What to know about angioplasty

Angioplasty is a medical procedure that opens up a blocked or narrowed artery around the heart. It is a standard treatment for narrowed or blocked arteries in this area of the body.

Doctors also refer to angioplasty as percutaneous coronary intervention, or PCI.

During angioplasty, a surgeon inserts a tube into an artery in the groin or wrist. They then thread the tube towards the affected artery around the heart. Finally, they insert a balloon or stent (metal tube) to open the artery.

Doctors perform more than 1.2 million angioplasties a year in the United States, according to the American College of Cardiology.

Here, we give an overview of angioplasty or PCI, including its uses, types, risks, procedure, and recovery.

In the term angioplasty, "angio" means blood vessel, and "plasty" is opening up.

In PCI, the "P" stands for percutaneous or "through the skin" while coronary refers to the location of blood vessels around the heart.

Angioplasty is a conventional treatment for coronary heart disease (CHD) and heart attacks (acute coronary syndrome).

In these conditions, there is a buildup of plaque, or atherosclerosis, on the walls of the arteries. As plaque accumulates, the arteries narrow and can become blocked.

In a heart attack, the plaque may rupture, spilling cholesterol into an artery, potentially leading to a clot that stops blood flow.

During a standard angioplasty, the doctor makes an incision in the groin or wrist and inserts a tube, or catheter, into an artery.

Next, they thread the catheter upwards and into the affected blood vessel around the heart.

Usually, the catheter contains an inflatable balloon that displaces the plaque or clot, effectively opening up the artery.

Doctors use live X-rays and a contrast dye to guide the catheter and assess the arteries they need to treat.

Compared with heart surgery, angioplasty is a minimally invasive as it does not involve opening up the chest.

Doctors may recommend angioplasty to:

• treat an abnormal stress test
• increase blood flow to the heart
• reduce chest pain, or angina
• improve blood supply to the heart muscle during or after a heart attack
• support more activity for people with chest pain

Types

There are two main types of angioplasty:

• Balloon angioplasty, which involves using the pressure of an inflating balloon to clear plaque that is blocking an artery. This is rarely done alone except in cases when doctors are unable to place a stent in the required position.
• Stent placement in the artery, which involves a tube, or stent, made out of wire mesh. Stents help to prevent an artery narrowing again after angioplasty.

Stents may be made of bare metal or have a coating of medication. When they include medication, they are called drug eluting stents (DES) and are less likely to plug up again.

DES are now used almost exclusively with very little use of bare metal stents.

Research from 2018 estimates that doctors in the U.S. implant over 1.8 million stents each year.