Matters Of The Heart: Angioplasty And When Is It Needed

Angioplasty is a surgical procedure used to unblock or widen clogged blood vessels (arteries). While it can be performed in other parts of the body, angioplasty is most commonly employed to relieve cardiac (heart) arteries. However, before an in-depth study of this procedure, we must first understand how arteries are blocked in the first place.

This generally happens due to an accumulation of plaque on the inner walls of your arteries. Plaque constitutes of various substances that circulate in your blood. These include calcium, fat, cholesterol, muscle cells, cellular waste, connective tissues and fibrin, a material involved in blood clotting. In response to plaque buildup, cells in your artery walls multiply and secrete additional substances that can worsen the condition of clogged arteries.

In the cases of excessive buildup, arteriosclerosis may result, which is the narrowing and hardening of blood vessels over time. Arteriosclerosis obstructs adequate oxygen supply to the heart, particularly when the arteries are narrowed by 50 to 70%, leading to chest pain, heart attacks and Coronary Artery Disease (CAD).

Men and Women with a genetic history of coronary disease and those over the age of 45 and 55 respectively are at an increased risk of arteriosclerosis. Other factors such as high blood pressure, stress, obesity,cholesterol, smoking and diabetes can also accelerate the process.

Procedures Used for Angioplasty

Doctors may choose any one of the following procedures depending upon the patient’s condition:

• Balloon Angioplasty

A thin and flexible hollow tube (catheter) with a deflated balloon at one end is inserted into the blocked cardiac artery via an artery in the wrist or groin. On reaching the blockage site, the balloon is inflated, pushing out the plaque and widening the artery.

• Stents

Used often with balloon angioplasty, these small, hollow, metallic tubes are attached to the catheter and inserted into the blocked artery, after which the balloon is inflated and they expand to a fixed amount with artery.

While the balloon and catheter are removed following unblocking and expansion, these stents remain inside to ensure that the artery doesn’t collapse and retains the induced expansion. They can either be drug-elated, i.e. coated with medication to avoid re-blockage or plain and uncoated bare-metal stents.

• Rot-ablation

A special catheter with a diamond-coated and acorn-shaped tip spins rapidly in the blocked artery to grind away the accumulated plaque, which is then washed away into the bloodstream. It is, however, rarely used due to the procedure being difficult to perform and having a low-rate of long-term performance and results as compared to stented balloon angioplasty.

• Atherectomy

Plaque is shaved off the artery walls via a sharp blade protruding from a specialized catheter which also contains a hollow chamber in which the shaved plaque is collected. The catheter is then removed and the chamber emptied, and the process is repeated until the artery is cleared of plaque. Like rot-ablation, atherectomy is also rarely used.

Benefits of Angioplasty

Not only does angioplasty improve blood flow in the arteries and minimize heart muscle damage after a heart attack,  increasing the chances of survival, it also reduces the possibility of future heart attacks.

Additionally, angioplasty reduces chest pain, shortness of breath and fatigue caused by reduced blood flow to the heart. After a heart attack, the sooner a doctor restores ample blood flow to the heart, the lesser the risk of more damage to the heart muscles.

In addition, an angioplasty may reduce the chances that you require a more invasive procedure known as open-heart bypass surgery which also requires a significantly longer recovery duration.

When To Have an Angioplasty

While most coronary artery blockages can be treated with medication and positive lifestyle changes, angioplasty may be required if you have:

• Coronary Artery Disease (CAD),
• A heart attack,
• Recurrent angina (chest pains) which is unresponsive to medicinal or lifestyle changes,
• One or more narrowed arteries, resulting in extremely reduced blood flow to a certain area of the heart, or
• An artery which is narrowed by or close to 70% or is blocked.

Risks of Angioplasty

Like all medical procedures, particularly those that are somewhat invasive, angioplasty comes with its own set of risks. All medical procedures come with a certain amount of risk. There is the chance of undergoing an allergic reaction to anaesthesia, the dye or other substances used in the procedure. Some other risks are listed below: 

• Bleeding, clotting, or bruising at the point of insertion
• Scar tissue or blood clots developing in the stent
• Arrhythmia, or irregular heartbeats
• Damage to a heart valve, blood vessel or artery
• A heart attack
• Kidney damage may result, particularly in people who suffer from pre-existing kidney problems
• An infection

This procedure is accompanied by the risk of stroke, although the risk is low. 

When NOT to have an Angioplasty

Angioplasty is not recommended when:

• There is no evidence of severe angina symptoms and reduced blood flow,
• You are diabetic,
• Only small areas of the heart are blood-deprived,
• The affected artery is unreachable via catheter, or
• You are unable to take blood thinners, aspirin or other anti-platelets, after stenting.

Remember to consult with a couple of cardiac surgeons before choosing to undergo an angioplasty or any other coronary surgery, as it is advised to have a second opinion before proceeding with such surgical procedures.

You can book an appointment with a top Cardiac Surgeon in Lahore, Karachi and Islamabad through oladoc.com. Or call our helpline at 042 3890 0939 for assistance to find the RIGHT Doctor for your heart-related issues.