Coronary Angioplasty and Stent Insertion

What is coronary angioplasty and stent insertion?

Coronary angioplasty is a procedure used to open narrowed or blocked arteries in the heart. It involves the use of specialised balloon catheters to initially treat the narrowings, followed by the insertion of one or more stents. A stent is a hollow tube made out of wire mesh that when implanted in the area of narrowing, relieves the blockage and holds the vessel open to stop it collapsing back down. The stents most commonly used today are made of metal alloys and are coated with special drugs that act on the vessel wall to stop excessive scar tissue formation that can sometimes occur. These type of stents are known as a drug-eluting stents. They are very effective and are associated with excellent long-term results.

Why might I need angioplasty and a stent?

The need for coronary angioplasty and stent insertion is determined by your symptoms, test results and the findings of your angiogram. Typically, coronary angioplasty is performed in people who have angina, an abnormal stress test or a heart attack. In all these cases, the angiogram must also demonstrate blockages that are appropriate for angioplasty. Sometimes, alternative treatments other than angioplasty are recommended such as bypass surgery or more intensive medications.

How is the procedure performed?

Your angioplasty may be performed immediately after your coronary angiogram so that the two procedures are performed one after the other. Alternatively, you may just undergo angioplasty alone. This happens when it was not possible to perform the angioplasty at the time of your earlier angiogram, or in people who need two or more angioplasties and the procedures are staged at different times. Your doctor will explain how this works in your case before the procedure commences.

The actual procedure involves initially treating the narrowings in the coronary artery with a balloon catheter placed into the coronary artery either through the main artery in the groin or wrist. The balloon on the catheter is then inflated, stretching and dilating the area of the artery that is narrowed. In most cases, one or more stents are then placed in the area just treated with the balloon to optimise the result and reduce the risk of the artery re-narrowing in the future. In some cases, balloon treatment alone is considered enough to ensure successful restoration of blood flow and a stent is not required.

How do I prepare for the procedure?

You will be admitted to the hospital either the same day or night before the procedure. Please bring all your normal medications and personal items for an overnight stay. You will need to fast (no food or drink) for 6 hours prior to the procedure. Our office staff will provide information on the scheduled time for the procedure and any other special instructions that may be required. You will also be required to complete a Cabrini registration form, and return it to the Admissions Desk on your arrival to the hospital.

If you don’t feel well on the day of the procedure, please inform our office.

How do I manage my normal medications?

In general, your regular mediations can be taken at their usual time with a sip of water, even if you are fasting. However, there are some special instructions for certain medications such as anticoagulants, insulin and other diabetic medications, and our office will provide you with these instructions prior to your admission. If you are in any doubt about what to do, please contact our office to enquire.

People on warfarin and other anticoagulants such as dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis) need to be aware that there is a risk of bleeding and haemorrhage if the procedure is performed while on these medications. They will generally need to be stopped 2-5 days before the procedure. Please ensure that you notify our staff at the time of your booking if you are taking one of these medications, especially if you have not yet received instructions about what to do with them yet.

Other blood thinners including aspirin and clopidogrel (Plavix, Iscover), prasugrel (Effient) and ticagrelor (Brilinta) should be continued and NOT stopped prior to your procedure.

Diabetics may require adjustments to their treatment on the day of the procedure. People on metformin (Diaformin, Diabex) are now advised not to take this medication on the day of the procedure. Please clarify this with your doctor if he/she has not already done so. People on insulin may need special instructions. Please ask your doctor about this if it has not already been dealt with.

What do I go on the day of the procedure?

You need to present to the Cardiac Catheter Lab reception area, located in Area F, level 2. This can be reached via the Isabella St entrance, near Pathology and Day Oncology. Take the lifts just in from the entrance to level 2. You will need to bring your Medicare card, private health insurance details and a list of the medications you are currently on.

What happens after the procedure?

You will be required to stay in bed and keep relatively still for at least 6 hours afterwards. You will not be allowed to get up to the toilet during this period. If this may be a particular problem in your case eg. chronic back pain, unable to urinate lying down, restless legs, please discuss this with your doctor before the procedure.

You will not be able to drive on the day after the procedure. Most people can drive on the second day, but your doctor will discuss recommendations in your particular situation before you are discharged. Active sport including tennis, golf and lawn bowls should be deferred for 1 week following the procedure.

Your doctor will usually prescribe a new blood thinning medication, in addition to aspirin following the insertion of stents if you are not already on it. Examples include clopidogrel (Plavix, Iscover), ticagrelor (Brilinta) or prasugrel (Effient). These medicines help prevent clots developing inside newly inserted stents. It is very important that you take these medicines as directed and that you keep taking them unless your doctor says it’s OK to stop.

What problems can happen after the procedure?

The most common problems that occur after an angioplasty are bruising, bleeding, or soreness in the area where the tube was put in. These problems can last for a few days, especially if the tube was put in the leg. Please let your doctor know if you have any concerns regarding the site of insertion of the tube in the days and weeks after the procedure.

Coronary angioplasty is a safe procedure with an overall risk of a complication estimated at about 1 chance in every 500 cases. However, some of the complications are potentially very serious. These include:

  • heart attack during or after the procedure
  • damage to the coronary artery that cannot be repaired with further angioplasty and therefore requires emergency bypass surgery
  • risk of stroke which may cause speech disturbance, difficulty swallowing, paralysis and blindness
  • blockage of other major body arteries such as the artery to the arm and hand, bowel, kidneys and legs. This may result in significant damage to any of these organs or limbs.
  • kidney damage caused by a toxic effect of the dye. There is an increased risk of this occurring if there is pre-existing kidney problems or if the person is diabetic
  • allergic reactions to the dye which can be very severe in vulnerable individuals
  • other rare complications include thyroid problems precipitated by the iodine content in the dye, infection introduced into the body causing septicaemia, infection at the site of catheter insertion (wound infection).
  • death – people have died from coronary angiopasty, sometimes from one of the complications above, sometimes from a combination of factors

When should I call my doctor after the procedure?

If you have any serious concerns in the days and weeks after your angioplasty, you should discus them with either your local doctor or your cardiologist. Some examples of concerning problems include:

  • chest pain that does not get better with 1 dose of sublingual (under the tongue) nitroglycerin (Anginine or Nitrolingual Spray)
  • development of a fever
  • pain, swelling, or redness where the tube went in