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Coronary Angioplasty and Stenting

Baylor Scott & White Heart and Vascular Hospital – Dallas

Angioplasty and stent placement for blocked coronary arteries

Coronary artery disease occurs when the coronary arteries become narrowed or blocked as a result of atherosclerosis. Atherosclerosis is the build-up of fatty deposits and plaque on the arteries' inner walls that restricts blood flow to the heart. Without adequate blood flow, the heart is starved of the oxygen and vital nutrients it needs to function properly. The most common symptom of coronary artery disease is angina or chest pain.

Angioplasty is an interventional heart procedure used to open narrowed or blocked coronary arteries that carry blood to the heart.

A coronary artery stent, which is often placed during or immediately after angioplasty, is a small, metal mesh tube that expands once inside a coronary artery. Its purpose is to prevent the artery from becoming blocked again. A drug-eluting stent is coated with medicine to help prevent the artery from closing.

Interventional cardiologists use angioplasty to treat:

  • Blockage in a coronary artery during or after a heart attack
  • Blockage of one or more coronary arteries that puts you at risk for a heart attack
  • Persistent chest pain (angina) not controlled by medication
A close-up image of a metal stent

Left main disease is blockage in the coronary, which supplies the vast majority of the blood flow to the heart muscle

If you've been told that you need bypass surgery or you have blockages too severe to be fixed, or blockages that can't be fixed and limit your lifestyle, we may have other options for you that aren't available on other sites.

The physicians on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Dallas have successfully treated patients with left main disease using percutaneous coronary intervention (PCI) techniques with stents. This provides a rapid, less-invasive procedure, and a faster hospital discharge and return to daily activities.

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How angioplasty is performed

Before the beginning of the angioplasty procedure, you are given pain medication. You may also be given blood thinners to prevent blood clots from forming.

Once you are lying on a padded table, your heart physician will insert a flexible tube or catheter through a needle puncture into an artery in your groin, arm or wrist.

Your physician uses live X-rays to guide the catheter into your heart and arteries carefully. Dye is injected into your body to provide a picture of the blood flow through your arteries and lets your heart physician see any blockages in the blood vessels.

A guide wire is moved into and across the blockage. A balloon catheter is then advanced over the guide wire and into the blockage, where the balloon inflates to open the blocked vessel and restore sufficient blood flow to the heart. A stent may be placed in the blockage and also expands when the balloon is inflated. The stent is left in your artery to help keep it open.

Risks of angioplasty and stent placement

Angioplasty is generally safe, but as with any interventional procedure, complications are possible

 
  • Allergic reaction to the drug used in a drug-eluting stent, the stent material or the X-ray dye
  • Bleeding or clotting in the area where the catheter is inserted
  • Blood clot
  • Clogging inside of the stent (in-stent restenosis)
  • Damage to a heart valve or blood vessel
  • Heart attack
  • Kidney failure (higher risk in people who already have kidney problems)
  • Arrhythmias (irregular heartbeats)
  • Stroke (rare)

Prognosis after angioplasty

For most people, angioplasty greatly improves blood flow through the coronary arteries and the heart. But since angioplasty does not cure the underlying condition that caused the blockage in your arteries, your arteries may become blocked again.

To lower your risk, follow a heart-healthy diet, exercise, stop smoking if you smoke and reduce stress to lower your chances of having another blocked artery. Your heart doctor may prescribe medication to help lower your cholesterol.

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Angioplasty vs. coronary artery bypass graft (CABG) surgery

 

Bypass surgery is considered open-heart surgery. During the CABG procedure a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. This healthy artery or vein bypasses the blocked portion of the coronary artery, creating a detour for oxygen-rich blood to flow to the heart muscle.

Learn more about bypass surgery

Procedure

Advantages

Disadvantages

Angioplasty

Less invasive (avoids the risks of surgery)

Can be repeated in the future if necessary

Greater chance the artery will narrow again (restenosis) within the first year

May be less effective for people with diabetes who have significant coronary disease affecting two or more arteries

Coronary artery bypass graft (CABG) surgery

Can bypass blockages in several arteries

May benefit people with many blocked arteries or weakened heart muscle

Higher risk of complications in the short term after surgery, including death and stroke

Longer stay in the hospital and recovery time

Clinical trials for left main disease

SYNTAX Trial

A study to determine whether comparable outcomes can be achieved with coronary artery bypass grafting (CABG) and percutaneous coronary interventions with drug-eluting stents in patients with left main coronary artery disease.

EXCEL Trial

A study to evaluate the safety and effectiveness of the XIENCE PRIME/XIENCE V Everolimus Eluting Coronary Stent Systems compared to coronary artery bypass grafting (CABG) in select patients with left main coronary artery disease.

To learn more about our clinical trials or to enroll, please call the Soltero Cardiovascular Research Center at 214.820.2273.

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