Balloon Angioplasty with stenting<\/strong><\/span><\/li>\n<\/ol>\nIn most cases, balloon angioplasty is performed in combination with implantation of a stent. A stent is a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery.<\/p>\n
A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed, and the stent stays in place permanently. During a period of several months, the artery heals by forming a thin layer of tissue over the stent and the stent gradually becomes part of the blood vessel wall.<\/p>\n
Specialized techniques such as rotablation and shock-wave therapy may be used by your interventional cardiologist to treat more complex coronary disease if needed.<\/p>\n
Contrary to what many believe, coronary angioplasty does not reduce the blockage by removing the cholesterol and fatty deposits (plaque). Instead, these deposits are displaced to the side by the stent so that normal blood flow may be restored.<\/p>\n
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<\/span><\/p>\n <\/strong><\/p>\nWhy do I need a Coronary Angioplasty?<\/h2>\n1. You have Angina Pectoris<\/h3>\n
![\"\"](\"\/\/www.sozocardiology.com\/wp-content\/uploads\/2020\/05\/angina_pectoris.jpg\" "\\"angina_pectoris\\"")
<\/span><\/p>\n2. Your cardiac test results are abnormal<\/h3>\n
![\"\"](\"\/\/www.sozocardiology.com\/wp-content\/uploads\/2020\/07\/abnormal_Test_restuls01.jpg\" "\\"abnormal_Test_restuls01\\"")
<\/span><\/p>\n3. You are suspected of having a heart attack<\/h3>\n
![\"\"](\"\/\/www.sozocardiology.com\/wp-content\/uploads\/2020\/07\/heart_attack2.jpg\" "\\"heart_attack2\\"")
<\/span><\/p>\n <\/strong>Is this procedure safe?<\/h2>\nIn recommending this procedure, your cardiologist has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your doctor believes there is a net benefit to you going ahead. The procedure should only be performed by certified interventional cardiologists.<\/p>\n
An Coronary Angioplasty is generally a safe procedure. However, as with any invasive procedure, there are risks and special precautions will be taken to decrease these risks.<\/p>\n
The complications from a Coronary Angioplasty include:<\/h2>\n
Common risks<\/strong> (more than 5%)<\/p>\n\n- Minor bleeding or infection at the puncture site<\/span><\/li>\n
- Abnormal heartbeat lasting several seconds which settles by itself<\/span><\/li>\n<\/ul>\n
Uncommon risks<\/strong> (1-5%)<\/p>\n\n- Unable to get the catheter into the leg vein – the procedure may be changed to the opposite leg<\/span><\/li>\n
- Abnormal heart rhythm that continues for a long time – this may need an electric shock to correct<\/span><\/li>\n
- The femoral artery (in the groin) is accidentally punctured – this usually just requires pressure on the artery<\/span><\/li>\n
- Damage to the blood vessels where the catheter travelled to get to the heart<\/span><\/li>\n<\/ul>\n
Rare risks<\/strong> (less than 1%)<\/p>\n\n- Damage to the heart muscle or valves<\/span><\/li>\n
- Damage to your heart’s electrical system, which could worsen your arrhythmia and require a pacemaker to correct<\/span><\/li>\n<\/ul>\n
\n- 1<\/span>a. Development of blood clots in the legs or lungs<\/span><\/li>\n
- 2<\/span>b. Stroke or Heart attack<\/span><\/li>\n
- 3<\/span>c. Death in extremely rare cases.<\/span><\/li>\n<\/ol>\n
Please talk to your cardiologist about any concerns you may have about the risks and benefits of the procedure.<\/p>\n
<\/strong><\/p>\n <\/strong>What other options do I have?<\/h2>\nThe build-up of fatty deposits (plaques) in the arteries of the heart change the once normally smooth and flexible artery to one that is hardened and inflexible (termed atherosclerosis). This is unfortunately not reversible even with dietary modification, supplements and exercise.<\/p>\n
The treatment strategy for Coronary artery disease (CAD) is largely dependent on the Severity of Disease<\/strong> at the point of diagnosis. Apart from Coronary angioplasty, the other options include:<\/p>\n\n- 1<\/span>Lifestyle modification and medications<\/strong><\/span><\/li>\n<\/ol>\n
