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Treatment

 
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PostPosted: Mon Mar 27, 2006 12:16 pm    Post subject: Treatment  Reply with quote

Coronary angioplasty is a technique for treating coronary artery disease. It was first used in 1977 and has developed rapidly since then. Over 20,000 angioplasties are now done each year in the UK.

Coronary angioplasty 'squashes' the atheroma (fatty tissue) in the narrowed artery, allowing the blood to flow more easily.

Before you have the angioplasty you will be given a local anaesthetic. A catheter (a fine, hollow tube) with a small inflatable balloon at its tip is passed into an artery in either your groin or your arm. The operator then uses X-ray screening to direct the catheter to a coronary artery until its tip reaches the narrowed or blocked section. The balloon is then gently inflated so that it squashes the fatty tissue responsible for the narrowing. As a result, this widens the artery. The catheter contains a 'stent' which is a short tube of stainless-steel mesh. As the balloon is inflated, the stent expands so that it holds open the narrowed blood vessel. The balloon is then let down and removed, leaving the stent in place.
In the past, angioplasty was done without using stents, but stenting is now routine, unless the artery is not large enough to accept one.

Although it sounds simple, angioplasty is technically very difficult to do. It is very similar to the cardiac catheterisation test. However, it can take much longer to get the balloon catheter into exactly the right position. While the balloon is being inflated, you will probably get angina symptoms, but the pain eases very quickly when the balloon is let down again.

If you are having angioplasty with stenting, you will be given 'anti-platelet drugs' at around the time of the angioplasty. This will help reduce the risk of clots forming around the new stent. (Platelets are tiny particles in the blood which are the first step in forming clots that may block the stent. The anti-platelet drugs combat this effect.)

Coronary angioplasty cannot be used for all people with angina. Before you are accepted for coronary angioplasty, you will need to have a cardiac catheterisation test (angiogram). At the moment, only about half of the people tested are suitable for angioplasty. This is because, in many patients, either there are too many narrowings in the arteries, or the narrowings are too tight or too long and cannot be put right with current technology.

Angioplasty can also be used if you have had coronary bypass surgery but your graft has become narrowed.
How successful is coronary angioplasty?

At least nine out of every ten angioplasties are successful.

A small number of patients may have complications. Sometimes the treatment completely blocks off the narrowed artery. If this happens and the doctor thinks this will do serious damage to the heart, he or she may ask a surgeon to do an immediate bypass graft operation. So, if you are having angioplasty, you need to understand that you may have to have urgent heart bypass surgery and you must be prepared for this. Urgent surgery is needed in no more than 2 in every 100 cases, and the results of this type of surgery are good.

If you have the angioplasty but it does not clear the narrowed artery successfully, you may be referred for heart surgery. However, you won't need to have the operation immediately.

After angioplasty, the arteries may get narrow again in time. Using stents has greatly improved the success rate of angioplasty. After angioplasty with stents, only 3 in 100 arteries get narrow again (restenosis) within 6 months. Before stents were used, 1 in 3 arteries got narrow again within 4 to 6 months. Stents can also help to reduce the small risk of the coronary artery becoming completely blocked, which sometimes happens when an angioplasty is carried out.

Other methods of angioplasty

Other methods of angioplasty, such as rotablation, are used occasionally. Researchers are still trying to find out whether these new methods have definite advantages over ordinary angioplasty or angioplasty with stenting. In most cases balloon angioplasty with or without stenting is the treatment most doctors choose.

After the angioplasty

After the angioplasty, a nurse will check your blood pressure and heart rate regularly for four to eight hours. The nurse will also check the place where the catheter was inserted (the 'puncture site'), and the pulses in your feet or arm.

If the puncture site was in your groin, you will have to stay in bed lying on your back for a few hours after the operation. If the puncture site was in your arm, you may be able to sit up.

The introducer sheath (the device through which the catheter was passed into your artery) is usually removed several hours later. This is to help make sure there is not too much bleeding when it is taken out. The nurse or doctor will put pressure on the puncture site for about 20 minutes or until there is no bleeding. 'Collagen plugs' are often used now to close the hole in the artery so that the sheath can be removed immediately after the angioplasty.

If you get chest pain after the angioplasty, tell the nurse or doctor. You can expect to have some mild pain, but if the pain is severe you may need to have more tests.

Most people can go home the day after the angioplasty. Arrange for someone to take you home rather than driving yourself. Before you leave the hospital the doctor or nurse will tell you what you can and cannot do when you get home. They will tell you about what drugs you need to take and about your follow-up appointment. They will also offer advice on how you can improve your diet and lifestyle once you get home.

For the first few days after you get home, check your puncture site. You can expect to have some bruising, but if there is any redness or swelling, contact your GP (family doctor) or the hospital doctor.

It is best to avoid any demanding activities, like heavy lifting, for at least a week.

If you have an ordinary driving licence, you should not drive in the first week after having your angioplasty.

If you have an LGV (large goods vehicle) or PCV (passenger-carrying vehicle) licence, you should not drive for at least six weeks after angioplasty and you will need to have further tests before you can drive an LGV or PCV again.

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