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Coronary Angioplasty / Stenting

Overview

Where a narrowing is identified in a coronary artery during a coronary angiogram, the cardiologist may treat the lesion using a stent (fine mesh tube). This is known as Percutaneous Coronary Intervention (PCI), which means ways of opening narrowings in coronary arteries using fine tubes called catheters introduced from the wrist or groin. Narrowings are treated with balloons and stents (fine mesh stainless steel tubes) that reduce the chance of renarrowing. PCI is also known as angioplasty or stenting.

Before and After Stenting

LCA-diseased
This image shows a narrowing (arrow) in Left Coronary Artery (LCA) which supplies blood to the left side of the heart.
LCA-after-stent
This image shows the disease area treated with a bioresorbable stent restoring the blood supply to the heart. 
Refer to Related Documents on coronary angiography and angioplasty (PCI).

 

How is Angioplasty / Stenting performed?

The procedure is conducted in an angiography suite (“cath lab”) at Mercy Angiography, which is in the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your interventional cardiologist will be assisted by nurses and other highly trained staff. 
 
  • Once a suitable narrowing is found in the coronary arteries during you coronary angiogram / diagnostic procedure, the angioplasty / stenting to treat the lesion will follow on directly as part of the same procedure.
  • Through a guiding catheter, a wire about the thickness of a hair, is passed across the narrowing in the artery.
  • A stent (a fine mesh tube that comes squashed down on a balloon) is directed across the narrowing by the wire.
  • The balloon is inflated to expand the stent and artery.
  • The stent is pushed into the artery wall holding the artery open.
  • The balloon is deflated and removed leaving the expanded stent in place. Once expanded, the stent cannot move.
 
Angioplasty 1 resized   Angioplasty 2 resized
1. Through the guiding catheter, a wire about the thickness of a hair, is passed across the narrowing.   2. A stent (a fine mesh stainless steel tube that comes squashed down on a balloon) is directed across the narrowing by the wire.
Angioplasty 3   Angioplasty 4
3. The balloon is inflated to expand the stent and artery. The stent is pushed into the artery wall holding the artery open.   4. The balloon is deflated and removed leaving the expanded stent in place. Once expanded the stent cannot move. For some patients the artery is widened by the balloon alone.
 
 
Angioplasty before Angioplasty after
Coronary artery before stenting. Coronary artery after stenting.


Drug eluting stentsAngioplasty 5

The majority of stents used during PCI are drug eluting stents. These stents are coated with a medication to abolish or substantially reduce the chance of renarrowing and the need to repeat the treatment.



Bioresorbable scaffolds (stents)

These are drug-eluting stents that do their job and then dissolve. An artery only needs support for about three months and after this a permanent stent is unnecessary. This is similar to the analogy that if you break your arm, the plaster cast is kept on only until the bones have healed, not for the rest of your life. While metal drug-eluting stents are excellent, a resorbable stent may be a step forward.

Not all patients may be suitable for resorbable stents. Mercy Angiography Cardiologists led by Professor John Ormiston have been in the forefront of international research on these.
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What will I experience during the procedure?

  • You will be lightly sedated but awake throughout the procedure.
  • You should not feel any pain at the catheter entry site but there may be some non-painful sensations such as pressure.
  • You cannot feel the catheter moving inside your arteries.
  • You may feel discomfort similar to your angina when the stent is being deployed.
You should tell the cardiologist if you are experiencing any pain. Usually people have little or no discomfort. Sever pain is very rare.
 
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How should I prepare for my procedure?

  • Fasting: You may eat until 2 hours before admission then you should not have anything to  eat. You may continue to drink clear fluids.
  • Allergies or previous reactions to contrast (x-ray dye): Please inform Mercy Angiography staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
  • Diabetes: If you are a diabetic you should tell the Mercy Angiography staff at the time of booking. You may need to discuss your insulin dose with your cardiologist.
  • Warfarin or Coumadin: If you are taking Warfarin (a “blood thinner”) you should make this known to Mercy Angiography staff at the time of booking. It is likely that you will need to stop this medication temporarily for a few days before angiography.
  • Other usual medications: Continue these unless advised otherwise by your cardiologist. In particular, please continue taking your aspirin. 

Please bring with you any medication and any recent blood test results or chest x-rays. 

You may bring a favourite music CD as this can be played during the procedure.

You are encouraged to bring a friend or family member.
 
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What happens after my procedure?

  • The catheter is removed from the artery and pressure applied.
  • Your cardiologist will discuss their findings with you while you are in hospital or at a follow-up appointment.
  • You will usually be required to stay overnight following percutaneous coronary invention (angioplasty / stenting).
  • The Land Transport Safety Authority (LTSA) says you should not drive for 48 hours after having percutaneous coronary invention (angioplasty / stenting).
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What are the risks?

  • Percutaneous coronary intervention is a very common test and important complications are rare.
  • A small amount of bruising at the catheter entry point is relatively common. Discolouration may spread down the leg or up over the lower abdomen. This usually is not clinically important unless the groin is becoming more painful.
  • Uncommonly bleeding from the groin early after the procedure may occur.
  • Sometimes a “false aneurysm” or out-pouching of the artery deep under the skin occurs at the puncture site. This shows up as increasing pain at the puncture site. The diagnosis is made by an ultrasound test and treatment is usually by an injection.
  • Abnormal or irregular beating of the heart may occur but is usually brief and easily treated.
  • An allergic reaction to the X-ray contrast (dye) with rash or itching, sometimes occurs. Exceptionally rarely a very severe life-threatening allergic reaction can occur.
  • A heart attack or a stroke is a very rare complication.
  • The x-ray contrast may cause some damage to kidneys that is usually temporary. It is more common in those patients who already have damaged kidneys or who suffer from diabetes.
  • Infection is very rare.
  • Restenosis: Although stents reduce the chance of renarrowing of the angioplasty site, it can still occur and is due to the healing cells growing through the mesh of the stent. It is most common between six weeks and six months after stenting but exceptionally rare beyond six months. It is most likely to occur in small diameter vessels, long narrowings and in diabetic patients. If it does occur, it is usually possible to treat the artery again.
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