Treatment: Angioplasty & stents
Angioplasty is a procedure done under local anaesthetic, in order to dilate or unblock narrowed or blocked arteries. Coronary angioplasty is performed by threading a long thin tube (catheter), at the tip of which is a small inflatable balloon, from an artery in the arm or leg to the narrowed artery in the heart.
The deflated balloon is passed into the narrowed or blocked arterial segment and the balloon is inflated and then deflated, in order to restore normal blood flow along the artery. In many cases, a short cylinder of expandable wire mesh (or "stent") is first placed over the deflated balloon, so that the stent can be left in place within the artery, holding the dilated segment open. Angioplasty may not be suitable for everyone (see British Heart Foundation for more information).
In some situations, angioplasty can be performed as the initial ("primary") treatment for a heart attack, within the first few hours of the onset of its symptoms. This is called primary angioplasty (see 'Initial treatments').
In other situations, other treatments are given initially, after which angioplasty may or may not be used, either before the patient goes home from hospital, or at some later time. One man was transferred to a specialist hospital to have a stent fitted before he was discharged home after his heart attack. Another man had an angioplasty after thrombolytic drugs hadn't worked. Others were discharged from hospital to wait for a date for angioplasty, usually several months later.
Before angioplasty is done, patients need to sign a consent form. One man said his doctor explained very clearly the risks and possible outcomes of the procedure before he signed the form.
Most people said angioplasty was very straightforward and not painful, or only a little uncomfortable. For one man the worst part of the procedure was needing to lie flat for several hours afterwards, to prevent any bleeding from the artery in his leg, and to ensure his blood pressure is stable and he was not having any adverse reactions to the medication he had been given. One man, who was transferred from his local hospital to a regional cardiac centre after an acute heart attack, explains that a balloon pump was used to support the heart during angioplasty.
One woman who had quite a lot of discomfort immediately after the procedure said it didn't last long.
The benefits of angioplasty may not be permanent so that it may have to be done again or coronary bypass surgery may be necessary. One man who had angioplasty two years ago, was beginning to experience angina and was waiting to have another angiogram (see 'Making a diagnosis') for information about angiograms.
