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Angioplasty and Stenting

What are Angioplasty and Vascular Stenting?
Angioplasty, also called balloon angioplasty, and vascular stenting are minimally invasive procedures performed by an interventional radiologist to improve blood flow in the body's arteries. 

In the angioplasty procedure, the doctor threads a balloon-tipped catheter—a thin, plastic tube—to the site of a narrow or blocked artery and then inflates the balloon to open the vessel. The balloon is then deflated and removed from the artery. 

Vascular stenting, which is often performed at the same time as an angioplasty, involves the placement of a small wire mesh tube called a stent in the newly opened artery. This may be necessary after some angioplasty procedures if the artery is very narrowed or completely blocked. The stent is a permanent device that is left in the artery and may be needed to help the artery heal in an open position after the angioplasty.

What are some common uses of the procedures?
Narrowing or blockage in the arteries is most often caused by atherosclerosis, also called hardening of the arteries. Although it is commonly thought of as a heart disease, atherosclerosis can affect arteries anywhere in the body, including the legs and the brain. It is a gradual process in which cholesterol and other fatty deposits—called plaques—build up on the artery walls. These plaques act as barriers that limit blood flow through the arteries to tissues and organs. Other barriers to adequate blood flow include clots or plaques that break away from the blood vessel wall and become lodged in an artery.

When a blood clot, plaque or scar tissue cause an artery to become narrow or completely blocked, blood circulation is limited and the organs and tissues supplied by that artery do not receive enough oxygen.

Angioplasty and vascular stenting are commonly used to treat conditions that result when arteries throughout the body become narrowed or blocked, including:

  • Peripheral vascular disease (PVD)/peripheral artery disease (PAD) (narrowing of the arteries in the legs or arms).
  • Renal vascular hypertension (high blood pressure caused by narrowing of the kidney arteries).
  • Hemodialysis access maintenance.
  • Carotid artery disease (narrowing of the neck arteries supplying blood to the brain).
  • Coronary artery disease (narrowing of the heart arteries).

How should I prepare for the procedure?
Prior to the procedure, you may have several tests performed, such as x-rays, an electrocardiogram (ECG) and blood tests. You should tell your doctor what medications you are currently taking and about any allergies you have, especially to the contrast material necessary to create the x-ray images of your blood vessels.

You will be asked not to eat or drink anything after midnight on the night before your procedure. In most cases, you should take any medications that you usually take, especially blood pressure medications. These can be taken with some water in the morning before your procedure. If you are on any blood thinning medication such as Coumadin, you should check with your doctor about if and when you should stop the medication. It is a good idea to check with your doctor about which medications you should take.

You should plan for an overnight at the Hospital, and have someone drive you home when you are ready to leave.

How does the procedure work?
Angioplasty uses an inflatable balloon mounted on a catheter that is passed to the site of the blockage where it is inflated and deflated. In this process, the balloon expands the artery wall, increasing the flow through the artery. The stent is placed at the site to hold the artery open; this may be helpful in allowing the artery to heal in an open position.

What will I experience during the procedure?
An intravenous (IV) line will be inserted into your arm so that you can be given a mild sedative and other medications as necessary during the procedure. Although this sedative will make you feel relaxed and drowsy, you will probably remain awake during the procedure. Devices to monitor your heart rate and blood pressure will be attached to your body.

Next, depending on which artery your doctor is using for the procedure, your groin area, wrist or arm will be cleaned, shaved and numbed with a local anesthetic. A short tube called a sheath is commonly inserted into the artery.

Next, the doctor will insert a catheter (a long, flexible tube) through the sheath and advance it to the site of the blockage. An x-ray camera connected to a video monitor will help the physician guide the catheter. You may experience a dull pressure where the physician is working with the catheters, but no pain.

Once the catheter is in place, contrast material will be injected into the artery and an angiogram will be taken of the blocked artery to help identify the site of the blockage. With x-ray guidance, a guide wire will then be advanced to the site, followed by the balloon-tipped catheter. Once it reaches the blockage, the balloon will be inflated for several seconds. The same site may be repeatedly treated or the balloon may be moved to other sites. It is common for patients to feel some mild discomfort when the balloon is inflated because the artery is being stretched. Your discomfort should disappear as the balloon is deflated.
Additional x-ray pictures will be taken to determine how much the blood flow has improved. When your physician is satisfied that the artery has been opened enough, the balloon catheter, guide wire and guiding catheter will be removed.

The entire procedure usually lasts 30 minutes to two hours. The length of the procedure varies depending on the time spent evaluating the vascular system prior to any therapy, as well as the complexity of the treatment.

When the procedure is completed, you will be moved to a recovery room or your Hospital room. You may feel groggy from the sedative. The catheter insertion site may be bruised and sore. If the sheath was inserted into your arm or wrist, it will be removed and the site will be bandaged. If the catheter was inserted into your groin, you may need to lie in bed with your legs straight for several hours. In some cases, your doctor may use a device that seals the small hole in the artery; this may allow you to move around more quickly.

Commonly, patients stay overnight and return home the day after the procedure. You will typically be able to walk within two to six hours following the procedure.
After you return home, you should rest and drink plenty of fluids. You should avoid lifting heavy objects, strenuous exercise and smoking for at least 24 hours (and smoking you should avoid permanently since this is a major cause of atherosclerosis).

If bleeding begins where the catheter was inserted, you should lie down, apply pressure to the site and call your physician.

Any change in color in your leg, pain or a warm feeling in the area where the catheter was inserted should be reported to your physician.

You should be able to return to your normal routine by the following week.

Who interprets the results and how do I get them?
The interventional radiologist will judge the results of the angioplasty and stent placement by comparing the pre- and post-procedure angiograms. If any narrowing remains in the artery, it should not be greater than 30 percent of the normal vessel diameter. The results of your procedure will be available immediately following the procedure.

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