Angioplasty and stents

Angioplasty is done if the blood vessels to your heart (coronary arteries) are blocked or narrowed from a build-up of cholesterol and other substances (called plaque). This condition is known as atherosclerosis which can cause coronary artery disease.

The main symptoms of the blockage or narrowing are chest pain (angina) or shortness of breath. While angina can often be treated with medicines, a coronary angioplasty may be needed in severe cases where medicines aren't enough. After an angioplasty, many people find their symptoms get much better and they're able to do more than they could before the procedure.

Angioplasty may also be done as an emergency treatment after a heart attack, when blood flow to a section of heart muscle becomes blocked.

Angioplasty can increase your chances of surviving more than clot-busting medication (thrombolysis) and can lower your chances of having another heart attack in the future. 

A coronary angioplasty is performed using local anaesthetic, which means you'll be awake while the procedure is carried out.

• The start of the procedure is the same as for a coronary angiogram.
• A catheter (which is a fine, flexible hollow tube), with a small inflatable balloon at its tip, will be passed into an artery in either your groin or arm.
• Your doctor will then use X-ray screening to direct the catheter into a coronary artery until its tip reaches a narrow or blocked section. The balloon is then gently inflated to flatten the plaque against the artery wall, opening the artery to allow blood to flow more easily.
• During this time you may experience mild chest pain as the blood supply to the heart muscle is temporarily interrupted. It's important to let your doctor know if this happens.
• Once the artery has been sufficiently opened, the balloon is deflated and removed.

Stent implantation

Sometimes a stent is placed over the balloon. A stent is a tiny wire mesh tube that expands with the balloon and stays in the artery when the balloon is removed. As the balloon is inflated, it opens the stent against the artery walls. The stent stays in this position to help keep the artery open.

Image credit: iStock

Video: Coronary Stents: What you need to know

This video provides lots of information about angioplasty and coronary stents. It may take a few moments to load.

(Heart Matters, Australia, 2021)

A shorter video on coronary angioplasty(external link) can be watched on YouTube. 

Before an angioplasty, you should consider what changes you can make to your lifestyle to benefit fully from the procedure. This will reduce your risk factors and help reduce the possibility of further heart problems after an angioplasty. You can discuss your risk factors with your doctor or nurse.

There will be a routine examination and some tests before the procedure, eg, blood tests and an electrocardiogram (ECG). When you're admitted to hospital the doctor or nurse will explain the procedure and answer any questions you may have. They will record your medical history, the medicines you're taking and any allergies.

If you are taking medication, especially warfarin, your healthcare provider will advise you on whether to continue or stop taking it. If you're not sure what to do, ask your doctor, nurse or cardiologist. You should take all your medications to hospital with you.

When you return to the ward the nursing staff will closely monitor you until you're fully recovered. If the insertion sheath was in your groin, it's usually removed about 2 to 4 hours after you get back to the ward. However, if the sheath was in your arm, it will be removed at the end of the procedure. 

When the sheath is removed, pressure is applied to the area for about 20 minutes to stop any bleeding – it's very important that you lie still during and after the removal process. Follow the directions of the nurses, as they will let you know when it's safe to slowly move around. If you feel any bleeding, pain, dizziness, sweating or a warm, wet feeling around the insertion site, call the nurse immediately.

It's normal to have some bruising around the site and for it to be slightly tender. If you experience discomfort at the site, inform the nurse and you will be given pain relief. You may feel a small lump where the sheath was inserted, but this should disappear over the next few months. If this increases in size or becomes painful, seek medical advice.

Before you go home, a nurse will teach you how to check the site for bleeding and explain what to do if this happens. It's unlikely to happen if you've been walking around the ward. You'll be advised not to do any heavy lifting or straining for about a week, to prevent bleeding from the insertion site.

After an angioplasty you may go home that evening or stay the night in hospital and go home the following day. You will need to arrange for someone to take you home.

Before leaving hospital you'll be started on medicines, which must be continued when you go home. These will help prevent further heart problems. To prevent blood clots forming, you'll be given medicines including aspirin and either clopidogrel or ticagrelor. You should also take cholesterol-lowering medications (statins) which help protect you from further narrowings in the heart arteries and often you will also be prescribed medicines to lower your blood pressure. Always follow your doctor's instructions and don't stop taking any medicines without talking to your healthcare provider first.

After an angioplasty most people return to normal, everyday activities within 1–2 days of returning home, and can usually return to work after a week.

Remember that having an angioplasty is not a cure for heart disease. Your symptoms may have stopped, but you will still need to make, and maintain, changes to your lifestyle to prevent the angina returning. The best way to prevent further heart disease is to reduce or remove any risk factors. Every risk factor you reduce or remove can have a major effect on lowering your chances of having further heart disease problems, such as angina or a heart attack. 

Learn more about:  

• stopping smoking
• exercise and physical activity
• eating and drinking for a healthy heart(external link)
• reaching a healthy weight
• managing stress.

You may also be invited to go on a cardiac rehabilitation programme.

The New Zealand Transport Agency (NZTA) cardiovascular guide(external link) states you mustn't drive for at least 2 days after an angioplasty.

If you have complications arising from the procedure, or you have had a heart attack resulting in angioplasty, you must not drive until you have been given medical clearance, which is generally 2 weeks for a car licence.

If you hold a vocational licence (eg, you drive passenger vehicles, trucks, forklifts, courier vans or fly aeroplanes) different rules apply. Your licence needs to be approved by a cardiologist or specialist who will examine you and make sure it's safe for you to drive.

It also pays to check with your insurance company to ensure you're fully covered.

All types of surgery have a risk of complications, including coronary angioplasty, but the risk of serious problems is small. Coronary angioplasty doesn't involve major surgery and doctors describe it as a minimally invasive form of treatment.

Overall, the risk of serious complications from a coronary angioplasty is small, but this depends on factors such as:

• whether the procedure was planned or as emergency treatment
• your age
• your general health
• whether you've had a heart attack.

Your healthcare provider can give you more information about your individual risks and benefits.

Possible complications during or after an angioplasty

• It's quite common to have some discomfort, bleeding or bruising under the skin where the catheter was inserted.
• Some people may be allergic to the contrast agent used during the procedure. 
• More serious complications are less common but can include damage to the artery where the angioplasty was done, severe bleeding requiring a blood transfusion or a heart attack, stroke or death.