You may be a candidate for angioplasty and
stenting if you have moderate to severe narrowing or blockage in one or more of
your blood vessels. Usually, you will also have symptoms of artery disease,
such as pain or ulceration, in one of your limbs.
If you have extremely hard plaque deposits,
blockages that contain blood clots or a large amount of calcium, extensive or
particularly long blockages, blood vessel spasms that don't go away, or
complete blockages that cannot be crossed with the catheter, you probably are
not a good candidate for angioplasty.
Am I at risk for complications during Angioplasty and Stenting?
Complications to angioplasty and stenting may
include reactions to the contrast dye, weakening of the artery wall, bleeding
at the access puncture site in the vessel or the angioplasty site, re-blocking
of the treated artery, and kidney problems. Additionally, blockages can develop
in the arteries downstream from the plaque if plaque particles break free
during the angioplasty procedure. If severe, these can lead to worsening of the
blood flow.
If you have diabetes or kidney disease, you
may have a higher risk of complications from the contrast dye, such as kidney
failure. In the case of kidney disease, sometimes pre-treatment with
medications or fluids may decrease the impact on your kidneys.
People with blood clotting disorders also may
have a higher risk of complications from the procedure. If the plaque deposits
in your arteries are especially long, you may have a greater chance of your
artery closing up again after angioplasty and stenting.
Your physician will usually insert the
angioplasty catheter through a small puncture point over an artery in your
groin, your wrist, or your elbow. Before the insertion, he or she will clean
your skin and shave any hair in the immediate area. This is done to reduce your
risk of infection. Your physician numbs your skin and then makes a small cut or
puncture to reach the artery below. Although you may be given some mild
sedation, your vascular surgeon will usually want you to stay reasonably alert
to follow instructions and describe your sensations during the procedure.
Your vascular surgeon then inserts a guide
wire or a guide catheter into your artery. Using a type of x ray that projects
moving pictures on a screen, your physician guides the catheter through your
blood vessels. Because you have no nerve endings in your arteries, you will not
feel the catheters as they move through your body.
Next, your vascular surgeon will insert a
balloon catheter over the guide wire or through the guide catheter. The balloon
catheter carries a deflated and folded balloon on its tip. Your vascular
surgeon guides the balloon catheter to the narrowed section of your artery. He
or she partially inflates the balloon by sending fluid through the balloon
catheter.
Your vascular surgeon watches the x ray screen
for signs of a pinch in the balloon. Then, your vascular surgeon will inflate
the balloon more, until the pinch caused by your artery flattens out. When the
balloon is full, your vascular surgeon may deflate and re-inflate it repeatedly
to press the plaque against your artery walls. Usually, this process takes a
few minutes. Sometimes, if you have a severe blockage, your physician may need
to inflate and deflate the balloon longer.
Your artery may stretch and your blood flow
through the artery stops when the balloon is pushing your artery open. This may
cause pain. However, the pain should go away when your vascular surgeon
deflates the balloon and normal blood flow resumes. Make sure to tell your
physician if you experience any symptoms during angioplasty.
There is a risk that your artery will
re-narrow or become blocked again at the site where the balloon was inflated.
This can happen soon after the procedure, or months to years later.
Re-narrowing of your artery is called restenosis, and if your artery suddenly
becomes blocked again it is called re-occlusion. Restenosis can happen when
scar tissue builds up inside your arteries where the balloon compressed your
plaque deposits.
After angioplasty, your vascular surgeon will
sometimes need to use a stent to brace the artery open to prevent re-occlusion.
A stent is a tiny mesh tube that looks like a small spring, and comes in a
variety of sizes. To place a stent, your physician removes the angioplasty
balloon catheter and inserts a new catheter. On this catheter, a closed stent
surrounds a deflated balloon. Your vascular surgeon guides the stent through
your blood vessels to the place where the angioplasty balloon widened your
artery. Your physician inflates the balloon inside of the stent. This expands
the stent. Your physician then deflates and removes the balloon. The stent
remains in place to support the walls of your artery. Your artery walls grow
over the stent, preventing it from moving. Although stents help prop open your
arteries, scar tissue sometimes can eventually form around stents and cause
restenosis.
A new type of stent is coated with drugs.
These drugs may help prevent scar tissue from forming inside a stent. Studies
have shown that these new stents may be more likely to prevent restenosis than
ordinary, non-coated stents. In the United States, physicians currently use
drug-coated stents in coronary arteries (the arteries supplying the heart).
Experts are still testing drug-coated stents for use in other arteries.
Once your vascular surgeon finishes
angioplasty and stenting, he or she removes all of the catheters from your
body. If blood-thinning medications have been used, your physician may leave a
short tube, called a sheath, in your artery for a short time until the
medications have worn off sufficiently to allow the puncture site to seal over
when the sheath is removed.
Eventually, your physician removes the sheath
and presses on the puncture area for 15 to 30 minutes to prevent bleeding.
Sometimes, instead of pressing, your physician may close the area with a device
that functions like a tiny cork, or he or she may use stitches.
Angioplasty and stenting usually takes between
45 minutes and 3 hours, but sometimes longer depending upon the particular
circumstances.
What can I expect after Angioplasty and Stenting?
Usually, you will stay in bed for six hours
after your angioplasty. During this time, your vascular surgeon and the
hospital staff closely monitor you for any complications. If your physician
inserted the catheters through an artery in your groin, you may have to hold
your leg straight for several hours. Similarly, if your arm was used, then you
will need to hold it still to minimize the risk of bleeding.
If you notice any unusual symptoms after your
procedure, you should tell your vascular surgeon immediately. These symptoms
include leg pain that lingers or gets worse, a fever, shortness of breath, an
arm or a leg that turns blue or feels cold, and problems around your access
site, such as bleeding, swelling, pain, or numbness.
After you return home, your vascular surgeon
will give you instructions about everyday tasks. For example, you should not
lift more than about 10 pounds for the first few days after your procedure. You
should drink plenty of water for 2 days to help flush the contrast dye out of
your body. You can usually shower 24 hours after your procedure, but you should
avoid baths for a few days.
Your physician may prescribe aspirin or other
medications that thin your blood. These medications will help prevent clots
from forming on your stent. Your physician may also ask you to follow an easy
exercise program, like walking.
You will be asked to schedule a time to see
your physician after the procedure. At this appointment, your physician may
check your blood to make sure your medications are at the right dosage. He or
she may also use tests to see how blood is flowing through your treated artery.
Serious complications are unusual following
angioplasty and stenting but, nevertheless, can occur.
Less serious complications include bleeding or
bruising where your vascular surgeon inserted the catheters. Sometimes, the
hole created by the catheter does not completely close. This can create a false
channel of blood flow. Rarely, an abnormal connection can form between an
artery and a vein at the place where the catheter was inserted. These problems
usually go away. However, if you have any serious symptoms, your vascular
surgeon can treat you.
You may have an increased risk for blood clots
forming along your stent, especially in the first month after your procedure.
To reduce this risk, your physician may prescribe medications that thin your
blood.
As more time passes after your angioplasty and
stenting, restenosis becomes more likely. Stents, especially drug-coated
stents, may reduce this risk. However, in some cases, you may need a repeat
angioplasty or a bypass surgery if a restenosis develops.
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A new preventative treatment for heart attacks could cut repeat problems in victims and save lives, doctors believe. In heart operations, patients are usually fitted with a stent - a thin mesh tube - in the artery that triggered the heart attack to restore the blood flow, a treatment known as angioplasty.
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