Angioplasty and Stenting

Narrowing or blockage of arteries causes a reduced inflow of blood. This can cause symptoms such as muscle pain, difficulty walking ( claudication), dizziness, and tissue damage/wounds as the affected regions are deprived of blood and oxygen.

Angioplasty or stenting is a procedure used to treat the narrowing or blockage of an artery. This uses either a balloon to stretch the artery (angioplasty) or a metal scaffold to hold the artery open (stent). These procedures improve blood flow which helps to relieve any symptoms you are experiencing.

A Vascular Surgeon will determine if you are fit for this procedure or require open surgery.

What does the procedure involve?

This minimally invasive procedure is performed in the Cath Lab under x-ray guidance. Local anaesthetic is used to numb the skin and a small tube is placed in the artery in the groin, this is the only uncomfortable part of the procedure. In some cases, it may not be possible to use the groin artery and an alternative artery in the elbow is used. Under x-ray guidance, a fine wire is passed through the narrowing or blockage in the artery. A balloon is passed across the narrowing or blockage and the artery is then stretched by inflating the balloon. The balloon is then removed from the artery.

The angioplasty may need to be repeated. To maintain improved blood flow , a metal scaffold (stent) may be placed in the artery.

Do I need to come into the hospital for the procedure?

You will be asked to come directly to the ward the day before, or on the morning of the procedure and will need to stay in overnight. The procedure generally takes about 90-120 minutes to perform. At the end of the procedure, the tube will be removed and the doctor or nurse will press over the entry site in the groin or elbow for 10 minutes until the artery stops bleeding. Once the bleeding has stopped you will need to remain flat in bed for minimum of 6 hours and then be allowed to sit up. A nurse will escort you back to the ward after the procedure. It is important for you to lie relatively still during this time to prevent the artery from bleeding again.

Are there any risks with the procedure?

The overall risk of the procedure is extremely low. Normal activity can be resumed after 24 hrs. The potential risks can be divided into the following categories:

At the puncture site:

• Some bruising is common after an artery puncture.
• Very rarely significant bleeding from the artery or blockage of the artery can occur which may require a small operation.
• The risk of requiring an operation is less than 1%.

Related to the contrast:

• Some patients experience an allergic reaction to the X-ray contrast. In most cases this is minor but very rarely (1 in 3000) a reaction may be severe and require urgent treatment with medicines.
• The x-ray contrast can, in some patients, affect the kidney function. If you are likely to be at risk of this, special precautions will be taken to reduce the chances of this problem occurring.
• If you are a diabetic on Metformin tablets, you should not take this on the day of the procedure and for 48 hours after the procedure.

Related to the treatment:

• Vessel blockage can occur after angioplasty of a narrowed artery. It can sometimes be treated with a stent.
• Vessel rupture following angioplasty occurs rarely. This can sometimes be treated in the cath lab by putting a stent with a covering around it (stent-graft) into the artery to seal the tear. If this is not possible, an operation may be required to repair the artery.
• Small fragments from the lining of the artery can occasionally break off and lodge in an artery below the angioplasty site (distal embolisation). This may also require an operation to ‘fish out’ the fragment if it is causing a problem with the blood flow. The overall risk of requiring an operation is low (1-2%)

How successful are angioplasty and stenting?

Angioplasty/stenting is successful in treating the narrowing/blockage of the artery in the vast majority of patients (90-95%). In the small number of patients in whom the procedure is unsuccessful, a surgical bypass operation using a vein or artificial tube may be offered as an alternative.