Percutaneous Transluminal Coronary Angioplasty
Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure used to open blocked coronary arteries, to improve blood flow and allow blood to circulate to the heart muscle. This procedure is often performed to treat blockages that have developed as a result of atherosclerosis or coronary artery disease. Atherosclerosis occurs when plaque builds up on the inner walls of the arteries and causes them to harden and narrow, often leading to coronary artery disease. A percutaneous transluminal coronary angioplasty involves the insertion of a tiny balloon that is inflated to open and widen the artery. It is often combined with the insertion of a small wire tube, called a stent, that helps keep the artery open. This less invasive procedure is often considered as an option to more invasive open heart surgery.
Candidates for a Percutaneous Transluminal Coronary Angioplasty
A percutaneous transluminal coronary angioplasty may be recommended for people with blockages in the arteries of their heart, especially if they are experiencing chest pain and discomfort. It may also be performed if lifestyle changes and medication have not been effective, or after an individual has had a heart attack.
Preparation for a Percutaneous Transluminal Coronary Angioplasty
Patients will be advised about any fasting and whether they have to stop taking any medications, prior to the procedure. The procedure is performed in a hospital. Prior to the percutaneous transluminal coronary angioplasty, an intravenous (IV) line is placed into the patient's arm to administer fluid and medication. The medication is used to relax the patient and prevent blood clots from forming. The area where the doctor will insert the catheter (usually the groin) will be shaved. After it is shaved, that area is cleaned and then numbed. The numbing medicine may sting as it is administered.
The Percutaneous Transluminal Coronary Angioplasty Procedure
During the percutaneous transluminal coronary angioplasty procedure, an incision is made in the groin, and a catheter is inserted. A contrast dye is injected through the catheter, to highlight the clogged areas during the procedure. A tube with a deflated balloon is inserted through the catheter to the blockage. The balloon is inflated to widen the artery, pushing the plaque aside to allow the blood to flow through smoothly. To hold the artery open and prevent it from narrowing again, a wire mesh tube called a stent may be inserted. Some stents are coated with medication that is slowly released into the arteries to help prevent scar tissue from forming and blocking the artery. Once the procedure is completed, the catheter is removed from the artery. Pressure may be applied to stop any bleeding at the catheter insertion site. During the procedure, patients are often sleepy but awake. The procedure takes approximately 1 to 2 hours to complete.
Recovery from Percutaneous Transluminal Coronary Angioplasty
After the procedure, patients are required to stay in the hospital for a few hours for monitoring. Some patients may stay in the hospital overnight for observation. The site where the catheter was inserted is checked for bleeding and patients may experience soreness or tenderness in the area. Medication is prescribed to help prevent blood clots from forming. Patients are often able to return to work approximately 1 week after the angioplasty procedure. Cardiac rehabilitation may be recommended after a coronary angioplasty. Patients are encouraged to make certain lifestyle changes after this procedure to lower their risk of coronary artery disease. Life style modifications may include exercise, quitting smoking, losing weight and reducing stress.
Risks of Percutaneous Transluminal Coronary Angioplasty
Although rare, complications of percutaneous transluminal coronary angioplasty include the following:
- Blood clots
- Abnormal heart rhythms
- Rupture of the coronary artery, requiring open-heart surgery
- Allergic reaction to contrast dye
- Heart attack
The risk of complications is higher in people older than 65 years of age; those who have extensive heart disease and blockages in their coronary arteries; and people who have chronic kidney disease or diabetes.