What is Angioplasty/Stenting?

Coronary angioplasty also called percutaneous coronary intervention, is a procedure used to open blocked heart arteries. Angioplasty uses a tiny balloon catheter that is inserted in a blocked blood vessel to help widen it and improve blood flow to your heart.

Angioplasty is often combined with the placement of a small spring like tube called a stent. The stent helps keep the artery open, most stents are coated with drug to help keep your artery open (drug-eluting stents).

Angioplasty can improve symptoms such as chest pain and shortness of breath. Angioplasty is also often used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart.

Why is Angioplasty done?

Angioplasty is used to treat the buildup of fatty plaques causing blockages in your heart’s blood vessels.

Angioplasty may be a treatment option for you if:

• You have tried medications or lifestyle changes but these have not improved your heart health.
• You have chest pain (angina) that is worsening.
• You have a heart attack. Angioplasty can quickly open a blocked artery, reducing damage to your heart.

Angioplasty isn’t for everyone. Depending on the extent of your heart disease and your overall health, your doctor may determine that coronary artery bypass surgery is a better option than angioplasty for you.

You may need coronary artery bypass surgery if:

• The main artery that brings blood to the left side of your heart is narrow
• Your heart muscle is weak
• You have diabetes and multiple severe blockages in your arteries

In coronary artery bypass surgery, the blocked part of your artery is bypassed using a healthy blood vessel from another part of your body.

Risks of Angioplasty

Although angioplasty is a less invasive way to open clogged arteries than bypass surgery is, the procedure still carries some risks.

The most common angioplasty risks include:

• Re-narrowing of your artery.When angioplasty is combined with drug-eluting stent placement, there’s a small risk the treated artery may become clogged again (less than 5%).
• Blood clots.Blood clots can form within stents even after the procedure (1-2% risk). These clots can close the artery, causing a heart attack. It’s important to take aspirin in combination with clopidogrel or Tricagrelor, prasugrel that helps reduce the risk of blood clots exactly as prescribed to decrease the chance of clots forming in your stent.

Talk to your doctor about how long you’ll need to take these medications. Never discontinue these medications without discussing it with your doctor.

• You may have bleeding in your leg or arm where a catheter was inserted. Usually this simply results in a bruise, but sometimes serious bleeding occurs (uncommon) and may require a blood transfusion or surgical procedures.

Other rare risks of angioplasty include:

• Heart attack.Though rare, you may have a heart attack during the procedure.
• Coronary artery damage.Your coronary artery may be damaged during the procedure. These complications may require emergency bypass surgery.
• Kidney problems.The dye used during angioplasty and stent placement can cause kidney damage, especially in people who already have kidney problems. If you’re at increased risk, your doctor may take steps to try to protect your kidneys, such as limiting the amount of contrast dye and making sure that you’re well hydrated during the procedure.
• During angioplasty, a stroke can occur if plaques break loose when the catheters are being threaded through the aorta. Blood clots also can form in catheters and travel to the brain if they break loose. A stroke is an extremely rare complication of coronary angioplasty, and blood thinners are used during the procedure to reduce the risk.
• Abnormal heart rhythms.During the procedure, the heart may beat too quickly or too slowly. These heart rhythm problems are usually short-lived, but sometimes medications or a temporary pacemaker is needed.

What are the Emergency Signs after Angioplasty?

• The site where your catheter was inserted starts bleeding or swelling
• You develop acute pain or discomfort at the site where your catheter was inserted
• You have signs of infection, such as redness, swelling, drainage or fever
• There’s a change in temperature or color of the leg or arm that was used for the procedure
• You feel faint or weak especially if your BP is low
• You develop chest pain or shortness of breath at rest, especially if chest discomfort or pain if similar to one before angioplasty

What are Precautions after Angioplasty?

• Avoid lifting and give rest to site from where procedure was done for 1-2 days.
• Take medicines on time
• Report if you have fever or pain swelling at site of procedure
• Do not smoke
• Monitor BP if you are on BP drugs
• Monitor sugar if you are a diabetic
• Have an Emergency Plan in care there is some emergency at odd hours. Keep numbers of ambulance/hospital/doctor in hand

How long does it take to recover after angioplasty/stenting?

Bed Rest is generally not required and home limited activities can be started immediately in most cases. It generally takes most people a couple of weeks (1-4 weeks) to start returning to their normal activities after angioplasty/stenting. It depends on whether there was a heart attack and the level of damage to heart muscle. It may take longer if damage is more.

It’s very common to feel weak/low for a short while after your coronary angioplasty/stenting procedure.Pre disease exercise status can be reached generally in 1 month.

What should I eat after angioplasty/stenting?

After your angioplasty/stenting, you should focus on eating a healthy diet. This will help your body to heal, reduce your risk of complications and enable you to recover well. A healthy diet will also reduce the risk of plaque building up in your arteries again.

Moderation of Diet with Reduction in Calories (amount of food especially which is not nutritious like white flour (Maida) breads, biscuits, potatoes etc) by 20-30%, especially if you are Overweight.

