- Angioplasty or percutaneous transluminal coronary angioplasty (PTCA) is a technique used to widen the narrowing in your artery without surgery. The basic idea of angioplasty is to position a catheter with a small inflatable balloon on the end within the narrowed section of the artery. The balloon is then inflated, which pushes outward against the narrowing and surrounding wall of the artery. The inflated balloon opens the narrowed artery by splitting and compressing the plaque and slightly stretching the wall of the artery.
- The balloon may be inflated several times during angioplasty. Each balloon is made of special materials that allow it to inflate to a specific size. Your doctor will select a balloon that will be approximately the same size as your artery. It is possible the first balloon will be removed and other, larger balloons used if additional expansion is required.
You will probably be asked not to eat or drink anything after midnight on the night before your procedure. If you have not already stopped smoking, your doctor may recommend that you do so prior to being admitted to the hospital in preparation for the upcoming procedure.
Some hospitals do not allow patients to wear dentures or glasses during the procedure. If you have dentures or glasses and want to wear them, ask your nurse about hospital policy.
Your preparation prior to treatment will include tests such as an ECG, a chest x-ray, and routine blood tests.
Talking With Your Doctor
Your doctor will discuss the procedure in detail and tell you the approximate time the procedure is scheduled. He or she will explain the possible risks and benefits and answer any questions you or your family may have.
Be sure to tell your doctor what medications you are currently taking. You should also tell your doctor about any allergies you have, especially to x-ray dye or iodine. These allergies may require additional medication prior to a procedure. It is also important to let your doctor know if you cannot take aspirin, since this and other medications are usually begun prior to a procedure and continued for several months thereafter
Ensuring Your Comfort
Just before you leave your room, empty your bladder so you will be comfortable during the procedure. At this time, your nurse will give you some medication to help you relax.
The following two preparatory steps are typically done at this time, but may sometimes be done after you are brought to the catheterization laboratory:
An intravenous (IV) needle and tube will be placed in the vein in your hand or arm before the procedure. Fluids or medications can be given quickly and easily through this tube if they are needed.
Your nurse will make marks on your hands and feet where your pulse can be felt. These marks make it easier to check your circulation during and after the procedure.
Your procedure will be performed in a catheterization laboratory or a special procedure radiology suite. This room may be similar to the one where you had your diagnostic angiogram. You will lie on an x-ray table, and an x-ray camera will move over your chest during the procedure. The staff will monitor your heart by attaching several small, sticky patches to your chest and use a specialized ECG recorder and monitor
Preparing Your Skin
The area where the catheters are to be inserted, either your groin, arm or wrist, will be shaved and scrubbed with antiseptic solution to prevent infection. You will then be covered with sterile sheets.
Before starting the procedure your doctor will inject a local anesthetic (numbing medicine) where the catheters will be inserted. You may feel a stinging sensation as he or she does this. However, after the medication takes effect, you should only feel dull pressure where the physician is working with the catheters. If you do feel pain, please tell your doctor.
Inserting the Guiding Catheter
Your doctor will choose to insert your guiding catheter in one of three spots:
Groin/Femoral Approach
Catheter introduction into the groin requires a small incision to be made on the inside of your upper thigh so an introducer sheath (short tube) can be inserted into your femoral artery. Next, your doctor will insert a guiding catheter (long, flexible tube) into the introducer sheath and advance it through the aorta to where the coronary arteries branch off to the heart or affected peripheral artery.
Arm/Brachial Approach
Catheter introduction into the arm requires that a small incision be made on the inside of your elbow after local anesthesia has been given. The guiding catheter is then inserted directly into the artery through the small incision and advanced to where the coronary arteries branch off to the heart or the affected peripheral artery.
Transradial Approach
Catheter introduction into the wrist requires that a small incision be made on the inside of your wrist after local anesthesia has been given. The guiding catheter is then inserted directly into the artery through the small incision and advanced to where the coronary arteries branch off to the heart or affected peripheral artery.
Injecting the Dye
After the catheters are inserted, your doctor will inject x-ray dye through the guiding catheter into your artery to look at the narrowing. Your doctor will watch this injection on an x-ray monitor, much like a TV screen. You may be able to watch these pictures yourself. While these x-rays are being taken, your doctor may ask you to take a deep breath and hold it for a few seconds. You may also be asked to cough after the x-ray picture is completed to help speed the removal of the x-ray dye from the arteries.
