Angioplasty with Stent Placement: How it Helps Open Blocked Arteries

21 March,2024

Your heart is the tireless engine that keeps you going, pumping life-giving blood throughout your body. But what happens when the highways delivering that blood become blocked? Coronary artery disease (CAD) can cause fatty deposits to build up in your coronary arteries, restricting blood flow to your heart muscle. It can lead to angina (chest pain), shortness of breath, and even heart attack.

There's good news! If your arteries are blocked, a minimally invasive procedure called angioplasty with stent placement can help restore blood flow and improve your heart health. In this blog, we will explore this procedure and its benefits.

What is Coronary Angioplasty and Stent Placement?

Coronary angioplasty is a minimally invasive cardiac procedure to treat blockages in the arteries supplying blood to the heart. It is one of the most common cardiac surgeries, with over 2 million stent placement procedures performed every year.

During angioplasty, a heart specialist inserts a flexible tube into a blood vessel, generally in the arm, wrist, or groin. The catheter is then guided through the arteries until it reaches the blockage. Once there, a tiny balloon at the tip of the catheter is inflated, pushing plaque build-up against the artery wall and opening the blockage.

But here's the twist: A small mesh tube called a stent is often placed inside the artery simultaneously to keep the artery open for a long time. This stent acts like a scaffold, opening the artery and preventing it from narrowing again.

How do Stents Work?

A stent is a tiny device that can save lives. It comprises fine metal mesh 15 to 20 mm in length. Stents are made of stainless steel, cobalt-chromium, or platinum-cobalt. They might also have a drug coating to prevent scar tissue growth between the stent gaps. These types of stents are known as drug-eluting stents. They offer better long-term results and are used in over 95% of cases. 

Stents work by preventing the re-narrowing of the arteries. When the clogged artery is opened by just using the balloon, there is a 30% chance that it may recoil and become narrowed again. Using stents reduces the probability of recoil to 10-15%. If the cardiologist opts for drug-eluting stents, it further reduces to 2-3%.

How Long Does Stents Last?

A stent placement is a permanent procedure. However, as mentioned earlier, there is a 2 to 3% chance that the artery will narrow again. It usually occurs within 6 to 9 months of stent implantation, in which case, the cardiologist will insert another stent to open the artery.

You can reduce the likelihood of getting multiple stents by following the doctor's advice on lifestyle modifications such as lowering cholesterol levels, eating a balanced diet, quitting smoking, and managing blood pressure.

Who Needs Angioplasty with Stent Placement?

People with sedentary lifestyles and bad eating habits are prone to a condition known as atherosclerosis. In atherosclerosis, plaque accumulates inside the arteries. Plaque causes blockages in the arteries, narrowing them and reducing the amount of blood flowing through them.

When atherosclerosis occurs in vessels carrying blood to the heart (coronary arteries), it is known as coronary artery disease. Angioplasty with stent placement is the first choice of treatment for such patients. However, if multiple coronary arteries are blocked, a CABG might be the right procedure. 

A cardiologist recommends angioplasty with stent placement to patients if – 

• Lifestyle changes and medications are not helping to improve heart health
• Chest pain due to angina is worsening
• Blood flow needs a quick fix to treat heart attack

What to Expect Before Angioplasty with Stent Placement?

Angioplasty with stent placement is crucial for improving blood flow to the heart. But before you head into the cath lab, a few crucial steps help ensure a smooth and successful experience. These include – 

• Initial Consultation: Your doctor will thoroughly discuss your medical history, symptoms, and medications. Then, they will brief you about the procedure, address your concerns, and answer your questions.
• Imaging Tests: You'll likely undergo imaging tests like coronary angiography. This procedure uses a special X-ray and contrast dye to visualize your coronary arteries and identify any blockages.
• Blood Tests: Blood tests might be required to assess your overall health and blood clotting ability.
• Medications: Your doctor might adjust or prescribe new medicines to manage risk factors like high BP or cholesterol.
• Fasting: Your healthcare team will instruct you to fast for 8-12 hours before the procedure to ensure an empty stomach.
• Medications on Hold: Certain medications, especially blood thinners, might need to be temporarily stopped before the procedure. Only stop medication after discussing it with the physician. 
• Allergies: Notify your doctor about allergies you have (if any), especially to medications or contrast dye used in imaging tests.

