You may have a pre-assessment of your health a few days before the operation. This will give you an opportunity to discuss any concerns with your surgeon.
Before a coronary angioplasty is carried out, the arteries near your heart need to be assessed to make sure the operation is technically possible. This is done using a test called coronary angiography.
During coronary angiography, a long, flexible plastic tube called a catheter (about the width of the lead in a pencil) is inserted into a blood vessel, either in your groin or arm.
The tip of the catheter is guided using an X-ray to your heart or the arteries that supply your heart. A special fluid that shows up on X-rays, known as contrast medium, is injected through the catheter. The resulting pictures are called angiograms.
You may be asked not to eat or drink anything for four hours before a coronary angioplasty. You will usually be able to take most medications as normal up to the day of the procedure, with the exception of blood-thinning medication (anticoagulants), such as warfarin. You may also need to alter the timing of any diabetes medication you take. Your medical team can give you more information about this.
Read more about preparing for an operation.
The operation
A coronary angioplasty usually takes place in a room called a catheterisation laboratory, rather than in an operating theatre. A catheterisation laboratory is a room that is fitted with X-ray video to allow the doctor to monitor the procedure on a screen.
Coronary angioplasty usually takes about 30 minutes, although it may take longer depending on how many sections of your artery need to be treated.
You will be asked to lie on your back on an X-ray table. You will be linked up to a heart monitor and given a local anaesthetic to numb your skin. An intravenous (IV) line will also be inserted into a vein, in case you need to have painkillers or a sedative.
The cardiologist (heart specialist) will make a small incision in the skin of your groin or wrist and will insert a catheter. They will guide the catheter through the artery in your groin or arm, passing it through the main artery in your body (the aorta) and into the opening of your left or right coronary artery.
A thin, flexible wire is then passed down the inside of the blood vessel being treated to beyond the narrowed area. A small, sausage-shaped balloon is passed over the wire to the narrowed area and inflated for up to 60 seconds. This squashes the fatty material on the inside walls of the artery to widen it. This may be done several times.
While the balloon is inflated, the artery will be completely blocked and you may have some chest pain. However, this is normal and is nothing to worry about. The pain should go away when the balloon is deflated. Ask your cardiologist for pain medication if you find it uncomfortable.
You should not feel anything else as the catheter moves through the artery, but you may feel an occasional missed or extra heartbeat. This is nothing to worry about and is completely normal.
If you are having a stent inserted (see below), it will open up as the balloon is inflated and will be left inside your artery.
When the operation is finished, the cardiologist will check that your artery is wide enough to allow blood to flow through more easily. This is done by monitoring a small amount of contrast dye as it flows through the artery.
The balloon, wire and catheter are then removed and any bleeding is stopped with a dissolvable plug or firm pressure.
Going home
A coronary angioplasty often involves an overnight stay in hospital, but many people can go home on the same day if the procedure is straightforward. After the operation, you will not be able to drive for one week so you will need to arrange for someone to drive you home from hospital. Read more information about recovering from a coronary angioplasty.
What type of stent?
A stent is a short, wire-mesh tube that acts like a scaffold to help keep your artery open. There are two main types of stent:
- bare metal (uncoated) stent
- drug-eluting stent, which is coated with medication that reduces the risk of the artery becoming blocked again
The biggest drawback of using bare metal stents is that, in around 30% of cases, the arteries begin to narrow again. This is because the immune system sees the stent as a foreign body and attacks it, causing swelling and excessive tissue growth around the stent.
Many cardiologists avoid this problem by using drug-eluting stents. These are coated with medication that reduces the body’s abnormal response and tissue growth.
Once the stent is in place, the medication is released over time into the area that is most likely to become blocked again. The two most researched types of medication are:
- "-limus" drugs (such as sirolimus, everolimus and zotarolimus), which have previously been used to prevent rejection in organ transplants
- paclitaxel, which inhibits cell growth and is commonly used in cancer chemotherapy
The use of drug-eluting stents has reduced the rate of arteries re-narrowing from around 30% to below 10%. However, as drug-eluting stents are still a relatively new technology, it is uncertain how effective or safe they are in the long term.
Before your procedure, discuss the benefits and risks of each type of stent with your cardiologist.
If you have a stent, you’ll also need to take certain anti-platelet drugs to help reduce the risk of blood clots forming around the stent. These include:
- aspirin, taken every morning for life
- clopidogrel, taken for 11 or 12 months depending on whether you have had a bare metal or drug-eluting stent, or whether you have had a heart attack
- prasugrel, which is used as an alternative to clopidogrel in some hospitals
