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Coronary Angioplasty and Stents
Coronary angioplasty and stenting, also called percutaneous coronary intervention (PCI), opens narrowed or blocked heart arteries through a small tube placed in the wrist or groin.
What it is
The coronary arteries carry blood to the heart muscle. Fatty plaque can narrow them, causing chest pain or pressure with exertion (angina), or it can rupture and block an artery suddenly, causing a heart attack. A heart catheterization uses X-ray dye to show where the arteries are narrowed. If a blockage needs treatment, a small balloon opens it and a stent, a tiny mesh tube usually coated with medicine, holds it open.
Who it may help
PCI is used in three main settings: during a heart attack, when opening the artery fast saves heart muscle; for angina that continues despite medicines; and for some patients with abnormal stress test or CT results. Not every blockage needs a stent. Medicines and healthy habits are the foundation of treatment, and some patients are better served by bypass surgery. Your cardiologist will explain which approach fits you.
How it's done
Most procedures use the artery in the wrist (radial) or at the top of the leg (femoral). You receive numbing medicine and light sedation and are usually awake. A thin wire is passed across the blockage, followed by the balloon and stent. Sometimes the doctor uses a pressure wire or imaging inside the artery to decide whether a stent is needed and to size it. For the sickest heart attack patients, a temporary heart pump may support circulation during and after the procedure.
Recovery
After a planned procedure, many patients go home the same day or the next day. With the wrist approach, avoid lifting with that arm for a few days; with the groin approach, avoid heavy lifting for about a week. You will take aspirin and a second antiplatelet medicine for a period your cardiologist sets. Do not stop these medicines without talking with your cardiologist first. Cardiac rehabilitation helps recovery after a heart attack or stent.
Risks
Possible risks include bleeding or bruising where the catheter entered, injury to the artery, an allergic reaction to dye, kidney injury, irregular heartbeat, heart attack, stroke, and a stent clotting or narrowing again. Rarely, emergency bypass surgery is needed or the procedure results in death. Your doctor will review your own risks.
Dr. Smith's experience
Dr. Smith completed his interventional cardiology fellowship at the University of Alabama at Birmingham and is board certified in interventional cardiology. He performs diagnostic heart catheterization and PCI, including emergency heart attack (STEMI) care, cases that need a temporary heart pump, and right heart catheterization. At Baton Rouge General he co-designed the hospital's heart attack cardiogenic shock pathway, modeled on the National Cardiogenic Shock Initiative, covering care from the EMS pre-alert through heart pump support and the ICU.
Frequently asked questions
Am I awake during the procedure?
Usually yes. You receive numbing medicine and light sedation, so most people are relaxed and comfortable.
Why is the wrist often used instead of the groin?
The wrist approach is linked with less bleeding and lets most people sit up and walk sooner. The groin is still used when it is the better route.
How long do stents last?
Stents are permanent. The treated artery can narrow again, but this is less common with modern drug-coated stents. Taking your medicines and controlling risk factors help protect it.
Why do I need two blood thinners after a stent?
Aspirin plus a second antiplatelet medicine lowers the chance of a clot forming in the new stent. Do not stop either one without talking with your cardiologist.
Can I have an MRI after a coronary stent?
Modern coronary stents generally allow MRI under specific conditions. Tell the MRI staff about your stent.
What are the warning signs of a heart attack?
Chest pressure or pain, pain spreading to the arm, jaw or back, shortness of breath, sweating, nausea or lightheadedness. Call 911 right away. Do not drive yourself.
Ask about coronary angioplasty and stents at Cardiovascular Institute of the South
Dr. Smith sees patients at CIS Baton Rouge, 8401 Picardy Avenue · (225) 308-0247, and CIS Zachary, 6550 Main Street, Suite 1000 · (225) 654-1559. Your primary care doctor or cardiologist can also send a referral.