What to Expect During Angioplasty and Vascular Stenting

Using image guidance, an inflatable balloon mounted at the tip of a catheter is inserted through the skin into an artery and advanced to the site of an arterial blockage where the balloon is inflated and deflated. In this process, the balloon expands the artery wall, increasing blood flow through the artery. A stent may be placed at the treatment site to hold the artery open.

This procedure is often done on an outpatient basis.

You will be positioned on the exam table and will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.

A nurse or technologist will insert an I.V. into a vein in your hand or arm so that sedative medication can be given intravenously. You may also receive general anesthesia.

The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape.

Your doctor will numb the area with a local anesthetic.

A very small nick is made in the skin at the site.

Guided by X-rays, the catheter is then inserted through the skin and maneuvered through the artery until it reaches the site of the blockage. 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.

Again with X-ray guidance, a guide wire will then be moved to the site, followed by the balloon-tipped catheter. Once it reaches the blockage, the balloon will be inflated for a short period of time. The same site may be repeatedly treated or the balloon may be moved to other sites.

Additional X-rays will be taken to determine how much the blood flow has improved. When your doctor is satisfied that the artery has been opened enough, the balloon catheter, the guide wire and catheter will be removed.

Many angioplasty procedures also include the placement of a stent, a small, flexible tube made of plastic or wire mesh to support the damaged artery walls. Stents can be self-expandable (opens up itself upon deployment) or balloon expandable (balloon needed to open the stent). Balloon expandable stents are typically placed over a balloon-tipped catheter so that when the balloon is expanded, it pushes the stent in place against the artery wall. When the balloon is deflated and removed, the stent remains permanently in place, acting like a scaffold for the artery. Self-expandable stents are easy to deploy, but may require additional angioplasty with balloon to obtain satisfactory dilation (opening) of the diseased vessel. Covered stents or stent-grafts have additional advantages over bare stents and are becoming more commonly used.

If a sheath was inserted into your arm or wrist, it will be removed.

At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.

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, called a closure device, which will allow you to move around more quickly.

When the procedure is completed, you will be moved to a recovery room or to a hospital room.

Your intravenous line will be removed.

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.

Other Factors

Devices to monitor your heart rate and blood pressure will be attached to your body.

You will feel a slight prick when the needle is inserted into your vein for the I.V. and when the local anesthetic is injected.

The I.V. sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.

You may feel slight pressure when the catheter is inserted but no serious discomfort.

As the contrast material passes through your body, you may get a warm feeling.

It is common for patients to feel some mild discomfort when the balloon is inflated because the artery is being stretched. Discomfort is more prominent when veins are dilated. Your discomfort should lessen as the balloon is deflated.

The catheter insertion site may be bruised and sore.

For several hours, your catheter site will be checked for bleeding or swelling and your blood pressure and heart rate will be monitored. Bleeding risk at the vascular entry site when veins are treated is less likely, therefore, you may be discharged earlier if the procedure is performed for vein disease, for example, dialysis fistula. Your doctor may prescribe medication to relax your arteries, to protect against spasm of the arteries and to prevent blood clots.

If a contrast material was used during the procedure, you will urinate often to rid your body of this material. You may be asked to drink extra fluids.

After you return home, you should rest and drink plenty of fluids. You should avoid lifting heavy objects and strenuous exercise for at least 24 hours. You should avoid smoking 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 promptly reported to your physician.

After an angioplasty or stent placement procedure you may be instructed to take one or more medications (such as aspirin, or blood thinners such as Plavix®, Lovenox® or Coumadin®) for a period of time. These medications can prevent blood clots from forming at the site of arterial treatment during healing. The effect of Coumadin will be monitored with frequent blood tests.

Magnetic resonance imaging (MRI) can probably be done immediately following stent placement, but make sure that you notify the MRI department that you have recently had a stent. Although stents used today may be considered safe for MRI, you may need several weeks after stent placement for MRI to be safe. Metal detectors will not affect a stent.

Limitations of Angioplasty and Vascular Stenting

Angioplasty with vascular stenting is just one way to treat narrowed or blocked arteries. Medications and exercise are often the first step in treating atherosclerosis.

Regardless of which artery is blocked, angioplasty does not reverse or cure the underlying disease of atherosclerosis. It is extremely important for patients to make lifestyle changes, including eating a healthy diet that is low in saturated fat, exercising and not smoking. Individuals with diabetes, high blood pressure and/or high cholesterol need to follow the treatment plan prescribed by their healthcare providers.

Angioplasty may have to be repeated if the same artery becomes blocked again, a condition called restenosis. If a stent is placed at the time of the angioplasty, the chance of restenosis may be reduced but can still occur.

Only about half of patients with renal vascular hypertension caused by atherosclerosis have their blood pressure successfully treated or improved by angioplasty/stenting. By the time the procedure is done, many of these patients have disease in small arteries within the kidney that does not respond to angioplasty.

Angioplasty and vascular stenting for peripheral artery disease (PAD) affecting arteries in the pelvis and legs are less successful when there are multiple leg vessels that are narrowed or when small vessels have to be opened. Patients with PAD can benefit from smoking cessation, eating a proper diet, exercising regularly and controlling blood cholesterol.

Angioplasty and stent placement in the carotid artery has been approved by the FDA, but there is not much long-term data to know how well this works, or if there are potential complications that can develop from stents being placed in the carotid arteries. A dedicated filter device may be used during stent placement to try and help keep blood clots and other plaques from passing into the brain during the procedure, thereby lowering the risk of stroke. Surgical repair has been done for many years and has been proven effective and safe when done by skilled surgeons. You should discuss with your physician what the potential risks and benefits of carotid artery stenting are in your particular situation.