Angioplasty and Stent

What is an angioplasty and stent procedure?

Angioplasty is a procedure used to stretch narrowed coronary arteries that supply blood to the heart. It is nearly always followed by a stent - a metal mesh coil expanded into the artery which reduces the chance of it narrowing again. By widening the artery it improves blood flow to the heart muscle and improves angina. Angioplasty and stent is often called 'Percutaneous Coronary Intervention' or PCI.

 
If the coronary arteries are narrowed, not all narrowing are suitable for stents and your doctor will need to carefully assess whether you stents, a bypass operation or just tablets are best for you.


Angioplasty and stents are done routinely as treatment for stable angina or urgently as an emergeny procedure following a heart attack to open up an artery that has suddenly blocked (below).

 

Blocked left anterior descending artery with trickle of blood beyond blockage during a heart attack (label and arrow) and on the right, after 'primary' angioplasty and stent with good flow down the vessel beyond

 

 

 

An elective or routine procedure for stable angina - the narrowing in the right coronary artery is shown before ....................and then after stent insertion

 

How is the procedure performed?

The procedure is started in an identical way to a coronary angiogram. However through the tube or catheter into the heart a very fine wire is passed which is used to go across the narrowing in the arteries. This wire is then used to guide a balloon which is inflated briefly to stretch the narrowing. A stent may then be positioned across the same site. The stent is wrapped onto another balloon and this balloon is expanded, opening up the stent and pushing it into the wall of the artery. Following this the balloon and wire are withdrawn and the stent will heal into the artery.

 

Will I be awake?

Most people are nervous to learn that they will be awake throughout the procedure. This is because you will need to follow some of the doctor's instructions. Often a mild sedative is given to help relax you but you should not experience any more than some mild discomfort at the very beginning of the test when the tube is inserted as with an angiogram. You may also experience some angina pains when the balloon is inflated as it does block the artery for a short while - this usually settles very quickly. If you have discomfort at any time then you must let the doctors and nurses know, so that this can be sorted out. The procedure time can vary from under half an hour to two hours.

 

How safe is angioplasty and stent?

As with all 'invasive' procedures there are some risks. The risks are higher than with a simple angiogram but they will have been weighed up against the risk of not performing the procedure. The risks and benefits will be discussed with you before the procedure by your doctor.


How long does a stent last?

Stents remain in the arteries and cannot be taken out. They can sometimes narrow due problem with over healing, where scar tissue grows into the stent and the artery narrows again causing more angina. If this is going to happen, by-and-large it does so in the first six months. This can be reduced by stents coated with a drug to reduce the over healing process called 'drug eluting stents'. The cardiologist putting in the stents will have to weight up the risks of over healing with a simple 'bare metal' stent with the risks of having to take prolonged blood thinning medication and the very small risk of clotting in a drug eluting stent.

 

Does it involve new medications?

Stents required the blood to be thinned with medication for at least one month, and up to one year. Aspirin is usually combined with an aspirin-like drug called clopidogrel which work in slightly different ways to thin the blood. Bare metal stents need a minimum of one month of both medications. Drug eluting stents need both medications for longer as the stents take longer to heal over, usually one year. It is very important that you are clear how long you should take these medications and if unsure check with your doctor before stopping them.

Please note:

Every effort has been made to ensure that the information on this website is up-to-date and accurate. However, it is intended to serve as a guide only. Symptoms may vary and if you have any medical concerns you should always consult a healthcare professional.