PERCUTANEOUS CORONARY INTERVENTION
The Purpose
Your doctor has advised you to have a coronary angioplasty. The purpose of this procedure is to stretch one or more narrowings in your coronary arteries. If successful, this may reduce angina and may decrease your risk of suffering a heart attack.
The Procedure
The angioplasty will be performed in a theatre with x-ray equipment. You will be awake during the procedure, but if you wish you can be given an injection to make you feel more relaxed. The groin or wrist will be 'frozen' with local anaesthetic and a short tube called a sheath will be inserted. A catheter (long hollow tube) will be passed through this sheath up to your coronary artery.
Then a fine wire will be guided through the narrowing in the artery and a balloon will be passed over the wire and inflated. During the inflation you may experience some chest discomfort, which is usually short-lived. It is then common for a stent (wire mesh) to be placed at the narrowing and pressed into the wall of the artery, reducing the chance of the vessel re-narrowing. However, even with a perfect result there is approximately a 1 in 10 chance of the vessel re-narrowing, usually within the first 6 months.
After the test...
After the angioplasty you will have to remain in bed for approximately 4 hours. Then a nurse will remove the sheath from your groin and apply pressure to stop it bleeding. You will then be on bed rest for a further 3 hours before being allowed up. Occasionally, the sheath is removed immediately after the angioplasty and the groin is sealed with a 'plug' or suture.
Complications
In the majority of cases there are no complications. However, there is a small risk of damaging one of the coronary arteries. If the artery blocks completely during the procedure it may result in a heart attack (1 in 200 cases). However, it is usually possible to repair the damaged vessel using a coronary stent. Infrequently, it is not possible to repair the vessel and emergency coronary artery bypass surgery is required (1 in 500 cases). In routine angioplasties the risk of death is small (1in 400 cases).
It is not uncommon to develop bruising in the groin at the puncture site, which will resolve with time. However, occasionally the hole created in the artery does not heal properly and further groin compression or even local surgery may be required (1 in 500 cases).
Other complications involving the blood vessels are very infrequent. The risk of stroke is 1 in 1000 cases.
After Discharge
Following discharge there is a small risk (less than 1 in 100) of a blood clot forming in the stent. If you develop prolonged chest pain you should seek medical attention immediately. In order to reduce the risk of this ‘stent thrombosis’ you are required to take both aspirin and clopidogrel (plavix) daily for up to 1 year. Combining these drugs slightly increases your risk of bleeding therefore you should report any unexpected bleeding to your GP.
After discharge it is best to avoid demanding activities such as heavy lifting for 1 week. If your leg should suddenly become painful or swollen you should seek medical advice.
There is a statutory requirement that you do not drive for 1 week. If you hold a LGV or PSV licence you should not drive for at least 6 weeks and must first perform a satisfactory treadmill test.
Any Queries
If you have any questions please discuss them with the doctor who is obtaining your written consent for this procedure.
