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Appendix: Angioplasty

Coronary angioplasty is a medical procedure in which a balloon is used to open a blockage in a coronary (heart) artery narrowed by atherosclerosis. This procedure improves blood flow to the heart.

Before coronary angioplasty is done, your doctor will need to know whether your coronary arteries are blocked. If one or more of your arteries are blocked, your doctor will need to know where and how severe the blockages are.

To find out, your doctor will do an angiogram and take an x-ray picture of your arteries. During an angiogram, a small tube called a catheter with a balloon at the end is put into a large blood vessel in the groin (upper thigh) or arm. The catheter is then threaded to the coronary arteries. A small amount of dye is injected into the coronary arteries and an x-ray picture is taken.

This picture will show any blockages, how many, and where they're located. Once your doctor has this information, the angioplasty can proceed. Your doctor will blow up (inflate) the balloon in the blockage and push the plaque outward against the artery wall. This opens the artery more and improves blood flow.

Coronary Balloon Angioplasty

Balloon Angioplasty

The illustration shows a cross-section of a coronary artery with plaque buildup. The coronary artery is located on the surface of the heart. Figure A shows the deflated balloon catheter inserted into the narrowed coronary artery. In figure B, the balloon is inflated, compressing the plaque and restoring the size of the artery. Figure C shows the widened artery.

 

A small mesh tube called a stent is usually placed in the newly widened part of the artery. The stent holds up the artery and lowers the risk of the artery renarrowing. Stents are made of metal mesh and look like small springs.

Some stents, called drug-eluting stents, are coated with medicines that are slowly and continuously released into the artery. These medicines help prevent the artery from becoming blocked again from scar tissue that grows around the stent.

Stent Placement

Stent Placement

The illustration shows the placement of a stent in a coronary artery with plaque buildup. Figure A shows the deflated balloon catheter and closed stent inserted into the narrowed coronary artery. The inset image on figure A shows a cross-section of the artery with the inserted balloon catheter and closed stent. In figure B, the balloon is inflated, expanding the stent and compressing the plaque to restore the size of the artery. Figure C shows the stent-widened artery. The inset image on figure C shows a cross-section of the compressed plaque and stent-widened artery.

In some cases, plaque is removed during angioplasty. In a procedure called atherectomy, a catheter with a rotating shaver on its tip is inserted into the artery to cut away plaque. Lasers also are used to dissolve or break up the plaque. These procedures are now rarely done because angioplasty gives better results for most patients.