Coronary Angioplasty, also called percutaneous coronary intervention (PCI), is a procedure used to treat the slow buildup of fatty plaques in your heart's blood vessels. This type of heart disease is known as atherosclerosis. By opening clogged heart arteries, angioplasty can improve some of the symptoms of blocked arteries, such as chest pain and shortness of breath.

 When you have a heart attack, worsening chest pain or other symptoms, your doctor might recommend angioplasty. It can quickly open a blocked artery during a heart attack and reduce the amount of damage to your heart. It can also open an artery to limit the risk of an immediate heart attack.

 Angioplasty involves only a very small incision that allows access to a blood vessel in the leg, arm or wrist. A small, thin tube (catheter) is threaded through this blood vessel to the heart. A small amount of dye is injected through the catheter. This helps your doctor look at the blockage on X-ray images called angiograms.

Stent placement
Most people who have angioplasty also have a stent placed in their blocked artery during the procedure. The stent supports the walls of your artery to help prevent it from re-narrowing after the angioplasty. The stent looks like a tiny coil of wire mesh.

The procedure includes the following steps:

1) The stent is collapsed and placed around a balloon at the tip of the catheter, then guided through the artery to the blockage.

2) At the blockage, the balloon is inflated and the spring-like stent expands and locks into place inside the artery.

3) The stent remains in the artery permanently to hold it open and improve blood flow to your heart.

4) Once the stent is in place, the balloon catheter is withdrawn and an angiogram is used to see how well blood now flows through your newly widened artery.

5) Finally, the guide catheter is removed and the procedure is complete.

General anesthesia isn't needed, so you're awake during the procedure. You'll receive fluids and medications to relax you through an IV.

Preparation
In preparation for your angioplasty, you'll receive instructions about eating or drinking the night before and the morning of your procedure. Typically, you have to stop eating or drinking by midnight the night before. Depending on whether the angioplasty is pre-scheduled or performed as an emergency, you'll likely have some routine tests first, including a chest X-ray, electrocardiogram (ECG) and blood tests.

The night before your procedure, you should:

• Follow your doctor's instructions about adjusting your current medications. Your doctor may instruct you to stop taking certain medications before angioplasty, particularly if you take certain diabetes medications or blood thinners.
• Gather all of your medications to take to the hospital with you, including nitroglycerin, if you take it.
• Swallow your approved medications with only small sips of water.

Arrange for transportation home. Angioplasty usually requires an overnight hospital stay and you won't be able to drive yourself home the next day.

Aftercare
You'll probably remain hospitalized one day while your heart is monitored. While you are in the hospital, your doctor will likely prescribe anticoagulant medications to prevent blood clots, as well as medications to relax your arteries and protect against coronary spasms that can cause a heart attack. You should be able to return to work or your normal routine the week after angioplasty.

When you return home, drink plenty of fluids to help rid your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for several days afterward. Ask your doctor or nurse about other restrictions in activity. After a stent placement, you may need prolonged treatment with medications to reduce the chance of blood clots adhering to the stent.

Call your doctor's office or hospital staff immediately if any of the following occurs:

• The site where your catheter was inserted starts bleeding or swelling
• You develop increasing pain or discomfort at the site where your catheter was inserted
• You have signs of infection, such as redness, swelling, drainage or fever
• There's a change in temperature or color of the leg or arm that was used for the procedure
• You feel faint or weak
• You develop chest pain or shortness of breath.

Pain Management
The expert health care team at Holland Hospital does all they can to ensure your comfort throughout all procedures. A light sedative and a pain reliever is administered intravenously at the outset of your angioplasty, then as needed throughout the procedure, so be sure to communicate your needs to the nurse. Should you experience discomfort or anxiety, let the care team know.

After light sedation, your angioplasty will start with an injection of local anesthetic at the catheter site. This is so you won't feel discomfort when the catheter is passed into the blood vessel. You might feel pressure, but you won't feel pain. Tell your doctor if you do. You also won't feel the catheter inside your body. You may feel some mild discomfort at the catheter site after your procedure is complete and when your sedation and local anesthetic has worn off. This should resolve in a day or two. A nonaspirin pain reliever, such as acetaminophen (Tylenol, others), may help relieve the pain. Avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve), as these may increase the risk of bleeding.

Time/Schedule
Typically your cardiologist or your primary care physician will order angioplasty for you. Insurance carriers often cover angioplasty; however all insurance plans are unique and patients are encouraged to check with their carrier regarding rules of coverage.

Consult with your physician or health care provider to learn more.