Coronary Angioplasty/Stent

A Coronary Angioplasty (PTCA) is a procedure in which a physician utilizes a small balloon catheter (flexible plastic tube) to open up a blockage in an artery that supplies blood to the heart muscle. Frequently a small, metal, spring-like device called a stent is also implanted into the coronary artery to reduce the chance that the blockage will recur.

Coronary Angioplasty/Stent can relieve blockages to allow a person to be active without chest discomfort and prevent a heart attack. Patients are usually given a mild sedative prior to the procedure. This will help you feel more relaxed and maybe a bit sleepy.

You will be taken to the cardiac catherization laboratory for the procedure. This is a room with special cameras to take x-ray pictures of your heart. Most PTCAs are done through a large artery in the groin, however sometimes they are done from the wrist or elbow area. The nurse or technician will cleanse and shave the groin (or arm) area and cover you with sterile drapes. The doctor will then numb the area and insert a small hollow tube or sheath into the artery in your groin (or arm). The physician can then thread special catheters (long, thin plastic tubes) up to the heart.

Through these specially shaped catheters, the physician can thread a wire across the blockage in the artery. Then, a thin expandable balloon is placed over the wire and inflated to open up the blockage. Several balloons of increasing size may be used to reduce the blockage. During a stent procedure, the stent, which is tightly mounted on a balloon, is placed across the blockage and the balloon is inflated opening the stent. Several other devices may be used during the procedure. Your physician will discuss these options with you.

Some people may notice mild chest discomfort while the balloon is inflated. You may be given a medication through your IV for several hours to reduce the chances of blood clots forming. The entire procedure can take as little as 30 minutes or sometimes more than an hour. After the procedure, most patients will be transferred to a post-procedure care area where the sheaths are removed from the groin when the blood thinners have worn off.

You will be asked to lie flat and still for several hours after the procedure to allow the hole in the artery to seal. Some physicians use a type of vascular closure device to seal the puncture in the artery. You should follow your physician's specific instructions about activity following the use of one of these devices. Most patients will stay in the hospital overnight.

After your procedure

It is normal for the puncture site to be a bit tender and bruised, and a small knot may even develop. If you notice redness, drainage, severe pain or swelling, talk to your doctor to see if further evaluation is indicated.

Patient Instructions:

1. Do not eat or drink anything after midnight before your test. Please take your medications as scheduled the morning of the test with a sip of water unless otherwise informed. Your physician will give you instructions on which medications to hold.

2. Bring your medications with you to the hospital the day you are admitted. Take your admission form with you to the hospital and give it to the admitting clerk.

3. Please inform your doctor if you have had a previous allergic reaction to x-ray contrast dye or shellfish. Your physician will prescribe medications to reduce the risk of an allergic reaction.

4. If you are diabetic and take insulin, take 1/2 dose the morning of the study unless otherwise instructed.

5. If you are diabetic and take medication containing Metformin (Glucophage), do not take the morning of the procedure.

6. If you are on Coumadin (Warfarin), your physician will give you instructions about this medication.

7. Your physician will prescribe Plavix 300mg to take the evening before your procedure unless you are already taking Plavix daily.

8. Your physician will order pre-procedure lab tests and a chest x-ray (if you did note have one in the past 6 months).

9. You may not drive for at least 36 hours after procedure.

10. Please leave all jewelry and valuables at home.

If you have additional questions about the procedure or instructions, contact your cardiologist.