Angioplasty

What is a stent?

A stent is a special device made of metal mesh that is placed across a narrowing or blockage to keep the artery open.

Are there any risks?

• Angioplasty is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise.

• A small bruise (haematoma) around the site of the needle can occur, but this is quite normal. The bruise might be sore for a few days but will disappear in a few weeks.

• Rarely a large bruise may develop and require a small operation to drain it.

• Occasionally, a tender pulsating swelling called a false aneurysm may develop over a few days due to ongoing leakage from the arterial puncture site. This can usually be treated by an injection of a blood-clotting agent under ultrasound guidance.

• Very rarely, some damage can be caused to the artery by the catheter or by displacement of the material causing a blockage in other arteries (an embolus). This may require a small operation or another procedure.

• The dye (contrast agent) used during the procedure is very safe, but occasionally can cause damage to the kidneys. This occurs mainly in patients whose kidney function is abnormal already and this will be identified on the blood tests that are performed before the procedure.

• Allergic reactions to the dye are also possible, but are very rarely serious.

Are you required to make any special preparations?

• An angioplasty may be carried out as a day case procedure under local anaesthetic, or may require longer admission. You may be asked not to eat for four hours before the procedure, although you may still drink clear fluids such as water.

• Certain medication may have to be stopped. The doctor will discuss this prior to planning the procedure.

• If you are diabetic, your doctors will advise you about any changes needed to your normal medication.

• If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the staff before you have the test.

Where will the procedure take place?

In the angiography suite or theatre. This is similar to an operating theatre into which specialised X-ray equipment has been installed.

What happens during an angioplasty?

Before the angioplasty, the interventional radiologist will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure, if you so wish.

You will be asked to get changed to hospital gown.

A small cannula (thin tube) may be placed into a vein in your arm. You may require a fluid drip to help your kidney function before the angioplasty.

You will be asked to lie on the X-ray table, generally flat on your back. The X-ray machine will be positioned above you. You may have monitoring devices attached to your chest and finger and may be given oxygen.

Your skin near the point of insertion, usually the groin area, will be swabbed with antiseptic and you will be covered with sterile drapes.

The skin and deeper tissues over the blood vessel will be numbed with local anaesthetic. A needle followed by a wire and catheter (fine plastic tube) will be inserted into the artery and guided to the correct position to obtain the images required.

Once the narrowing or blockage has been identified, a balloon is inflated to open up the artery and allow more blood to flow. Occasionally, the interventional radiologist will decide to place a stent (metal mesh) to keep the artery open. This is placed in exactly the same way as the balloon.

Once the interventional radiologist is satisfied with the images, the catheter will be removed. Firm pressure will be applied to the skin entry point, for about ten minutes, to prevent any bleeding. Sometimes a special device may be used to close the hole in the artery.

Will it hurt?

It may sting a little when the local anaesthetic is injected. You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine.

How long will it take?

Every patient is different, and it is not always easy to predict; however, expect the procedure to take about an hour.

What happens afterwards?

You will be taken back to the observation area. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You may stay in bed for a few hours, until you have recovered and are ready to go home.