Angioplasty is a non-surgical procedure designed to widen a narrowed artery or to open up the blockage by pressing the plague against the artery wall.

Stenting involves the implantation of a coronary stent, which is a small, slotted stainless steel mesh that is introduced to the arteries after angioplasty.

Indications

Narrowed or blocked arteries.

Preparation before angioplasty

Your cardiologist will detail the risk of angioplasty prior to the procedure and before you sign a consent form. The risks of angioplasty and stenting are usually outweighed by its benefits. The risks include:

A tear or puncture in the artery causing the artery to bleed or close suddenly (Re-stenosed) A dislodged piece of plague, which could impair the circulation to the foot or toe making bypass surgery necessary.

Recent advances in coronary stents are capable of minimizing these risks. Since May 2002 our Centre has used drug coated stents, which have been shown to reduce the re-stenosis rate significantly. Your cardiologist will be the best person to advice and recommend the correct type of stents to you.

You may be asked to take aspirin and/or other antiplatelet medications and some blood tests a few days before the procedure or before your admission. You should closely follow instructions given by your cardiologist or nurses.

You will need to remove all jewelry, dentures or contact lenses on the day of your procedure.

It is not necessary to have prolonged fasting for the procedure. It can be performed any time. Thus it is the ideal treatment for acute myocardial infarction in its initial stage. This procedure does not require general anesthesia. A mild sedative may be given to the anxious patient upon request.

Your nurse will set up an intravenous line for you. The discomfort is minimal during the procedure and you will remain alert.

How is angioplasty and stenting done?

The procedure will be performed in the Cath. Lab that is equipped with state-of-the-art instruments and radiographic equipment. Upon arrival, the cath lab team will assist you to lie on the X-ray table and drape you with sterile sheets.

Skin preparation will be done using an antiseptic solution before your cardiologist arrives. You will be asked to keep still during the procedure.

Your cardiologist will give you a local anesthetic to the groin or wrist area to minimize discomfort before inserting a small tube (sheath) into the blood vessel.

The procedure is similar to coronary angiogram. After insertion and guiding the catheter to the target artery, a wire is inserted through the narrowed segment of the artery. A balloon tipped catheter (a thin guide wire) is then inserted and threaded into the coronary artery to widen the passageway. An arteriogram is displayed on the video monitor so that your cardiologist can properly position the catheter. Your cardiologist will guide the balloon within the stent to the narrowed spot of the artery and deflate the balloon several times to crack the plague. This may cause the artery to expand slightly. When the blockage has been opened, the stent remains in place permanently to hold against the wall of the artery just before the balloon is deflated and removed.

The whole procedure usually lasts between 1-2 hours. Pressure will be applied to the puncture site until the bleeding has stopped. After the procedure you will then be transferred to an immediate care area or ICU.

You may eat and drink when you return to your room unless otherwise advised. You should take plenty of fluids to flush the contrast out of your kidneys.

You will need to lay flat for about 6 hours and should not bend the leg which has the puncture. If the insertion site is the wrist, you may bend your legs but not the wrist for a few hours. Your cardiologist will allow you to increase your activities gradually after the procedure. You will be able to go home in 1-2 days.