If you have been diagnosed by your physician with coronary artery disease (CAD), this means that blood vessels that feed your heart are narrowed or blocked. CAD can cause angina (pressure, tightness or pain in your chest, arm, neck or jaw). CAD can also lead to heart attack or even death. To help treat this heart problem, your physician may want you to consider a procedure called Percutaneous Transluminal Coronary Angioplasty (PTCA).
PTCA relieves symptoms of CAD by improving blood flow to your heart. During PTCA, a catheter (a thin, soft, flexible tube) with a balloon at the tip is inserted into your artery to widen the passageway. Then, the catheter is removed. After the procedure, you may need to stay in the hospital for a day or more.
The night before your PTCA, you may be asked not to eat or drink anything after midnight. You may be given routine blood tests, an ECG or EKG (electrocardiogram), and a chest x-ray prior to your procedure. You'll also be given medication to help you relax. You will be awake during the procedure, which usually takes 1 to 2 hours.
The skin is numbed where the catheter is inserted, so you won't be in pain. An introducing sheath is inserted into the artery through your groin, or possibly your arm. A guiding catheter (a thin, soft, flexible tube) is inserted through the sheath and moved to the artery that is blocked. X-ray contrast fluid is injected through the catheter to allow your physician to see your artery on an angiogram (video x-ray picture). A guide wire is inserted and positioned through the blockage. The guide wire is used to position the balloon catheter. The physician will compress the plaque buildup against the artery wall.
A guide wire is inserted through the guiding catheter and moved to the narrow spot in your artery. Your physician tracks its movement on the angiogram (x-ray video).
A balloon-tipped catheter is inserted through the guiding catheter and threaded over the guide wire. It is positioned at the narrow part of the artery.
The balloon is inflated and deflated and deflated several times to compress the plaque against the artery wall. You may feel angina when the balloon is inflated. Tell your physician if you do.
The balloon is deflated and the catheters and guide wire are removed. The artery is now open, and blood flow to the heart muscle increases.
The risks of angioplasty are fairly low and are usually outweighed by the benefits to your heart. Possible risks include:
- Tearing or cracking of the artery lining
- Bleeding from the insertion site
- Problems related to the x-ray contrast fluid (allergic reaction to iodine or kidney damage)
- Heart attack, stroke or death. Rarely, a complication occurs that makes emergency bypass surgery necessary. A cardiac surgery team stands by during your angioplasty, just in case.
After the PTCA, you'll be taken to a cardiac care unit or a special recovery room. If there are no complications, you'll probably go home day after the procedure. Your physician gives you instructions on medications and follow-up care, including any follow-up visits.
In addition to regular checkups and blood tests, your physician will usually schedule some other tests, including an exercise stress test, within the first six months after your procedure. These tests check to see whether your artery has remained open. If you start to feel symptoms like the ones you had before the stent implant, tell your physician. To treat the problem, your physician may recommend further testing or additional procedures.
During the first six months after your PTCA, your treated artery may narrow again. Tell your physician if you feel symptoms like the ones you had before your PTCA. Your physician may recommend further testing or other procedure to treat the problem.
While PTCA can help in the treatment of coronary artery disease, it is not a true cure. You need to change any unhealthy habits (also called risk factors) that helped create your heart problems in the first place. Some risk factors are smoking, eating too much fat and salt and not getting enough exercise. Making changes to reduce risk factors can help keep your heart condition from getting worse and may even improve the health of your heart. If you have any questions or concerns, be sure to ask your physician.