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Over time, there is a buildup of cholesterol, fat and calcium in the coronary arteries known as coronary plaque which can narrow arteries and block blood flow to the heart. This condition is known as Atherosclerosis which leads to coronary artery disease .It is treated with a balloon or stent procedure. If the blockage cannot be treated with a balloon or stent procedure, a patient might be considered for rotational atherectomy -In this procedure, rotating tip is used to remove the plaque off of the artery walls, returning blood flow to normal.
Patients who have extensive blockage in all three major arteries or in the “left main artery benefit more from open-heart surgery than the stenting .” In comparison to open-heart surgery, angioplasty(stenting) is less invasive than surgery because only a small incision is needed in the upper leg or the wrist and allow you to recover more quickly than you would from surgery, with less hospital stay and returning to your regular activities more quickly.
Angiogram(angiography) Vs. Angioplasty (Stent in heart))
An angiogram of the heart is a direct visualization of the coronary arteries under light anesthesia and is the gold standard test to diagnose blockages in the arteries by injecting contrast and taking pictures . If a significant blockage is found (60-70% or greater), then an angioplasty will be done. Coronary angiography may be done if:
You have angina for the first time.
Your angina is worsing , occurring more often, or happening at rest which is known as unstable angina.
You have aortic stenosis.
You have atypical chest pain, when other tests are normal.
You had an abnormal heart stress test (treadmill test) .
You have been diagnosed as having a heart attack
Prepararation for the angiography test and angioplasty
You should not eat or drink anything for 6 hours before the test starts. You will check in to the hospital the morning of the test.
You will wear a hospital dress.
You must sign a consent form before the test.
Your health care provider will explain the procedure and its risks.
Tell Your Nurse Or Doctor If You:
Are allergic to any medicines or if you have had a bad reaction to contrast material in the past.
Are taking Viagra.
You will be conscious during the procedure but may feel some pressure at the site where the catheter is placed and feel a flushing or warm sensation when the dye is injected.
After the test, the catheter is removed and a firm pressure is applied at the insertion site to prevent bleeding. If the catheter is placed in your groin, you will be asked to lie flat on your back for a few hours to several hours after the test to avoid bleeding. This may cause some mild back discomfort but all this is avoided now a days by angioplasty through radial artery(arm).
Compared to coronary artery bypass surgery, which is much more invasive, people who get stents have less discomfort and a shorter recovery time.
Coronary Angioplasty(stent in heart)
Time and Cost
The cost of angioplasty, or stent surgery in India varies with the type of stent , surgeon, hospital and city you choose for surgery and starts from around USD 2500 .
Overnight stay at the hospital is sufficient for post-operative recovery and procedure requires anywhere between 30 minutes to 2 hours depending on the complexity of the case.. You would need to stay in india for about 6-7 days for follow up.
Angioplasty may especially be recommended if you are having chest discomfort (angina) due to reduced blood flow that has not responded to medication and lifestyle changes It is a procedure to locate the arterial blockages. The arterial blockages are caused due to narrowing of the arterial walls that reduces the flow of blood through the artery and can lead to coronary artery diseases or myocardial infarction. The coronary arteries can become narrow and blocked due to building up of a plaques on their inner walls.
Angioplasty(stent in heart) or Balloon Angioplasty or percutaneous transluminal coronary angioplasty (PTCA) is performed after angiography if there is significant blockage in the coronary arteries. In this procedure a catheter is inserted and guided towards the blocked area of the artery. Thereafter, another catheter with a small balloon on the tip is passed through the first catheter and as the balloon reaches the blocked area, the balloon is inflated, which compresses the plaque and blood flow of the coronary artery is restored to its previous level due to widening of its lumen. Finally, the balloon is deflated and withdrawn and the patient is relieved of the symptoms.
Angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent to help prop the artery open and decrease its chance of narrowing again. Some stents are coated with medication to help keep your artery open (drug-eluting stents), while others are not (bare-metal stents).
Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart.
There are several types of stents available:
1). Bare Metal Coronary Stents.
These are tubular, mesh-like inert metal devices ado nd they not have any medications coated on them.
2). Drug-Eluting Stents
These stents have medications embedded in them that prevent inflammation and restenosis of the artery on a long term basis as sometimes there is too much tissue growth within the treated portion of the artery which can cause the artery to become narrow or blocked again which is known as restenosis .Use of drug-eluting stents can help prevent this problem. These stents are coated with medicine to stop excess tissue growth.
Some stents with a wire releasing radiations threaded through a catheter to the stent can delay tissue growth. The wire releases radiation and stops cells around the stent from growing and blocking the artery. There can be a heart attack, stroke, or other serious problems due to a blood clot at the stent site in 1–2 percent of people who have stented arteries. The risk of blood clots is greatest during the first few months of stenting.This can be prevented by taking aspirin and another anticlotting medicine, such as clopidogrel, for at least a year or more depending upon the type of stent.
3 New Technology: Absorable Heart Stent
There's a game-changing breakthrough in cardiovascular care that may help you lead a better and healthier life. Previously angioplasty mean that a cardiologist had to implant metal stents that became a permanent part of your body and with a risk of blockage inside the stent again (restenosis).
But this new stent is similar to dissolving sutures and is expected to absorb entirely in about two to three years leaving only two pairs of tiny markers to help cardiologists to identify where the stent was placed. This restored artery pulse naturally which is not possible with the metal stents as it cannot flex.
The procedure takes only about an hour in the cardiac catheterization lab. Through a small incision a small tube is inserted into an opening in your wrist or groin. The doctor passes the medicated stent, made of a biodegradable polymer through the thin flexible tube to the area of blockage which is expanded to prop up your affected artery, pushing the plaque back in the artery wall to restore blood flow. This stent slowly release a drug to limit the growth of scar tissue and reduce inflammation. Like a metal stent, it props open your diseased vessel, restoring blood flow, before being completely and naturally absorbed by the body like dissolving suture . After your artery is healed it leaves almost no material behind and restores natural pulsating motion.
Benefits to patients may include:
Restoration of blood flow leading to immediate relief of Coronary Artery Disease symptoms.
Reduced risk of future blockages(restenosis) that can occur with metal stents as inflammation and tissue growth at the treatment site is decreased..
Similar to angioplasty except that the catheter has a laser tip that opens the blocked artery. Pulsating beams of light vaporize the plaque buildup.