Coronary angioplasty is a procedure done to help open up clogged arteries. It is most commonly done after a coronary angiogram. It is commonly done in cases wherein the clogged arteries don’t get better with preexisting treatments/medications, or when chest pain seems to get worse with time. However, angioplasty is not a procedure that can be done for everyone. For those with a blockage in a main artery, or weak heart muscles, or other underlying conditions like diabetes, angioplasty cannot be recommended.
The coronary angioplasty procedure is an invasive one, and hence requires the patient to follow several preparatory steps beforehand itself. The doctor may suggest temporary halting of any medication that could affect or interfere with the procedure. The doctor may also suggest avoiding heavy eating a few hours beforehand, and only sipping water until the procedure is complete. Once the procedure commences, a thin wire is manipulated inside the targeted blood vessel and passed in towards the blockage. This is followed by the placement of a balloon and/or stents to unblock the narrowed heart artery, thus restoring normal blood flow to the heart muscle.
- What is the difference between “ballooning” an artery and “stenting” it?
- While the two terms are often used interchangeably, they refer to slightly different steps of the angioplasty procedure. When the artery is blocked, the doctor often needs to “prepare” the vessel or by stretching it open with a balloon inflation. In some cases, the artery opens up nicely and stays open after ballooning and this may be all that is needed. However, in most cases, the “balloon-ed” segment can recoil leaving significant residual narrowing behind. The cardiologist will move on to implant a stent that act as a physical scaffold to keep the artery wide open.
- How long would the stent last?
- Stents are made of metallic alloy (stainless steel, cobalt chromium, platinum) and are permanently implanted inside the vessel during angioplasty. They cannot be removed and will stay there permanently. The real question is how long will the stent stay open? Modern stents are coated with anti-inflammatory medication to promote healing and greatly improves the long term patency of the stents. With proper implantation technique, robust risk factors control with medication and lifestyle modification, one should expect a very good long term outcome after angioplasty.
- What happen to the other 50% blocked artery that you did not “balloon” last time?
- As we gain wrinkles and wisdom, there are bound to be some degree of narrowing of our arteries, just like we inevitably develop age spots and grey hair. As long as these mildly narrowed arteries are able to do the job in supplying fresh blood and oxygen to our heart it is sometimes safer to stabilise them with medication alone. This is particularly true when you are free from symptoms like chest pain or breathlessness on exercise.
- Can I stop my medication now that my arteries have been successfully cured by angioplasty?
- No, you must not let your guard down! The pre-existing conditions like diabetes, hypertension and cholesterol will continue to wreak havoc to your heart if you do not take medication to keep the risk factors under control.
- I was put on double blood thinner after the angioplasty and stent, can I have the drugs stopped for my dental treatment?
- The first 6 to 12 months after a new stent implantation is the healing phase of the blood vessel. Interrupting or stopping the blood thinners (also known as antiplatelet therapy) soon after angioplasty may result in blood clot forming in the stent that can put you in danger. It is advisable to delay non urgent surgery for at least 6 months after angioplasty. This is a decision that should be carefully taken jointly by your dental surgeon, your cardiologist and you.