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How Is Angioplasty Performed And What Is The Recovery Time

Dr. Purshotam Lal

An angioplasty is a common procedure that’s performed to treat people with acute coronary syndrome (ACS). An angioplasty is used to clear blockages in the arteries The angioplasty procedure is similar to that used to perform an angiogram. It is performed with the help of a catheter by an interventional cardiologist in a cath lab. In a cath lab patient lie on a table and be mildly sedated but he remain awake throughout the procedure.

The cardiologist uses a small needle to inject lidocaine, a local anesthetic, to numb an area in the groin, or upper leg, or in the arm.  This needle prick could be the only pain that patient feels throughout the procedure.

How catheter is inserted?

Catheter is a flexible tube that is smaller than the vessels. The femoral artery in the groin – near where your leg bends from the hip – is one of the vessels cardiologists most commonly use to insert a catheter and thread it through the arteries to the heart to perform the angioplasty. Instead of the femoral artery, your doctor may choose to insert the catheter in the brachial or radial artery in the inside of the elbow or wrist.

From this “access” point in leg or arm, a “guiding” catheter is threaded through the arteries to the heart. (Since there are no nerves in your arteries, patient will not feel the catheter.) An x-ray camera and images of your arteries on a TV screen help the physician guide the catheter to the blockage.

When the guiding catheter is properly positioned, the cardiologist injects a contrast dye (radiographic contrast agent) through the catheter into the heart and its arteries. Most people do not feel the dye injection. However, some feel minor discomfort, typically lasting only a few seconds, in their chest. A few feel lightheaded or nauseous.

How blockage is removed?

Next, a balloon catheter – a long, thin flexible tube with a small uninflated balloon at its tip – is threaded through the guiding catheter to where the artery is narrowed. A guide wire – a tiny, thin wire of about .014 inches’ diameter – is then passed across the narrowed segment. It serves as a guide for positioning the tiny balloon across the blockage.

Once in position, the balloon is inflated with water and x-ray dye. (It may be inflated several times.) When fully inflated, the balloon pushes the plaque against the wall of the artery. Some patients feel minor discomfort when it is inflated. If you have more than minor discomfort, medication to relieve it can be given immediately.

As the balloon inflates, plaque that extends into the wall of the artery may tear or crack. This is normal and necessary.

Once the balloon is deflated, x-ray pictures are taken ensure the blockage is gone. When the balloon catheter is removed, final x-ray pictures are made.

What is the recovery time after angioplasty?

Once your cardiologist has completed the procedure, recovery will begin. After the procedure, the artery is closed with a closure device or manual pressure is applied to stop bleeding. Patients are able to walk with assistance in four to six hours and usually stay in the hospital overnight for observation. This is far less time than is required in the case of more invasive procedures, like heart surgery.

Recovery from angioplasty and stenting is typically brief. Discharge from the hospital is usually 12 to 24 hours after the catheter is removed. Each case, of course, is different. In some cases patients were able to go home the same day of their angioplasty without a higher risk of complications. Your doctor will give you specific recovery instructions like no heavy lifting or strenuous exercise for a few weeks after the procedure.

Most people are able to return to work within 1 to 2 weeks after an angioplasty procedure. In case of a heart attack, recovery may be longer.

 Chairman  – Metro Group of Hospitals & Director Interventional Cardiology Cardiology & CTVS in Metro Hospitals & Heart Institute, Noida

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