Angioplasty

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Angioplasty is used to treat narrowing (stenoses) of the arteries related to atherosclerosis. Through the groin, a small tube (catheter) is inserted into the artery. Contrast dye is injected under continuous x-ray (fluoroscopy) to outline the areas of stenosis. A wire and balloon catheter are negotiated past the region of blockage and used to dilate the artery from the inside, literally “cracking” the plaque and expanding the vessel to increase the channel blood takes through the artery. In some cases, we use special “cutting balloons” to score the plaque; other times we use freezing balloons (cryoplasty) to treat the plaque or we deploy a metal tube (stent or stent graft) to help keep the artery open. The technique used depends on the condition of the plaque.

Angioplasty can be performed under a local anesthetic with sedation, either in the operating room or fluoroscopy suite. Generally, patients can be discharged the same day, after a period of bed rest to heal the puncture site. If we are successful at angioplasty, most people are advised to take a blood thinner for a period of time afterwards. This helps to keep the newly treated artery open.

Often, if the artery is completely blocked, we do not know ahead of time whether we will be successful with an angioplasty. Sometimes, we cannot re-open the artery, and we must consider other methods (like bypass). The advantage to angioplasty is that it is minimally invasive and healing time after the procedure is generally very brief. The disadvantage is that angioplasty may not last as long as bypass surgery. Re-narrowing of the artery (restenosis) is not uncommon over time. Maintaining good control of risk factors (watching blood pressure and cholesterol, managing diabetes, not smoking) maximizes the chances of long-term success after angioplasty.

After angioplasty, patients are encouraged to be active, but to avoid heavy lifting or straining for a week. Risks of angioplasty include puncture site complications, bleeding or bruising, downstream embolization.