Many studies have shown that a diet rich in fruits, vegetables, wholegrain, nuts and seeds can reduce your risk of heart disease.

A healthy diet provides your body with plenty of heart-protective nutrients – like vitamins, minerals, antioxidants and dietary fiber. Ideally, your diet should include:

• Wholegrain– good wholegrain choices include whole meal or wholegrain bread, brown rice, whole meal pasta, quinoa, rolled oats
• Milk– preferably low fat
• Meat– Avoid Red Meat. You can use Chicken or Protein Rich alternatives such as eggs, tofu, legumes and nuts
• Fish– 2 serves of oily fish per week such as salmon, mackerel or sardines will help you get plenty of heart healthy omega-3 fats
• Healthy fats– a small amount of healthy fats and oils from nuts, seeds, avocado and oily fish. Use up to 15 ml of Olive oil or Mustard oil or other vegetable oils. Avoid Ghee and Butter.
• Water – avoid sugary soft drinks and avoid alcohol early after procedure. In case heart function is low, restricted fluids upto 1.2-1.5L

Aim to consume 2 serves of fruit (200g), 5 serves of vegetables (400g) – depending on your energy needs. Some other tips to help you eat well include:

• Reduce your salt intake– use as little salt as possible when cooking as this will help to lower your blood pressure and help prevent fluid retention
• Avoid sugary foods– these are often eaten in place of healthy foods and can contribute to weight gain

What medications will I need to take after angioplasty/stenting?

After angioplasty/stenting, you’ll be given medicines to lower your risk of complications and a further cardiac event. Medications work best when you’re being healthy in all areas of your life – for example, exercising, quitting smoking and eating a healthy diet.

Generally, you’ll be given one or more of the following types of medications:

• Antiplatelets (Blood thinners) – these medications help to stop blood clots from forming inside the stent and prevent heart attack, stroke, or other problems with your heart. Stopping suddenly can cause clotting in blood vessel & heart attack.
• Statins (lipid lowering medications)– Statins control your blood levels of cholesterol, and large studies have shown that they can reduce the risk of blood vessel diseases, heart attacks and stroke
• Blood pressure medications– if you have pre-existing heart conditions (eg hypertension, myocardial infarction or heart failure) you may need to take Beta Blockers and/or ACE Inhibitors, which are medications that help control high blood pressure and prevent angina and heart attacks

As you’re taking medication to prevent clots from forming inside your stent, your blood will be thinner than it was before your surgery. As a result, there are some things you’ll now need to be aware of:

• You may notice that you will bruise easier
• Any cuts to the skin will bleed longer
• If your work or hobby involves the use of sharp objects, you should wear protective clothing

Everyone has individual requirements for medications, and you’ll be given a personalized medicine plan that’s right for you. If you have any questions about the medication you’re taking, speak to your doctor. 

Some medications like Blood Thinners, Statins, BP drugs need to be taken lifelong. Other medications will be stopped in few weeks to few months.

How do I reduce my risk of further heart problems after coronary angioplasty/stenting?

After your angioplasty/stenting procedure, it’s very important to take steps to reduce your risk of having another heart problem. Some of the risk factors for heart disease that you may be able to control include:

• High blood pressure
• High cholesterol
• Being overweight
• Inactivity
• Diabetes
• Smoking

You may need follow-up tests, such as blood tests, echocardiograms and ECG, throughout the first year after your stent surgery. Sometimes, you could feel a type of discomfort, localized to your chest, which feels sharp and niggling. These feelings may come and go. They’re thought to be caused by the angioplasty/stenting procedure and aren’t an emergency. This will feel different to the chest discomfort that brought you into hospital. You can ignore sharp localized pain, which increase movement or pressure or breathing.   

If you do experience chest pain that lasts longer for 10 minutes and feels like the type of pain that brought you into hospital previously, call an ambulance and go immediately to your closest hospital emergency department. You may use a nitrate tablet (sorbitrate) or spray as advised by your doctor.

How do I resume my regular activities after coronary angioplasty/stenting?

As you recover from your angioplasty/stenting, you’ll need to ease back into your regular activities slowly.

• Driving– if you have not had a heart attack, you can resume driving as soon as 7 days after your surgery. If you have had a heart attack, though, you will need to discuss with your doctor when you can resume driving which can vary from 2-4 weeks 
• Heavy lifting– it’s best to avoid lifting objects heavier than 5kg for 1 week. If any work or leisure activities involve heavy physical activity, discuss these with your doctor.
• Travelling– Metal detectors used in airports and other screening areas don’t affect stents. Your stent won’t cause metal detectors to go off

How do I start exercising again after coronary angioplasty/stenting?

Exercising will help to speed up your recovery, and it’s a key component of a healthy lifestyle. Exercise increases your fitness levels, helps control blood pressure, weight and cholesterol, and keeps you relaxed. Start with short and simple walks after few days and gradually increase length and intensity.

You can walk as much as you like as long as you feel comfortable, and daily walking – if only for a few minutes – is ideal. You should be walking 30-45 mins a day within 1-4 weeks.