A Patient's Guide to Coronary Angioplasty

By Brian Shaw, DO, Virtua Interventional Cardiologist

It’s possible that certain bad habits (such as smoking, poor diet, and lack of exercise) or hereditary factors have caught up to you as you’ve gotten older. When you have trouble with your blood pressure or cholesterol levels, doctors often prescribe medications and recommend lifestyle changes to improve your health. But in time, these conditions can lead to the build-up of plaque and hardening of your arteries, which is known as atherosclerosis.

If you notice a tightening in your chest, difficulty breathing, or discomfort during heavy activity, you may be experiencing angina, a collection of symptoms indicating blockage or narrowing of a coronary artery. The coronary arteries supply the heart muscle with blood. To evaluate your coronary health, a cardiologist usually orders a stress test to determine how your heart responds to physical activity.

Depending on the results of the stress test, your doctor may refer you for a cardiac catheterization procedure to identify the location(s) of the blockage(s) and decide if you need a coronary angioplasty. This procedure treats atherosclerosis by mechanically opening the artery to push the plaque out of the way and restore blood flow.

How does coronary angioplasty work?

• Coronary angioplasty takes place in the cardiac catheterization (cath) laboratory at the hospital. Patients are instructed not to eat or drink anything after midnight, except for their usual medications with a sip of water. Patients typically receive a call from a cath lab nurse with specific instructions the day before the procedure.
• The patient is gently sedated during cardiac catheterization. A local anesthetic is injected at the site of catheter insertion, which may be through the groin or wrist. 
• The interventional cardiologist inserts a catheter into the artery until it reaches the heart. Then, he injects a dye and takes X-rays to locate the blockage.
• Once the doctor confirms that coronary angioplasty will solve the problem, the procedure is often done at the same time. A balloon is inserted at the site of the blockage and inflated for a few seconds to re-open the artery; the balloon is then removed.
• If a permanent stent is required, this will be inserted at the time of the catheterization as well. A stent is an expandable metal mesh tube that holds the artery open. Most stents are coated with medication, which absorbs into the wall of the artery over time to help prevent reformation of the blockage.
• Once the procedure is done, the catheters are removed.  Patients recover for a few hours and are usually discharged home on the same day.

In certain circumstances, the following will happen:

• Patients who are allergic to iodine will be instructed to take steroids prior to the procedure to prevent an allergic reaction to the dye.
• Patients who are on chronic blood thinners will be asked to stop taking them 2-5 days prior to the procedure.
• Patients who have chronic kidney disease may be asked to arrive early to receive intravenous fluids prior to the procedure.

Some patients need emergency coronary angioplasty—such as during a heart attack or when severe symptoms occur. Although the procedure is the same, the doctor may look for other conditions such as a ruptured plaque, blood clot formation, or complete blockage of the artery.

Recovering from coronary angioplasty

Following a coronary angioplasty procedure, patients takes aspirin and anti-platelet medications to prevent blood clot formation for 6-12 months, or the length of time specified by the cardiologist. Lifestyle changes and pharmaceutical therapy are just as essential as they were before the procedure. Your doctor will also review habits and provide lifestyle guidance to improve your health.

Updated February 23, 2017