Coronary angioplasty is a vital medical procedure used to treat coronary artery disease, a condition characterised by the narrowing of the coronary arteries—the main vessels supplying blood and oxygen to the heart. The primary goal of coronary angioplasty is to restore adequate blood flow to the heart, thereby preventing or treating heart attacks and relieving symptoms like chest pain and shortness of breath. Typically, coronary angioplasty is followed by the placement of a stent to maintain the artery’s patency, ensuring sustained blood flow and minimising future blockages. Coronary angioplasty, placement of coronary artery stents, use of “Shockwave” balloons and various devices to ablate hard calcified plaques are collectively termed “Percutaneous Coronary Intervention (PCI)”.
Types of Percutaneous Coronary Intervention (PCI)
Coronary angioplasty
Procedure: Coronary angioplasty is the most common type of PCI. This technique involves guiding a balloon catheter into the narrowed artery and inflating it to expand the artery. This is usually followed by implanting a stent to optimally expand the segment of the coronary artery. Improvement in coronary angioplasty techniques and equipment have enabled us to successfully reopen coronary arteries with chronic total occlusions (CTOs).
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Transradial PCI
Most PCI procedures are now performed via a minimally invasive approach through the radial artery in the wrist. As compared to the older method through the femoral artery in the groin, transradial PCI has been shown to be safer (fewer bleeding complications) and is more comfortable for the patient (no need to lie flat for several hours). Dr Chiam previously published a manuscript in EuroIntervention(1) where thin walled Sheathless catheters were compared to conventional catheters in transradial PCI, showing greater patient comfort with Sheathless catheters and lesser complications. Thus, our doctors use the thin walled Sheathless catheters for all transradial PCI procedures.
Suitability for PCI:
- Patients with significant atherosclerosis: PCI is recommended for those with severe narrowing of the heart’s blood vessels caused by the buildup of cholesterol plaques in the arteries. Ideal candidates are those experiencing worsening angina (chest pain on exertion) or who are at high risk of a heart attack.
- Little response to other treatments: This coronary angioplasty procedure is also advisable for patients who have not seen improvements through medications or lifestyle changes alone.
Atherectomy
For more complex cases, particularly where the arteries are heavily calcified, traditional PCI might not be sufficient. Calcified plaque modification is crucial for PCI success. We perform the following based on each patient’s unique condition.
Coronary Orbital Atherectomy
Procedure: This PCI technique uses a device that sands down calcified plaque in the arteries, restoring flexibility to the arterial walls and facilitating the successful deployment of balloons and stents.
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Rotational Atherectomy
Procedure: This coronary angioplasty technique uses a high-speed rotating tiny diamond-tipped drill to grind away hard plaque from the artery walls.
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Intravascular Lithotripsy (IVL)
Procedure: IVL is a novel cutting-edge technique that utilises sonic waves (Shockwave balloon) to fracture severe calcium deposits within the arteries.
Source: https://www.heartvascularcentre.com/our-services/coronary-artery-intervention
IVL has been shown to enhance vessel compliance, facilitating easier and safer stent placement. Since receiving the CE mark in 2017, IVL has been increasingly utilised to manage complex calcified lesions due to its good safety profile.
Recovery After Percutaneous Coronary Intervention (PCI)
Recovery from PCI varies slightly based on the specific procedure and individual health factors. In general, patients are able to be discharged from hospital the next day, and are able to resume normal activities a few days later.
Initial Recovery: After the procedure, patients are monitored closely for several hours. If the catheter (tube) was inserted through the groin, they will need to lie flat for several hours to minimise bleeding risks.
Hospital Stay and Monitoring: The length of your hospital stay depends on the type of coronary angioplasty, your response to the procedure, and any complications that may arise. Often, an overnight stay is necessary for safe monitoring.
Post-Discharge Recovery: Resume daily activities gradually. After PCI, most patients can return to light activities within a few days if there are no complications. Avoid very vigorous exercise for a week or so to allow wound healing.
Medication: Following your coronary angioplasty procedure, your doctor may prescribe blood thinners to prevent clot formation.
It is crucial to closely follow your doctor’s prescriptions and all post-procedural instructions to ensure treatment success. Strict adherence to dietary modifications and supervised increases in physical activity is also essential for effectively managing your health and optimising recovery.
Conclusion on Coronary Angioplasty Techniques
The advancement of coronary angioplasty techniques significantly enhances the treatment of coronary artery disease. These minimally invasive methods improve patient outcomes by effectively treating complex arterial blockages (including reopening totally occluded arteries) and reducing complications.
It is important to speak with a specialist at The Heart & Vascular Centre to determine which options are best suited for your condition. In cases where angioplasty may not be suitable, the specialist might recommend Coronary Artery Bypass Graft Surgery. Our experts can help you understand the potential benefits and risks, ensuring you make an informed decision about your heart health. For more detailed information and to discuss your specific needs, contact The Heart & Vascular Centre today!
References:
(1): Chiam PT, Liu B, Wong AS, Wong PE, Lim ST, Koh TH, Lim VY. Comparison of novel 6.5 Fr sheathless guiding catheters versus 5 Fr guiding catheters for transradial coronary intervention. EuroIntervention 2011; 7: 930-5.