Don't hesitate to voice your concerns or ask questions throughout this process. Understanding the procedure and what to expect beforehand can significantly reduce anxiety and promote a smoother experience.

How is the Procedure Performed?

Coronary angioplasty with stent placement is a simple procedure first performed in 1977 in Switzerland. It is natural to get jitters before any surgery, no matter how easy and simple it may be. But to help you ease, here is a brief about the procedure and the steps involved. 

• In the first step, you will receive pain medicines and sedatives via IV lines to make you relax and calm during the procedure. Local anesthesia will be given at the site of incision to numb the skin.
• Next, the surgeon will make a small incision on the wrist, groin, or arm. They will make the incision over an artery where the doctor can feel the pulse.
• A thin bendable tube known as a catheter will be inserted through the incision. The cardiologist will move it up to the point where the blockage is. X-rays and special contrast dyes help doctors guide the catheter through the vessels.
• Once the catheter reaches the desired location, another flexible wire is inserted into it. The cardiologist also sends along a small sausage-shaped balloon, which is inflated and deflated several times. The procedure pushes the plaque towards the artery's boundaries, ultimately widening it. 
• Placing the stent is the next step. Stents help prevent the recoiling of the blocked arteries. Once the stent is placed at its location, the cardiologist withdraws the catheter and wire. 
• The final step involves placing a closure device or applying pressure to stop the bleeding. A bandage is put over the incision site to cover it.

Are There Any Risks Involved in Angioplasty with Stent Placement?

Coronary angioplasty with stent placement is a highly successful and safe procedure. It has been performed for about 50 years and has seen significant improvements over time. But no invasive procedure is without risks. Complications in angioplasty are low, with an incidence of 1 in 100 procedures. Some of the risks associated with coronary angioplasty are – 

• Re-narrowing of the artery: Although the risk is low, the artery can always narrow again after stent placement. 
• Bleeding and infection: Since angioplasty is an invasive procedure that involves inserting the catheter, there are risks of pathogenic infection and bleeding at the incision site.
• Blood clots: Thrombus can form within the implanted stent. It can cause complete blockage of the artery, ultimately leading to a heart attack. 
• Artery damage: The coronary artery might get torn or ruptured during the surgery. It requires immediate open-heart surgery. 
• Stroke: If the plaque breaks loose, it can move to the brain and block blood flow. It is one of the rarest complications of angioplasty. 

Other not-so-common complications include kidney injury, heart attack, and irregular heartbeat. Choosing expert and experienced cardiologists can significantly reduce your chances of developing such complications.

How Can the Outcomes of the Surgery be Improved?

Angioplasty with stent placement is a powerful tool to improve your heart health. However, long-term lifestyle changes are essential to prevent future blockages. You can improve the surgery outcomes by following a few simple steps – 

• Heart-Healthy Diet: Limit the intake of added sugars, saturated and trans fats, and cholesterol-elevating foods. Focus on fruits, whole grains, vegetables, and lean protein.
• Exercise Regularly: Try doing moderate-intensity exercise for at least 30 minutes daily.
• Stress Management: Chronic stress leads to heart problems. Find healthy ways for stress management, such as yoga, meditation, or spending time in nature.
• Healthy Weight: Being obese or overweight is known to increase the risk of heart disease.
• Don't Smoke: Smoking is a considerable risk factor for many conditions, including heart disease. Quitting smoking is the best thing you can do for your heart health.

With proper care and lifestyle modifications, recovering from angioplasty with stent placement can be smooth. Remember, a positive outlook and commitment to a healthy lifestyle go a long way in promoting long-term heart health and overall well-being.

Conclusion

Coronary angioplasty with stent implantation is a minimally invasive and effective procedure that can open blocked arteries and improve blood flow to the cardiac muscles. It can significantly alleviate angina and other heart disease symptoms, allowing you to live a more fulfilling life. Timely diagnosis and intervention are the key to a successful treatment. So, if you ever experience any symptoms of heart trouble, don't hesitate to talk to your doctor. They can help you make an individualized treatment plan to keep your heart healthy and strong.