You will be awake during your procedure. From time to time, your doctor or a staff member may give you instructions. It is important to listen for these instructions and to do what is asked.
Angioplasty includes four major steps:
The balloon catheter will pass through the guiding catheter to the artery near the narrowing. A guide wire inside the balloon catheter is then advanced through the artery until the tip is beyond the narrowing.
Next, the angioplasty catheter is moved over the guide wire until the balloon is within the narrowed segment.
Once in position, the balloon is inflated. It is common to experience some pain when the balloon is inflated, because blood flow through the artery is temporarily decreased or blocked. This pain should decrease when the balloon is deflated. It is important to tell your doctor if you do experience pain.
When your doctor is satisfied that the plaque has been compressed and that the artery has been opened sufficiently, he or she will remove the deflated balloon catheter. By taking more x-ray pictures of the artery, your physician can see how much the blood flow has improved.
After the balloon catheter, guide wire, and guiding catheter are removed, the introducer sheath may be secured and left in your groin for several hours or overnight if your procedure was performed by the femoral approach. If a brachial or transradial approach was used, your doctor will close the artery and the incision and bandage your arm or wrist. If a sheath was inserted into the brachial or radial artery, it will be removed and a tight bandage will be placed to apply moderate pressure to the area where the catheter was inserted.
Monitoring After the procedure
you will return to your hospital room where you will be watched closely by the nursing staff. Your blood pressure will be checked frequently, and you will be attached to an ECG monitor so that your heart can be monitored continuously. While you are in bed, a nurse will check the site where the catheter was inserted as well as the pulse in your feet and arms.
Bed Rest
If the Catheter Was Inserted in Your Groin
If your groin was used for the procedure, you can expect to stay in bed for several hours. The introducer sheath is usually removed within six hours of the procedure, but may be left in longer if heparin, a medication given during your procedure, is continued. While the introducer sheath is in place, and for about six hours after its removal, you will lie flat on your back in bed, keeping your leg with the sheath straight and still. To remove the introducer sheath, a nurse or doctor will put pressure on the puncture site for 20 to 30 minutes, or until there is no bleeding. A sandbag may be placed over the puncture to keep pressure on it. Although bleeding will be unlikely at this time, if you feel a warm, wet sensation or sharp pain in the area of the puncture, call a nurse at once. Stay lying down in bed and press on the puncture with your fingers. The nurse will show you how to do this. If you happen to cough or sneeze, you should press on the site with your fingers. Do not try to sit up until your nurse or doctor instructs you to do so. It is important to lie flat and keep still to prevent bleeding from your artery.
If the Catheter Was Inserted in Your Arm
If your arm was used for the procedure, you may be allowed to sit up afterwards, but you may be asked to stay in bed for several hours.
Relieving Pain and Discomfort
You will urinate often because your kidneys will be getting rid of the x-ray dye that was injected into your arteries. You will also be asked to drink extra fluids so that your kidneys can get rid of this dye more easily. If you need help with any activity during this time (for example, in using the bedpan or bathroom), ask a nurse to help you. If you get back pain from lying still, your nurse can make you more comfortable. You may be allowed to bend the leg that was not used for the procedure. Your nurse may also be able to elevate the head of your bed slightly to help relieve back pain. If you are still uncomfortable, your nurse can give you medication for pain. Mild chest discomfort is common immediately following a coronary procedure but should fade within one or two hours. If your chest pain increases or returns, be sure to notify a nurse right away. If tests suggest that the pain may indicate a problem with the dilated artery, it may be necessary to take additional x-ray pictures of the artery before you go home. A return of chest pain is unusual beyond the first thirty minutes after the procedure.
Going Home
You will be asked to walk within 12-24 hours. The nurse will assist you the first time you get out of the bed. Before leaving the hospital, you may want to discuss your risk factors for coronary artery and/or peripheral vascular disease with your doctor or nurse. It is important to set realistic goals when planning changes in your lifestyle and eating habits. After the procedure a patient is usually sent home from the hospital in one to two days. You should arrange to have someone take you home rather than driving yourself.