\n- This forms the foundation of all treatment strategies for CAD and work to prevent the continuing build-up of plaque, reduce the symptoms of angina and has been proven to reduce the risk of death by reducing heart attack and heart failure.<\/span><\/li>\n
- Medications to reduce the risk of death include aspirin, beta-blockers (eg atenolol, bisoprolol, carvedilol) and angiotensin-converting enzyme inhibitors (lisinopril, perindopril, enalapril).<\/span><\/li>\n
- Medications that reduce the symptoms of angina include beta-blockers, nitroglycerin and calcium channel blockers (amlodipine, nifedipine, diltiazem and verapamil)<\/span><\/li>\n
- In some patients, the narrowing of the artery is so great that the lack of blood flow starves the heart muscle of oxygen. Patient will continue to have symptoms of angina despite lifestyle modifications and optimal medical therapy. Restoration of the normal blood flow will thus need to be achieved by coronary angioplasty or CABG.<\/span><\/li>\n<\/ul>\n
![\"\"](\"\/\/www.sozocardiology.com\/wp-content\/uploads\/2020\/06\/medication.jpg\" "\\"medication\\"")
<\/span><\/p>\n <\/strong><\/p>\n\n- 2<\/span>Coronary Artery Bypass Surgery (CABG)<\/strong><\/span><\/li>\n<\/ol>\n
The choice of angioplasty or bypass surgery is based on physician and patient preference, as well as patient specific characteristics. In some cases, coronary angioplasty is not the best option and bypass surgery may be advised instead by your cardiologist.<\/p>\n
![\"\"](\"\/\/www.sozocardiology.com\/wp-content\/uploads\/2020\/06\/coronary_artery_bypass_surgery.jpg\" "\\"coronary_artery_bypass_surgery\\"")
<\/span><\/p>\nThe situations by which CABG may be indicated include:<\/h3>\n\n- Severe left main (widow-maker) artery stenosis<\/span><\/li>\n
- Severe double or triple vessel disease in patients with diabetes and\/or heart failure<\/span><\/li>\n
- Coronary blockages not suitable for angioplasty (eg completely blocked arteries and severely calcified vessels)<\/span><\/li>\n<\/ul>\n
In a CABG, the surgeon uses a portion of a healthy artery (either the radial artery from the arm or the Internal mammary artery (IMA) from the chest) or vein (saphenous vein from the leg) to create a detour or bypass around the blocked portion of the coronary artery. Depending on the number of arteries blocked, the patient may receive 1 to 5 bypasses.<\/p>\n
CABG operations are performed under general anesthesia and during the CABG, a heart lung machine artificially maintains the blood circulation while the heart is stopped and the surgeon operates on the heart. It typically takes 3-5 hours and patients stay 5-7 days stay in the hospital. Hospitalization leave is typically 1 month and it may take up to 3 months to fully recover from the surgery.<\/p>\n
<\/strong>How should I prepare for procedure?<\/h2>\nBefore the day of the procedure<\/h3>\n\n- Your cardiologist will explain how the procedure is performed, the risks and benefits and expected duration of stay in the hospital<\/span><\/li>\n
- Informed consent will be obtained<\/span><\/li>\n
- Routine blood tests and ECG will be done before the procedure.<\/span><\/li>\n
- Inform the doctor of:<\/span><\/li>\n
- Any allergies (particularly allergies to iodine, X-ray contrast medium, latex, rubber, plaster and any pain-relieving medications)<\/span><\/li>\n<\/ul>\n
\n- Any history of peptic ulcer, recent strokes or bleeding tendencies<\/li>\n
- Any plans to go for surgery (eg cataract, knee, dental surgery)<\/li>\n
- Any history of impaired kidney function<\/li>\n<\/ol>\n
\n- Instructions for medications<\/span><\/li>\n<\/ul>\n
\n- Metformin (Glucophage) \u2013 Stop taking it 2 days before the procedure<\/li>\n
- Blood thinners should be stopped 2 days before the procedure at the advise of your doctor. These include:<\/li>\n<\/ol>\n
\n- 1<\/span>i. Warfarin (Coumadin; Marevan)<\/span><\/li>\n
- 2<\/span>ii. Dabigatran (Pradaxa)<\/span><\/li>\n
- 3<\/span>iii. Apixaban (Elequis) <\/span><\/li>\n
- 4<\/span>iv. Rivaroxaban (Xarelto)<\/span><\/li>\n<\/ol>\n
