Coronary Angioplasty

Angioplasty opens a narrowed coronary artery from the inside. A fine tube is passed from an artery at your wrist or groin up to the heart, a wire is steered across the narrowing, a balloon is inflated to push the deposit outward, and a stent, a small expandable mesh tube, is left behind to hold the artery open.

Almost all stents used today are drug-eluting, meaning they are coated with a medicine released slowly into the artery wall to stop scar tissue from growing back through the mesh. They become covered by the artery's own lining over the following months. They are permanent and they are not felt.

The stent fixes one segment of one artery. It does nothing about the process that narrowed it, so the tablets, the blood pressure and cholesterol targets, the exercise and stopping smoking are what protect the rest of the arteries, and they are as much a part of the treatment as the stent is.

You are admitted for the day or the night before. You will be asked to fast for a few hours, blood tests including kidney function are checked, and you will be given tablets to thin the platelets beforehand.

The skin over the artery at your wrist or your groin is numbed with local anaesthetic, so you are awake and talking throughout. Once the skin is numb you should feel pushing and pressure and no sharp pain. Contrast dye is injected to see the artery, which can produce a brief warm flush, and when the balloon is inflated you may feel a few seconds of the chest discomfort you came in with, which passes as soon as it is deflated. Tell the team what you are feeling as it happens.

The procedure takes 30 to 60 minutes and longer for a complex or completely blocked artery. Afterwards a tight band is put on the wrist and released gradually over a few hours, or pressure is held at the groin and you lie flat for several hours. You are monitored on the ward and usually go home the following day.

Most people feel well immediately and better than before if the artery was limiting them. Keep the puncture site dry for 48 hours and look at it daily.

After a wrist puncture, avoid lifting anything heavy with that arm for about a week. After a groin puncture, avoid straining, squatting and stairs where you can for two to three days and no heavy lifting for a week. Drink plenty of water for a day or two to help clear the contrast dye.

Most people return to desk work within a week of a planned procedure and drive after about a week, and both take longer where the angioplasty followed a heart attack, when four weeks off driving is more typical; your cardiologist will tell you what applies to you. A cardiac rehabilitation programme, which is supervised exercise plus education, measurably improves how you do afterwards and is worth asking for. Resume sexual activity when you can climb two flights of stairs comfortably.

The part that carries the greatest weight is the medication. You will be on two antiplatelet tablets for a defined period, commonly six to twelve months, and one of them usually for life.