PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

PTCA involves opening a narrowed or blocked segment of coronary artery by insertion of a small balloon catheter via the femoral artery in the groin (or occasionally the brachial artery located in the arm). This is performed under sedation and local anaesthetic.

A fine guidewire is introduced through a guide into the coronary artery. A balloon catheter is then inserted over the wire and positioned across the narrowed / blocked segment. The balloon is then inflated. This procedure opens the narrowed artery by compressing the fatty material (plaque) against the wall of the artery and restores blood flow to the area of the heart previously deprived by the narrowed or occluded artery.

It is not uncommon to experience some angina during inflation of the balloon as the coronary artery is temporarily occluded and the heart muscle is deprived of oxygen.

This only lasts for a very brief period of time and resolves as soon as the balloon is deflated.

At the same time a stent may be placed in the coronary artery. A stent is a small stainless steel mesh tube that supports the coronaryartery and maintains patency.

Preparation:

Fasting:

You will be required to fast for 6 hours prior to your procedure. Fasting means no food or fluids- except a sip of water with medications.You may be allowed to have a light early breakfast and tea/coffee on the morning of your appointment.

Hygiene:No special requirements – shower or bath as per usual.

Types of Percutaneous Transluminal Coronary Angioplasty (PTCA)

  • Balloon angioplasty
  • Carotid artery angioplasty
  • Cerebral angioplasty
  • Coronary artery stent
  • Laser angioplasty
  • PTA of the Femoral Artery

Procedure :

Angioplasty is performed while you are awake, under local anesthetic. It’s sometimes uncomfortable, but not usually painful. The surgeon makes a small incision in the groin or arm and inserts a thin tube, called a catheter, into the artery. The catheter includes a small balloon and a small wire tube, called a stent. Once the catheter is in place, a dye is injected and X-rays are taken, which tell the physician exactly where the blockages are and how narrow the artery is. This is also known as an angiogram and functions as a map for the doctor.The doctor will then inflate the balloon, opening the stent and pushing it against the artery wall. After the procedure is complete, the cells that line the blood vessel will grow around the stent, holding it in place. The whole procedure usually lasts 30 minutes but may last as long as several hours. Sometimes, people will have to return to get their arteries redone because of renarrowing (restenosis) at the site of the balloon inflation.

Post OP Care :

Most people are admitted to hospital and monitored overnight after angioplasty. They are usually sent home early the next day.Once home, you can starting doing routine activities after a few days, but should avoid any type of lifting or other strenuous physical activity for about 5 days or as long as your doctor advises. Your doctor will advise you when you will be able to return to work and resume driving and other physical activity.

If you have a stent, you will usually have to take an extra blood thinner medication such as clopidogrel* in addition to acetylsalicylic acid for at least the first few months in order to prevent blood from clotting on the metal stent. This treatment may continue for one year. You may also have to put off dental work for several months due to the risk of endocarditis (an infection of the heart).

Angioplasty is safer than bypass surgery. Less than 1% of people die from complications of angioplasty. Non-fatal serious complications occur in 1% to 5% of people who undergo this procedure.

These complications include:

  • Tearing of the lining of the artery resulting in total blockage and possible heart attack – this can usually be repaired with a stent.
  • Stroke from a clot that is dislodged while the catheter is inside the body
  • Bleeding or Bruising
  • Kidney problems, especially in people with underlying kidney disease and diabetes – this is caused by the iodine contrast dye used for the X-ray; intravenous fluids and medications can be given before and after the procedure to try to reduce this risk