CORONARY ANGIOPLASTY AND STENTING
One of the most common non-surgical treatments for opening obstructed coronary arteries
is Percutanueous Transluminal Coronary Angioplasty (PTCA).
Whereas twenty years ago, the majority of patients with arterial blockages were sent for
bypass surgery, today many patients are now eligible for CoronaryAngioplasty, a
procedure that is far less invasive and requires for the majority of patients, a vastly shorter
recovery time. There will still be instances where patients are referred for surgery.
Preparing for the Procedure – What do you need to do?
You should not eat or drink anything for four hours prior to the procedure. You will be given
special instructions if you are diabetic. Your groin area will be washed and shaved in
preparation for the PTCA. If you have had coronary angiography prior to the angioplasty,
this will have been completed already.
Angioplasty Procedure – What happens?
The length of time of each procedure depends on the complexity of the individual diagnosis
and situation. Procedures last between 1-3 hours for most patients. Of course, due to the
nature of the procedure, each individual will encounter different parameters. Variables
include the extent and nature of each blockage, as well as the number of blockages.
You will receive various medications through an intravenous line in your arm. As with
angiography, you will remain awake, but drowsy during the procedure. Dr Flood may want
to give you directions during the procedure.
• As with Cardiac Catheterisation, you will be placed on an x-ray table upon your arrival
in the lab. Surgical sheets will cover you. Your groin will be cleansed with antiseptic and
numbed. (You will feel the sting of the needle, but then your groin will feel quite numb.)
• Heart monitoring equipment will be placed on your arms and legs, and you may be
given oxygen to breathe.
• The angioplasty catheter (balloon-tipped) is inserted at the numb area, and advanced to
your heart, using x-ray guidance. Dr Flood will inflate the tiny balloon in the area where
the blockage occurs. It is normal when the balloon is inflated at the point of the
blockage to feel chest pressure, or discomfort. Once the balloon is deflated, this will
subside. Some patients feel a stronger thumping of the heart or skipping of beats. Some
also feel a flushed feeling. All these sensations are normal. You will be asked at times to
hold your breath for a few seconds. You may also be asked to cough.
• Dr Flood may also put stents (tiny tubular shaped mesh devices that hold the arteries
open) in to the arteries to inhibit the reforming of the narrowing. Newer drug eluting stents offer even greater assurance of the longevity of the repair.
• This procedure may be repeated several times if there is more than one narrowing or a
narrowing that is particularly long.
After the Procedure
At the end of the procedure, a closure device for the groin incision may be used.
You will be moved to a recovery area for a short time, and then taken to your room. Your
vital signs and general well-being will be monitored in the room. Your groin area and
dressing will be frequently checked and you will remain in bed and keep your leg
immobilised. Pain medication will be given as required and you will be required to take
other postoperative medication.
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You will be able to eat as soon as you wish after the procedure.
Discharge
You will be required to stay in hospital at least overnight. Doctor Flood will discuss your
individual requirements with you prior to discharge.
Doctor Flood will see you the morning of discharge and discuss any further needs including
follow-up consultations in the rooms and also medication. The hospital staff may also
discuss these requirements with you after consultation with Dr Flood. You will receive
prescriptions for the medicines you will need.
Possible Complications And Risk
No invasive procedure occurs without a certain amount of potential risk and complications.
Dr Flood and the hospital staff follow your recovery closely so that if any complications
arise, corrective action can be taken immediately. Although the incidence is low, you
should be aware that the following complications may rarely occur:
• Allergic reaction to the dye or to other medications.
• A tear in the artery during the procedure.
• Severe bruising/bleeding into the groin area of the procedure leg. This may come to the
surface over the next few days.
• Changes in heart rhythm.
• Blood clotting
• A heart attack or stroke
Follow-up Care
Periodic follow-ups with Dr Flood are quite important. He will discuss when your next
appointment should be made. After this, there will be a schedule of follow-ups and at least
yearly consultations. In some patients, re-narrowing of the artery may occur in the future.
It is important to realise that angioplasty and stenting, whilst removing the immediate
problem, do not cure coronary artery disease. It is vital that you maintain both your health
and have regular visits with Doctor Flood and your GP to ensure continued health. Be
aware of the signs and symptoms of reoccurring heart problems and take measures to seek
medical help immediately.
It is also vital to ensure that any medications you are prescribed are taken as prescribed.
In patients who have had stents, there is a life-long commitment to medication.
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