Angioplasty is the procedure of opening the blood vessel. This is done in a patient with tight blockages in his coronary artery. Angioplasty helps in relieving angina and it can help in preventing major heart attack and life.
The initial steps of angioplasty are same as an angiogram. majority of cardiologists nowadays do angioplasty from wrist access only.
After explaining the procedure to patient and relatives, the patient is taken for angioplasty
We pass the special wire across the lesion . over this wire we pass a small sized balloon and dilated it across the tight blockage. gradually diameter of balloon is increased to achieve 100% of the lumen. Majority of patient have complex blockages with tear in blood vessel with fat and calcium, which requires placement of stent.
Stent gives a strong metallic scaffold and prevents re occlusion of blood vessel.
After completion of angioplasty [patient is monitored in ICU for a day or so.
Patient receives blood thinner tablet and injections during his hospital stay
The wrist puncture site is dressed with a tight bandage which is removed mostly next day and you may experience pain in hand and palm with mild discolouration and swelling.
Some of the patients do have bleeding issues. they develop bleeding from the gut when started on a blood thinner tablet. they can not take lifelong blood thinner tablet. in this group of patients, we advice plain balloon angioplasty without putting stents or putting stents with help of intracoronary imaging and use of special stents in which blood thinner dose can be decreased after 3 months.
Stent
Coronary stents were invented 2 decades back. since then there is a lot of improvement in technology and the present generation stents are far superior one.
Stents are made of metal, namely steel, titanium alloy. over this stent, there is a layer of drug attached with the help of polymer(plastic jacket).
Stents keep on releasing this drug over next 50 days or so, and this released drug prevents re occlusion of the blood vessel. these stents are called drug-eluting stents
Simple stents or bare-metal stents are those stents without any drug over it. nowadays there is hardly any specific indication for putting this type of stent
After coronary stent placement, the patient is required to take uninterrupted antiplatelet for the lifetime. the first 3 months and first year are crucial and stopping medicine during this time period may result in sudden clot formation in 8-10 % of cases.
Self-dissolving stents were in the market a few years back but now withdrawn from the market and we are awaiting the arrival of this stents with good long term result.
Why Emergency Angioplasty
With the advancement of science and technology, our life expectancy has increased from __ to __. ref
One of the main contributors to this increased life expectancy is prompt and proper treatment pf major heart attack.
In previous era, primary treatment of heart attack was giving clot buster injection within hours of start of heart attack. efficacy of this type of injection was in the range of 30-50%, and the remaining patients becomes sick and go for the rescue therapy .
With the widespread availability of cardiology services across the city, patients are offered treatment which is almost 99% effective in opening the blood vessel and risk of life decreases tremendously.
In case of heart attack, a minute lost is a muscle lost.
According to major international cardiology groups, like ACC and European cardiology group, many studies have shown that if heart attack patient undergoes angioplasty within 90 minutes of his arrival to the hospital, chances of death due to a major heart attack can be decreased significantly. we call this door to balloon time, and our average time at our centre is in the fifties. To achieve this fast many things have to be in place starting from rapid diagnosis of a heart attack at emergency, call to cardiologists, preliminary test. availability of cath lab and efficient staff.
This is to be noted that this applies to major ongoing heart attack only.