, which usually triggers emergency CABG surgery
    • Too-fast or too-slow heart rhythms (arrhythmias), which may require treatment with medication or a temporary pacemaker (heartbeat-regulating device)
    • Damage to the affected coronary artery from tearing or rupture during the procedure, which also may trigger emergency CABG surgery
    • Stroke from 1) a blood clot that forms on the catheter and travels to the brain or 2) a fatty plaque that breaks loose from a blood vessel during threading of the catheter
    • Kidney damage from the dye used for X-ray during the procedure

After the procedure:

  • Repeat narrowing or blockage of the affected artery (restenosis, also called in-stent restenosis)
    • After a stent is inserted, healthy arterial-wall cells grow around and through it to hold it in place, but later, scar tissue may form under this lining and thicken it so the artery narrows again.
    • With bare-metal stents, restenosis occurs in fewer than one in five patients; with drug-eluted stents, the risk is reduced to fewer than one in 10.
    • When it occurs, restenosis typically happens within three to six months after angioplasty with stent; it is rare after a year since the procedure.
  • Blood clotting in the stent (very rare)
    • This can happen even months after the angioplasty with stent procedure and may lead to a heart attack.
    • Minimizing this risk is the reason why it’s so important to take blood-thinning (anticoagulant) medications after your procedure—and to take them exactly as directed by your doctor. (See AFTER YOUR PROCEDURE: “What type(s) of care could I receive?”, below.)
  • Infection at the catheter insertion site

Fortunately, although these risks exist and angioplasty with stent doesn’t cure CHD, many people who have the procedure:

  • Achieve improved blood flow through the heart
  • Get relief from their CHD symptoms
  • Are able to avoid the need for CABG surgery

Now that you know what’s involved in having angioplasty with stent, you’re ready to learn more about the specialized team that does it. Next step:

  • Getting to know the health professionals who perform this often life-saving procedure

 

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