\n- Continue Aspirin and\/or Clopidogrel if prescribed by your doctor<\/span><\/li>\n
- Keep yourself well-hydrated. This will reduce the risk of kidney impairment due to the injection of the dye.<\/span><\/li>\n
- Arrange for an adult family member or friend to be with you while waiting for the procedure.<\/span><\/li>\n<\/ul>\n
On the day of the procedure<\/h3>\n\n- ARRIVE PUNCTUALLY<\/strong> \u2014 Proceed to the admission office where the staff will settle you comfortably in your room.<\/li>\n
- FASTING<\/strong> \u2014 You may drink water, consume a light breakfast (eg cereal\/eggs\/toast\/milo) 4 hours before your procedure. Please keep nil by mouth thereafter. Food will be provided for you after the procedure.<\/li>\n
- MEDICATIONS<\/strong> \u2014 Please consume all your prescribed medications (eg Aspirin and\/or Clopidogrel) with plain water on the morning of your procedure except your diabetic drugs (particularly metformin). Bring all your medications with you.<\/li>\n
- ATTIRE<\/strong> \u2014 Come in casual comfortable attire and bring your toiletries, an extra set of clothes & undergarments as you will be admitted to the hospital after the procedure.<\/li>\n
- ALLERGIES <\/strong>\u2014 Please inform your doctor if you are allergic to any drugs, contrast dye, latex, tape, local or general anaesthesia (numbing medicines or medicines used to make you sleepy).<\/li>\n<\/ul>\n
![\"\"](\"\/\/www.sozocardiology.com\/wp-content\/uploads\/2021\/05\/arriving-at-hospital.jpg\" "\\"Man,With,Suitcase,Being,Admitted,To,Hospital,By,Nurse\\"")
<\/span><\/p>\nWhere is the procedure performed?<\/h2>\n
This test is usually done in the Cardio Vascular Lab (CVL) in the X-ray department (not in the operating theatre).<\/p>\n
<\/strong>The following equipment is what you will see in the CVL<\/h2>\n\n- X-ray Equipment \u2013 sends pictures to be viewed on monitors<\/span><\/li>\n
- Video monitors \u2013 show the X-ray pictures, which are used to guide catheters to your heart<\/span><\/li>\n
- ECG monitor \u2013 continuously monitors your heart rhythm<\/span><\/li>\n<\/ul>\n
![\"\"](\"\/\/www.sozocardiology.com\/wp-content\/uploads\/2020\/06\/where-is-the-procedure-performed-1024x512.jpg\" "\\"where")
<\/span><\/p>\nHow is the procedure performed?<\/h2>\n
Coronary Angioplasty can be broken down into 3 steps:<\/strong><\/p>\n\n- 1<\/span>Preparation<\/strong><\/span><\/li>\n<\/ol>\n
\n- You will change into a hospital gown and asked to empty your bladder before the procedure so as to minimize any urinary urgency in event the procedure is prolonged.<\/span><\/li>\n
- A small intravenous (IV) cannula will be inserted to the left hand to facilitate any administration of IV fluids and medications.<\/span><\/li>\n
- You will be brought down to the Cardio Vascular Lab (CVL) where your interventional cardiologist together with a specialized team of cardiac technologists, radiographers and nurses will be on standby to do the procedure.<\/span><\/li>\n
- You will lie on a movable X-ray table equipped with X-ray cameras and heart monitors.<\/span><\/li>\n
- Three electrodes (small flat sticky patches) will be placed on your chest wall and attached to an ECG monitor that charts your heart\u2019s electrical activity during the test. A blood pressure cuff will also be worn on your left arm to measure. your blood pressure throughout the procedure.<\/span><\/li>\n
- A mild sedative will be given by your cardiologist and this will make you sleepy and relaxed but arousable.<\/span><\/li>\n
- You will be covered with a sterile drape and a nurse will clean your right wrist with a cool antiseptic solution.<\/span><\/li>\n<\/ul>\n
![\"\"](\"\/\/www.sozocardiology.com\/wp-content\/uploads\/2021\/05\/angio_2.jpg\" "\\"Interventional,Cardiology.,Male,Surgeon,Doctor,At,Operation\\"")
<\/span><\/p>\n\n- 2<\/span>Coronary angiogram will be performed<\/strong><\/span><\/li>\n<\/ol>\n
![\"\"](\"\/\/www.sozocardiology.com\/wp-content\/uploads\/2020\/07\/angiography.jpg\" "\\"angiography\\"")
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