Background Information:

What are the other Names for the Procedure?

• Balloon Angioplasty
• Percutaneous Coronary Intervention (PCI)
• PTCA

What is Coronary Angioplasty surgical procedure?

Angioplasty is a non-surgical procedure for widening a blood vessel that has become obstructed or narrowed.

What part of the Body does the Procedure involve?

The Coronary Angioplasty procedure, primarily involves the coronary arteries.

Why is the Coronary Angioplasty surgical procedure Performed?

• A Coronary Angioplasty is performed to remove or open, complete or partial blockages formed within the arteries in the heart
• However, in case of a heart attack, the physician may immediately perform an Angioplasty, to prevent further complication

What are some Alternative Choices for the Procedure?

• Coronary Angioplasty is a very good option if the person suffers from a complete or partial obstruction in the arteries
• However, if the patient has minor plaque(s); oral medications may be prescribed by the cardiologist, and this is a better alternative
• In case of severe arterial blockages; an Open Bypass Surgery may even be considered

What are the Recent Advances in the Procedure?

Angioplasty in itself is an advanced and reliable treatment option, for opening completely blocked or partially blocked arteries.

What is the Cost of performing the Coronary Angioplasty surgical procedure?

The cost of Coronary Angioplasty procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Angioplasty (Coronary) and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.mayoclinic.com/health/angioplasty/MY00352/DSECTION=risks

http://www.nhlbi.nih.gov/health/health-topics/topics/angioplasty/names.html

http://www.ncbi.nlm.nih.gov/pubmed/7671280

http://heart-disease.emedtv.com/angioplasty/expectations-with-angioplasty.html

Prior to Coronary Angioplasty surgical procedure:

How is the Coronary Angioplasty surgical procedure Performed?

• In a Coronary Angioplasty, a long thin tube called a catheter is inserted through the arm or upper thighs of the patient. It is slowly guided to the coronary artery where the blockage is situated
• The physician directs the catheter to the exact location of the blockage (or plaque deposition found in the interior of the arteries), with the help of X-ray imaging techniques and using a radio contrast dye that is injected in the patient’s blood
• The catheter is made to pass through the plaque and the balloon around the catheter is inflated. This results in compression of the plaque and widening of the arterial walls, thereby establishing normal flow of blood through the artery
• Throughout the procedure, the blood pressure, overall cardiac condition and stress to other vital organs are constantly monitored
• The physician may wait and examine the health status of the patient, before withdrawing the catheter. If the patient is stable, the catheter is removed and the skin bandaged
• Occasionally, the physician may place a stent around the balloon; and this gets implanted across the blocked area within the arteries, when the balloon is inflated. The stent helps by preventing the re-formation of plaque on the arterial walls
• In some cases, the stent is coated with medicines that assist in preventing any blockage of the artery, post Angioplasty. Such stents are called drug-eluting stents

Where is the Procedure Performed?

A  Coronary Angioplasty is performed in a hospital. The patient is admitted, undergoes the procedure, and is discharged as per the instruction of the physician.

Who Performs the Procedure?

The surgical procedure is performed by a cardiologist, assisted by a radiologist and a team of healthcare providers, specialized in cardiovascular treatment.

How long will the Procedure take?

• A Coronary Angioplasty does not take more than 1-2 hours
• However, the time to perform the procedure may increase, if the patient has more plaques or obstructions than previously determined
• The time is also dependent upon the number of coronary vessels the angioplasty is performed on

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

The physician will request your consent for the Coronary Angioplasty procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Coronary procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Coronary Angioplasty surgical procedure?

Prior to a Coronary Angioplasty, certain tests are performed, which are as follows:

• Routine blood test
• Electro Cardiogram (ECG)
• Chest X-ray (This is optional and depends on the physician’s advice)

The physician may suggest further tests depending on the health of the patient and their medical history.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Coronary Angioplasty?
• Why is this procedure necessary? How will this procedure help?
• What does the procedure involve?
• How soon should I get it done? Is there an emergency?
• What choices do I have apart from an Angioplasty?
• What are the other available, cost-effective surgical options?
• What are the risks involved?
• What are the possible complications that might take place, during recovery?
• Are there any chances for the failure of this surgery?
• Will an Angioplasty ensure that there shall be no future blockages, in the same artery?
• How long will it take to recover? When can I resume normal work?
• Do I have to follow any cardiac rehabilitation program post-surgery?
• How many such procedure have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Coronary Angioplasty surgical procedure:

What kind of Anesthesia is given, during the Procedure?

The patient is given local anesthesia with sedation, during the procedure.

How much Blood will you lose, during the Procedure?

Coronary Angioplasty does not involve any surgical incisions on the body. The insertion of the catheter into the artery normally causes, only a negligible amount of blood loss. If complications arise during the procedure, it could lead to further loss of blood.

What are the possible Risks and Complications during the Coronary Angioplasty surgical procedure?

The possible risks or complications that may arise during a Coronary Angioplasty are:

• Arrhythmia, or irregular heartbeat
• Blood clot formations
• Heart attack
• Stroke
• Rupture of the arterial lining or damage to the coronary artery. In such an instance, the patient may need an immediate bypass surgery
• The dislodged plaque could create a blockage in the artery, further downstream
• Allergic reactions to the dye used for X-ray imaging
• Bleeding from the spot where the catheter was inserted

What Post-Operative Care is needed at the Healthcare Facility after the Coronary Angioplasty surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Coronary Angioplasty surgical procedure:

What are the possible Risks and Complications after the Coronary Angioplasty surgical procedure?

Post Coronary Angioplasty, the following complications may arise:

• Restenosis: This occurs when there is a tissue growth, or reformation of plaque around the treated area in the artery, leading to a constriction
• Kidney failure
• Coronary spasms, which can lead to a temporary blockage of the coronary blood vessels, resulting in a new heart attack

What is the Prognosis after the Surgery?

• The prognosis is good with a high success rate for the surgical procedure
• Post Coronary Angioplasty, there are chances of the artery narrowing at the same spot, in a minority of the cases
• Use of drug-eluting stents has significantly decreased the incidence of re-blockage
• If the artery does not close within the first six months of Angioplasty; the chances are low that it would close later

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Sudden chest pain
• Shortness of breath
• Dizziness
• Pain, swelling, bleeding or discharge from the point, where the catheter was inserted
• Fever

What Post-Operative Care is needed at Home after the Coronary Angioplasty surgical procedure?

At home, the following post-operative care is recommended, after a Coronary Angioplasty procedure:

• Avoid any strenuous exercise or activities for a minimum period of 2 weeks
• Strictly adhere to, and complete the cardiac rehabilitation program, suggested by the physician
• The spot, where the catheter was inserted, may be gently cleaned with warm water and soap
• Completely avoid non-prescribed medication
• Resume routine daily activities as early as possible (under advise from your physician)

How long does it normally take to fully recover, from the Procedure?

It takes about 2-3 weeks to completely recover from a Coronary Angioplasty. 

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

A Coronary Angioplasty does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Coronary Angioplasty surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• A cardiologist
• A radiologist (if radiological tests were performed during the procedure)
• Other healthcare providers

The patient is advised to inquire and confirm the type of billing, before Coronary Angioplasty procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA