Introduction

Coronary angioplasty and stenting is a treatment used to widen and open up narrowed or blocked arteries supplying your heart muscle. 

During angioplasty and stenting, the narrowed artery is stretched open with a balloon (angioplasty), and a metal strut (stent) is implanted into the coronary artery. This keeps the narrowing open and allows your blood to flow more freely through it.

Coronary angioplasty is sometimes known as:

  • percutaneous transluminal coronary angioplasty (PTCA)
  • percutaneous coronary intervention (PCI)

Why is a coronary angioplasty necessary?

Like all organs in the body, the heart needs a constant supply of blood. The heart has its own network of blood vessels known as the coronary arteries. 

In adults, these arteries can become narrowed and hardened. This is known as atherosclerosis, which can restrict the flow of blood to the heart and lead to angina.

While many cases of angina can be treated with medication, a coronary angioplasty may be required to restore the blood supply to the heart in severe cases.

Coronary angioplasties are also often used as an emergency treatment after a heart attack.

What are the benefits of a coronary angioplasty?

If you have angina, an angioplasty can:

  • relieve your symptoms of discomfort, pain, tightness and heaviness
  • reduce your need for angina medication
  • ease symptoms such as breathlessness 
  • enable you to be more active 
  • improve your ability to do everyday activities, such as climbing stairs and walking any distance 
  • make you feel generally better so you're more able to do the things you want to do, such as going to work and enjoying a social life 

If you've had a heart attack, an angioplasty can reduce:

  • the damage to heart muscle
  • your chances of having another heart attack

Before having a coronary angioplasty

Before having a coronary angioplasty, you might be given a pre-assessment of your health a few days before the operation. This could involve blood tests and a general health check. 

Being as fit as you can be before the procedure can help your recovery from a coronary angioplasty. However, it is important to check what type of activity is suitable for you prior to the procedure.

The following short film is of Dr Peter Henriksen, Consultant Cardiologist for NHS Scotland, explaining what you need to know before having coronary angioplasty and stenting.

How is a coronary angioplasty performed?

During an angioplasty, a flexible tube called a catheter with a small inflatable balloon is passed through your artery.  

The balloon is inflated to widen your artery, a mesh tube known as a stent, may then be inserted into your coronary artery.  

The stent pushes against your artery walls, squashing fatty deposits against the artery wall so that blood can flow through it more freely.

The procedure usually takes around 30 minutes, but it can take longer depending on how many sections of your artery need treatment. 

You'll normally be able to go home the day after a coronary angioplasty. You must arrange for someone to collect you from hospital. 

How safe is a coronary angioplasty?

A coronary angioplasty is one of the most common types of treatment for the heart. 

It doesn't involve making major incisions in the body and is considered as a minimally invasive form of treatment. 

The risk of complications from a coronary angioplasty varies depending on individual circumstances. Risk increases slightly with age and if you have certain conditions. 

All risks will be fully discussed with you prior to your consent to the procedure.

Are there any alternatives to coronary angioplasty?

A coronary angioplasty may not be technically possible or the best treatment for you depending on your circumstances.

In such cases, an alternative surgical procedure known as a coronary artery bypass graft (CABG) may be considered. 

Your treatment will be decided upon between you and your specialist heart team. 

Why do I need a coronary angioplasty?

A coronary angioplasty is necessary when hardening and narrowing of the coronary arteries prevents the heart muscle from getting enough blood to function normally.

Atherosclerosis

Hardening of the arteries is known as atherosclerosis.

Your arteries harden and narrow as you get older, but this process can be accelerated by:

  • smoking 
  • having high blood pressure (hypertension)
  • having diabetes
  • eating a high fat diet
  • physical inactivity
  • your ethnicity (where you were born and your cultural background)

For reasons that are not fully understood, high blood pressure and atherosclerosis are more common among people of African-Caribbean and south Asian (Indian, Pakistani, Bangladeshi and Sri Lankan) origin.

Angina

Once the hardening and narrowing of your coronary arteries reaches a certain point, your heart no longer receives the blood supply it needs to work properly.

This can trigger the symptoms of angina, when you are walking or exerting yourself.

Angina doesn't harm the heart muscle but can cause the following symptoms:

  • pain, discomfort, heaviness in your chest, jaw or back
  • breathlessness
  • chest tightness

When the symptoms of angina start, it is sometimes called an angina attack.

Find out more about angina.

If your symptoms don't respond to your angina medication, you must phone 999 as you are potentially having a heart attack.

If your symptoms have worsened and not helped by medication, a coronary angioplasty and stent may be recommended.

Heart attack

A coronary angioplasty can be used as an emergency treatment for a heart attack if it's caused by an interruption to your heart’s blood supply.

Find out more about a heart attack.

How it's performed

When having a coronary angioplasty and stenting, you may have a pre-assessment of your health a few days before the operation.

This gives you an opportunity to discuss any concerns with your surgeon.

Your coronary arteries also need to be assessed to make sure the operation is technically possible. This is done using a test called coronary angiography.

You may be asked not to eat or drink anything for four hours before a coronary angioplasty.

You will usually be able to take most medications as normal up to the day of the procedure, with the exception of blood-thinning medication (anticoagulants), such as warfarin. You may also need to alter the timing of any diabetes medication you take. Your medical team can give you more information about this.

Where it takes place

A coronary angioplasty usually takes place in a room called a catheterisation laboratory, rather than in an operating theatre.

A catheterisation laboratory is a room that is fitted with X-ray video to allow the doctor to monitor the procedure on a screen.

How long it takes

Coronary angioplasty usually takes about 30 minutes, although it may take longer depending on how many sections of your artery need to be treated.

What you can expect to happen

You'll be asked to lie on your back on an X-ray table.

You'll  then be linked up to a heart monitor and given a local anaesthetic to numb your skin.

An intravenous (IV) line will also be inserted into a vein, in case you need to have painkillers or a sedative. The cardiologist (heart specialist) will make a small incision in the skin of your groin or wrist and will insert a catheter. They will guide the catheter through the artery in your groin or arm, passing it through the main artery in your body (the aorta) and into the opening of your left or right coronary artery.

A thin, flexible wire is then passed down the inside of the blood vessel being treated to beyond the narrowed area.

A small balloon is passed over the wire to the narrowed area and inflated for up to 60 seconds. This squashes the fatty material on the inside walls of the artery to widen it. This may be done several times.

While the balloon is inflated, the artery will be completely blocked and you may have some chest pain. However, this is normal and is nothing to worry about. The pain should go away when the balloon is deflated. Ask your cardiologist for pain medication if you find it uncomfortable.

You shouldn't feel anything else as the catheter moves through the artery, but you may feel an occasional missed or extra heartbeat. This is nothing to worry about and is completely normal.

If you are having a stent inserted, it will open up as the balloon is inflated and will be left inside your artery.

Types of stent

A stent is a short, wire-mesh tube that acts like a scaffold to help keep your artery open.

There are 2 main types of stent:

  • bare metal (uncoated) stent
  • drug-eluting stent, which is coated with medication that reduces the risk of the artery becoming blocked again

The biggest drawback of using bare metal stents is that, in around 30% of cases, the arteries begin to narrow again. This is because in some cases the healing response of the coronary vessel leads excessive tissue growth around the stent.

This problem can be much reduced by using drug-eluting stents. These are coated with medication that reduces the tendency to excessive tissue growth.

If you have a stent, you’ll also need to take certain anti-platelet drugs to help reduce the risk of blood clots forming around the stent.

These include:

  • aspirin - taken every morning for life
  • clopidogrel - taken for up to 12 months depending on whether you have had a bare metal or drug-eluting stent, or whether you have had a heart attack 
  • prasugrel and ticagrelor - sometimes used as alternatives to clopidogrel

At the end of the operation

When the operation is finished, the cardiologist will check that your artery is wide enough to allow blood to flow through more easily. 

The balloon, wire and catheter are then removed and any bleeding is stopped with a dissolvable plug or firm pressure.

Recovering from a coronary angioplasty

A coronary angioplasty often involves an overnight stay in hospital, but many people can go home on the same day if the procedure is straightforward.

Before leaving hospital, you should be told about any medication you need to take. You may also be given advice on improving your diet and lifestyle.

You'll be given a date on discharge (or posted to your home) for a follow-up appointment to check on your progress.

If you have had a planned coronary angioplasty, you should be able to resume your normal activities within a week. However, if you have had an emergency angioplasty following a heart attack, it may be several weeks or months before you recover fully.

Driving

After the operation, you will not be able to drive for one week so you'll need to arrange for someone to drive you home from hospital.

If you drive a heavy vehicle for a living, such as a lorry or a bus, you must inform the DVLA that you have had a coronary angioplasty.

They will arrange further testing before you can return to work.

Find out more about driving after a coronary angioplasty on the GOV.UK site.

Bruise where catheter was inserted

You may have a bruise where the catheter was inserted. This isn't serious, but it may be sore for a few days.

Occasionally, the wound can become infected.

Keep an eye on it to check that it's healing properly and tell your GP if it becomes red and sore.

Heavy lifting

After having a coronary angioplasty, avoid doing any heavy lifting for about a week or until the wound has healed.

Sex

If your sex life was previously affected by angina, you may be able to have a more active sex life as soon as you feel ready after a coronary angioplasty.

If you have any concerns, speak to your GP.

According to experts, having sex is the equivalent of climbing a couple of flights of stairs in terms of the strain that it puts on your heart.

Further treatment

Most people need to take blood-thinning medications for up to one year after having an angioplasty. This is often a combination of low-dose aspirin and clopidogrel.

It's very important to follow your medication schedule as stopping medication early greatly increases the risk of the stent becoming blocked suddenly and causing a heart attack.

Clopidogrel blocks one of the chemicals that the body uses to trigger blood clotting.

The course of clopidogrel will be withdrawn after the agreed period, but most people need to continue taking low-dose aspirin for the rest of their life.

Find out more about clopidogrel.

If your angina symptoms return

If your angina symptoms return, you'll need further assessment. It's very important that you monitor and report any symptoms of angina.

It's possible you may be assessed for another angioplasty and stenting procedure or alternatively, you may need a coronary artery bypass graft (CABG).

Risks of coronary angioplasty

As with all surgery, coronary angioplasty carries a risk of complications.

Who's at risk?

Factors that increase your chance of having complications include the following.

Your cardiology team can give you more information about your individual circumstances and level of risk.

Your age

The older you are, the higher the risk. For example, a 60-year-old man with no other risk factors has a less than 1% risk of developing complications, while an 80-year-old has a 3% risk.

Whether the procedure was planned for angina or emergency treatment after a heart attack

Emergency surgery is always riskier because there is less time to plan it.

Whether you have kidney disease

The intravenous dye used during an angioplasty can occasionally cause further damage to your kidneys.

Whether more than one coronary artery has become blocked

This is known as multi-vessel disease.

Whether you have a history of serious heart disease

This could include heart failure.

Complications that can occur

Complications that can occur after an coronary angioplasty include:

  • heart attack - estimated to occur in 1 in 100 cases
  • stroke - estimated to occur in 1 in 200 cases
  • excessive bleeding after the operation - estimated to occur in 1 in 200 cases and requires a blood transfusion

These complications can rarely result in death, which is estimated to occur in 1 in 500 cases.

What other surgery options are there?

The most widely used surgical alternative to a coronary angioplasty is a coronary artery bypass graft (CABG).

Find out more about CABG.

If you can choose between having a coronary angioplasty or a CABG, be aware of the advantages and disadvantages of each technique.

Coronary angioplasty

As a coronary angioplasty is minimally invasive, you will recover from the effects of the operation quicker than you will from a CABG.

The procedure also has a lower complication rate, but research has shown that up to one person in four who has a coronary angioplasty requires further treatment because the widened artery narrows again.

However, in the future, the number of people who need further surgery may fall sharply because of the use of drug-eluting stents.

CABG

CABG has a longer recovery time than coronary angioplasty and a higher complication rate.

However, only 1 person in 10 who has a CABG requires further treatment.

Also, research published in 2009 found that CABG is usually a more effective treatment option for people who are over 65 years of age and for people with diabetes.

You can discuss the benefits and risks of both types of surgery with your surgical team.

Percutaneous transluminal coronary rotational atherectomy (PTCRA)

Percutaneous transluminal coronary rotational atherectomy (PTCRA) is a similar technique to coronary angioplasty. However, rather than using a balloon and a stent to expand the artery, a small drill is used to break up and loosen hardened deposits that are blocking the artery

It's usually used when the coronary artery has a high level of calcium in it. Calcium makes the artery very hard and can prevent balloons or stents expanding properly to relieve the narrowing.

Once the small drill has been used, the artery is most commonly treated with balloons and stents as normal.

Last updated:
01 November 2021