Your guide to angioplasty and stents

This film will show you what to expect if you’re having a coronary angioplasty and stents inserted. My name’s Rick. I come from Bury. And I came into hospital for a coronary angioplasty. Chest pains and I used to get a banging headache. And I had sensations down both arms. But it could be exertion or sometimes just getting up out of bed. The hope is for the future, obviously, cut down on my medication. And I’ll be able to do things without discomfort in the chest. I’m Jaydeep Sarma. I’m a consultant interventional cardiologist at Wythenshaw Hospital here in South Manchester. So we’re with a young man called Richard, who’s in his mid-40s, who’s got significant coronary disease in three arteries in his heart.

So we’re going to start off with a veritably complex procedure of opening up his arteries using angioplasty, balloon, and wire techniques, so that we can start working away and unblocking the vessel. When you have coronary heart disease fatty deposits build up on the inner walls of your coronary arteries causing narrowing or blockages, which restrict blood flow to your heart. A coronary angioplasty, or PCI, is a procedure used to widen these blocked or narrowed areas. A catheter– thin, flexible tube– is passed into your artery through your groyne or arm and then up to your heart and into the blocked area.

The catheter has a small balloon at its tip, which is gently inflated so that it squashes the fatty tissue in the narrowed artery. The catheter also contains a stent, a small tube of stainless steel mesh. As the balloon is inflated, the stent expands so that it holds open the narrowed blood vessel. The balloon is let down and removed, leaving the stent in place, allowing your blood to flow more easily. The operation is performed under local anaesthesia with sedation. When we start an angioplasty we set up our equipment in much the same way that we do for an angiogram. We put a very small needle into the artery, again, either the groyne or the wrist.

And use that needle to feed a tiny wire into the artery. That allows us to put a plastic tube over the wire, removing the needles. And then that plastic tube allows us to inject liquid dye into the arteries, allowing us to see the course of the arteries on the x-ray machine. We open an artery that’s either blocked or tightly narrowed using a combination of very fine guide wires that we thread down the artery, and a balloon that’s tracked along the guide wire into the point of narrowing. We then use pressure to inflate the balloon and open up a channel. That allows us then, in almost every case, to put a little metal tube in called a stent.

That’s a cylindrical device that expands and works like scaffolding to keep the artery open permanently. People generally feel a little bit of pressure, but not discomfort when the tubing is being moved inside the arteries. We expect these operations to take anything between 30 or 40 minutes and a couple of hours. Sometimes depending on the complexity of the procedure it can take longer. Increasingly with use of the wrist artery it’s feasible for people to go home the afternoon of the procedure. The main complication that people suffer is bruising where the tubing goes into the artery, either in the wrist or in the groyne. Overall there’s less than 1% chance of serious complications.

When you have a stent put in you’ll need to be on aspirin and a blood thinning tablet for several months, if not a year, after the procedure. That’s routine and allows the artery to heal. I still was a bit apprehensive about it. You do you feel a bit of discomfort in the chest. I had a bit of a headache at one time. We were really happy with the results of the procedure. It restored flow to a previously blocked artery. And should improve the blood flow to a large portion of his heart. We would hope that his angina will be greatly reduced.

Obviously, I was overjoyed when they told me they got through it, and they managed to get three stents in it. It was well worth it in the end, I think.

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