Angioplasty and stenting

Angioplasty and stenting, also called percutaneous coronary intervention (PCI), is a minimally invasive procedure to open blocked coronary arteries, which supply blood to the heart. This procedure is a minimally invasive alternative to open-heart surgery.

During an angioplasty, an interventional cardiologist inserts a catheter with a deflated balloon into a blood vessel and guides it to a clogged artery. Then they inflate the balloon to open the artery. Without this treatment, blocked coronary arteries can limit blood flow to the heart, causing symptoms such as chest pain and shortness of breath. Over time, severely blocked arteries can lead to complications such as a heart attack or stroke.

Angioplasty is often used along with stenting. In a stent placement, a small, mesh tube (stent) is placed inside the artery after angioplasty to help keep the artery open and restore blood flow to the heart. Over time, heart tissue grows around the stent. Most stents are coated with medication to help prevent tissue overgrowth and ensure the artery stays open long-term.

Usually, cardiologists recommend angioplasty and stenting for people who have narrowed coronary arteries from coronary artery disease. Coronary artery disease usually occurs when a fatty substance called plaque builds up in the arteries, causing a condition known as atherosclerosis.

Some people may need angioplasty and stenting to treat a heart attack. Heart attacks occur when blood supply to the heart is abruptly cut off. An angioplasty and stenting procedure can quickly restore blood flow to the heart to reduce heart damage.

Your care team will give you specific instructions to prepare for an angioplasty and stenting procedure. They’ll ask you about any medications you take regularly, including over-the-counter medicines and herbal supplements. If you take anticoagulants or aspirin regularly, you may need to stop taking them for a brief period before the procedure.

Angioplasty and stent placement may take several hours, depending on how severe the coronary artery blockage is. You receive sedation to keep you comfortable. An entire team of specialists—including an interventional cardiologist, an interventional echocardiographic expert, and an anesthesia specialist—work together to perform angioplasty and stenting.

The team connects you to an electrocardiogram (EKG) machine to monitor your heart’s electrical activity. You are also attached to machines that keep track of your breathing, heart rate, blood pressure, and oxygen levels.

During an angioplasty and stenting procedure, an interventional cardiologist:

1. Makes a tiny incision and places a plastic, hollow tube (sheath) through a blood vessel in your wrist or groin
2. Inserts a catheter with a deflated balloon and collapsed stent through the sheath
3. Injects contrast dye through the catheter to highlight your coronary arteries
4. Uses X-rays to view the coronary arteries and guide the catheter to the blocked artery
5. Inflates the balloon to widen the artery. You may be asked to take a deep breath and hold it as the catheter is positioned. They may inflate and deflate the balloon several times to fully open the blocked artery.
6. Expands the stent into position to keep the artery open

Angioplasty and stenting effectively restores blood flow in coronary arteries affected by atherosclerosis. It often reduces the risk of complications such as heart attack and stroke and manages symptoms such as chest discomfort. This minimally invasive treatment allows us to treat coronary artery disease without the downsides of open-heart surgery. People who have angioplasty and stenting typically experience fewer complications and less pain. They also recover more quickly than with open-heart surgery and spend less time in the hospital.

Angioplasty and stenting complications are rare, especially when the procedure is performed by an experienced physician. When complications do occur, they may include:

• Arrhythmias (irregular heart rhythms)
• Bleeding
• Blood clots
• Heart attack
• Infection
• Stroke

You may stay in the hospital overnight after angioplasty and stenting so your team can monitor you for complications, or you may return home the same day. You’ll need to drink plenty of water to flush the contrast dye from your system, but most people can resume their usual diet immediately after angioplasty and stenting.

After you return home, you’ll need to avoid strenuous activities for one to two days. Most people can return to their usual activities within about a week. Your cardiologist will prescribe medication along with aspirin to reduce your risk of blood clots. Most people take aspirin or another blood-thinning medication for at least 30 days and up to one year.

You may notice some bruising around the catheter insertion site. This is normal. Call your doctor right away if you experience any symptoms of complications, including:

• Bleeding, swelling, or warmth around the catheter insertion site
• Chest pain or pressure
• Dizziness or fainting
• Excessive sweating
• Fever or chills
• Nausea or vomiting

The specialists in Interventional Cardiology at Penn Medicine are experts in angioplasty and stenting, with a long history of excellence and innovation. When you choose our team, you benefit from:

• Exceptional outcomes: Our success rates for angioplasty and stenting are above 95 percent, making our program one of the best in the country.
• Team-based care: We work closely with specialists in cardiac anesthesia, Heart Surgery, cardiac imaging, and nursing. This collaboration helps ensure we find the most effective treatment plan for your needs.
• Clinical trial treatments: Our specialists were among the first in the nation to start using heart stents in the 1990s. Today, we continue to stay at the leading edge of angioplasty and stenting by developing and implementing the newest techniques, often before they’re widely available.