Knowing about Coronary Angioplasty and Stenting
Coronary angioplasty or percutaneous coronary intervention (PCI) is a popularly used procedure to open the heart arteries that are clogged a condition referred to as Coronary Artery Disease (CAD).
What is CAD?
As you age, there is a buildup of a waxy substance called plaque inside the arteries. The condition is called atherosclerosis. When atherosclerosis occurs specifically in coronary arteries the disease is called Coronary Artery Disease. Over time the plaque can harden causing reduced flow of oxygen rich blood in heart and cause chest pain or discomfort called angina. The plaque may also rupture which is more dangerous since this can cause a large blood clot completely blocking the coronary artery which is the most common cause of a heart attack.
Why Coronary Angioplasty?
It is a simple, fairly low risk and established technique involving temporarily inserting a catheter containing an inflatable small balloon. An angiography is performed right before the angioplasty that involves injecting a contrast dye into blood vessels to visualize the image on an X-ray screen which can help doctors pinpoint the exact position of the block. The doctors inflate the balloon at the tip of the catheter exactly in the location of the block determined through the angiography.
The blowing up of the balloon squashes the plaque formation there and widens the artery and thus relaxes the blood flow within the artery. Angioplasty is a temporary procedure which is usually followed by a permanent procedure called stenting. Stenting is placement of a small wire mesh tube referred to as a stent to support the artery to remain open. Opting for this permanent procedure reduces the risk of narrowing of the artery again. One can now opt to choose a stent that is coated with medication called drug eluting stents or go with the more primitive bare metal stent consisting of the wire mesh alone.
A drug-eluting stent is a coronary stent that when placed into the diseased artery slowly releases a drug which generally blocks cell division. This prevents fibrosis that along with the clot can block a stented artery in a process called restenosis. Restonosis can be extremely dangerous as it can be much trickier to treat an already stented artery. Thus drug-eluting stent is recommended for those with a susceptible lipid profile having high cholesterol and a predisposition to recurring heart disease.
What happens during Coronary Angioplasty and stenting?
An angioplasty procedure can take anywhere between half hour to 2 hours depending on the persons profile.
- A local anesthetic is given to numb the area.
- The catheter with the inflatable balloon at its tip is inserted through an artery in the groin or arm
- The angioplasty is preceded by a angiogram to visual the location of block and extent of blockage
- The balloon is blown up at the exact location of the block leaving the stent in place and the balloon is deflated and the catheter is retracted and the holes are sometimes plugged with an angioseal
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