Blocked artery before and after a stent is inserted.
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|What Is Coronary Angioplasty?
Coronary angioplasty, also known as percutaneous coronary intervention (PCI), is a medical procedure used to open narrowed or blocked arteries of the heart. It results in better blood flow to the heart muscle and improves symptoms of coronary heart disease (CHD) such as angina pain and shortness of breath. A person who arrives in emergency with severe angina or a heart attack probably has one or more coronary arteries that is blocked and the first priority is for surgeons to release the blockage and restore blood flow. Angioplasty will be used in this instance. Once the blockage has been treated, the patient may be recommended coronary heart bypass surgery as a long-term solution to CHD. In non-emergency situations, as medications and lifestyle changes are not always enough to prevent CHD, angioplasty may also be carried out to relieve symptoms of angina or to try and prevent heart attacks occurring. More than 1.2 million angioplasties are carried out every year in the United States (61,000 in the UK). Due to the risk factors of heart disease, angioplasty is most commonly performed on patients over the age of 65. It can also be used to unblock brain and neck arteries to prevent stroke in women and men.
Coronary angioplasty is beneficial for people undergoing a heart attack (see heart attack treatment). Numerous studies show that early intervention with angioplasty and stenting (see below for explanation) during a heart attack can save lives. If a patient arrives in hospital due to a heart attack and the hospital has an interventional cardiologist on duty, then angioplasty is the treatment of choice. If the facilities are not available, then thrombolytic therapy is used instead.
Useful: Know The Causes of Coronary Heart Disease.
Coronary angioplasty is usually performed in a cath lab (catheterization laboratory), which is a specially equipped room in a hospital. The patient will be injected with sedatives and pain medications before the procedure to help them relax. This is known as conscious sedation which means that the patient is awake but their senses are dulled. Electrodes are placed on the patient's chest and are then attached to an electrocardiogram to monitor their heart rate throughout. Next an area of the leg (or sometimes the arm) is cleaned and anesthetized, ready for the insertion of a catheter (cath) which is a long plastic tube (see heart cath). Once the patient is comfortable, a small cut is made and the cath is inserted. The doctor will guide it to through the blood vessels, watching his progress on a nearby monitor. Once the cath is at the entrance of the main coronary artery a contrast dye is injected. This allows the doctor to identify the blocked vessels. Images are taken by an external X-ray machine which hovers over the patient. After studying any blockages he then inserts a device with a tiny deflated balloon into the affected artery. Once in place the balloon is inflated. It expands and squeezes the accumulation of cholesterol and plaque (atherosclerosis) away from the center and back into the wall of the artery. The balloon is kept in place for 2 minutes before being deflated and removed. If necessary the doctor can inflate the balloon several times to reshape the artery. This technique is known as balloon angioplasty but it has now been largely replaced by stenting.
Stenting is a more permanent solution to blocked arteries than balloon angioplasty alone. With this technique, once the cath is in place a small tube made of wire mesh is inserted into the blocked artery to open it. The procedure is performed by a specialist called an interventional cardiologist who uses a balloon to expand the stent at the correct point of the artery. The stent then locks into place once it is opened and any plaque or cholesterol is squeezed behind it. There are two main types of stents: bare-metal and drug-eluting. Bare metal is just that, a stent made of nothing but metal. A drug-eluting stent is covered with a chemical that releases a drug from the metal to stop any scarring over the stent. This is to prevent the necessity of replacing it in the future. Since drug-eluting stents were approved by the FDA in 2003 their popularity has grown rapidly. By the end of 2008, 68 percent of all PCI procedures used drug-eluting stents.
1. Calcium channel blockers to prevent coronary artery spasm.
2. Nitroglycerin tablets which are a vasodilator that relax and expand the coronary arteries.
3. Aspirin and other antiplatelets may be prescribed to prevent blood clots forming. If a stent was inserted you will need to take blood thinners permanently. An antiplatelet medication like clopidogrel will be necessary for one month after a bare-metal stent and one or more years after a drug-eluting stent. See also: Coronary heart disease treatment.
As stents are made of metal, you should not have an MRI (magnetic resonance imaging) for at least 4 weeks. However you can travel through airport security without causing the alarms to go off.
Overall angioplasty has been proven to save heart attack victims lives and it relieves discomfort in those with angina. It is generally well tolerated by patients and complications are not very common. If complications do occur, they are not usually severe. The most common complaint is bleeding or discomfort at the site where the cath was inserted. This can be controlled by pressure to the site and taking pain relief medications. Occasionally the technique can cause tears in the blood vessels but these normally heal by themselves. If the tear is severe however, immediate surgery is necessary - this may involve inserting another stent or in severe cases bypass surgery. Some patients can experience chest pain caused by minor tears, or caused by pieces of cholesterol plaque flowing away from the main artery down to smaller vessels where they then cause blockages or spasms. The pain is not normally severe. Other more worrying dangers however include:
According to a study by the Stanford University School of Medicine, the average cost of angioplasty with stents is about $21,000. The average UK cost is £8,500.
Registering Your Stent
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