Intervention/Angioplasty & Stents

Tchefuncte Cardiovascular Associates (TCA) has 4 cardiologists that have received specialized training in coronary and peripheral interventions. These physicians are: Dr. Gabriel Lasala, MD, FACC, and Dr. Jose A. Silva, MD, FACC. Interventions are procedures, such as angioplasty (balloon procedure) and stents, that are performed in the cardiac catherization lab. These procedures can correct problems without having to experience surgery in an operating room. Coronary procedures are used in the coronary arteries (the blood vessels feeding the heart). Peripheral procedures are performed in arteries outside of the heart, including the renal arteries (feeding the kidneys), mesenteric (feeding the stomach), iliac (feeding the groin and legs), femoral (feeding the legs), and popliteal (feeding the lower legs and feet). A diagnostic cardiologist may perform an angiogram and identify the problem. Then the interventional cardiologist may be consulted to correct the problem.

According to the American Heart Association, an estimated 657,000 angioplasties were performed on 640,000 patients in the United States. TCA performed 808 coronary stents and 424 peripheral stents in 2005. In addition TCA performed over 1,000 angioplasties.

Why are these procedures necessary?

The arteries in your body can become clogged from a buildup of cells, fats and cholesterol, called plaque. Plaque blocks the blood flow to the area fed by the arteries, such as the heart, kidneys, stomach, or legs. This blockage can cause pain, interrupt how well an organ works, cause color changes, coldness, and even death of the area being fed by the arteries. An angioplasty opens blocked arteries and allows the blood to flow again. A stent is a wire mesh tube that provides support for the artery to keep the artery open.

How is it done?

• The physician numbs a spot on your groin or arm and inserts a small tube into the artery.
• This thin tube or catheter is threaded through the arterial system until it gets into the artery suspected of having blockages.
• By watching on a special x-ray screen, the physician can move the catheter into the clogged spot. Next, a small catheter with a small balloon on its tip goes through the first catheter.
• When the balloon-tipped catheter reaches the clogged artery, its inflated. The inflated balloon pushes plaque to the side, opening the artery so blood can flow more easily. This may be done more than once.
• The stent in a collapsed form comes mounted onto a balloon catheter. The balloon and stent are delivered to the blockage as with the angioplasty. Once in place, the balloon is inflated. This pushes plaque against the wall and opens the stent. The balloon is then deflated and removed leaving the stent in place. Depending on the size of the plaque, more than one stent may be used per blockage.
• Afterwards, an angiogram is taken to confirm that blood flow is improved
• Finally the balloon and catheters are taken out. Now the clogged artery has been opened and your heart will get the blood it needs

Go to Patient Information on the home page to Conditions/Procedures for more detail.

Will the angioplasty hurt?

• No, angioplasty and stenting cause very little pain. The physician numbs the place where the catheter is inserted. You may feel some pressure as the catheter is put in.
• You’ll be awake and may be given medicine to help you relax and forget the specifics of the procedure. The angioplasty may last up to 30 minutes or longer.
• The place where the catheter was put in may be a little sore afterwards.

What are the possible risks?

• Bleeding or clotting
• Tearing of the artery lining
• Abnormal heartbeat (arrhythmias)
• Allergic reaction to the x-ray dye
• Kidney damage or failure
• The need for emergency bypass surgery (very rare)
• Heart attack, stroke, or death (very rare)

What about afterwards?

• Direct pressure may be applied for 15-30 minutes over the site where the catheter was inserted or a plug may be placed into the artery. Sometimes the catheter will be left in place in case you have to return to the lab for another procedure.
• For several hours after the angioplasty, you’ll lie quietly on your back, being checked frequently for any signs of bleeding or complications.
• You may stay in the hospital for 1-2 days to rest. Hospital stays vary a lot, depending on how difficult each case is.
• Learn about the risk factors you need to change to keep the disease from worsening.

What about when I go home?

• Take the medications directed by your physician. This is crucial to your recovery, especially if you’ve been given an anti-platelet drug like Plavix.
• Shower or take sponge baths for a few days. Don’t swim or soak in a tub.
• Avoid lifting anything over 10 pounds for at least 3 days.
• Avoid strenuous exercises for about a week. Ask your doctor when you can resume driving, exercise, and sex.
• Talk to your doctor about when you can return to work.

When should I call the doctor?

• The insertion site is increasingly painful, swollen, red, bleeding, warm to the touch, or draining
• Fever of greater than 101 degrees Fahrenheit
• Inability to urinate or blood in the urine
• Severe pain, coldness, or a bluish color in the leg or arm where the catheter was inserted.
• Call the clinic that you usually go to for your physician visits. You will be given instructions.

Have I been cured?

Unfortunately angioplasty and stents do not cure atherosclerosis, which is the disease process that causes blockage to the arteries. Your TCA cardiologist can help you manage your risk factors. Take your medications as prescribed. Talk to your cardiologist about side effects. Work on lifestyle changes. Keep your follow up appointments. Complete the tests ordered by your cardiologist. Your TCA cardiologist can help you with the following:

• Quit smoking
• A heart healthy diet
• Physical activity
• Weight loss
• Cardiac rehabilitation, if eligible

For further information, please visit www.guidant.com.

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