Coronary Angioplasty - by Interventional Cardiologist Dr. Praveen Chandra, Chairman, MBBS, MD, DM

Dr. Praveen Chandra is a Padma Shri awardee, leading interventional cardiologist, and Chairman of Medanta, The Medicity, Gurugram. Before that he held the position of Director of Cardiac Cath Lab and Acute MI Services at Max Healthcare, Dr. Praveen Chandra is a specialist in Balloon Mitral Valvuloplasty & Coronary Angioplasty and was a Consultant with Fortis Memorial Research Institute. 

Dr. Praveen Chandra has contributed immensely to the field of cardiac healthcare in India and led the first team of doctors in India to use Rotarex and Kensey Nash DPD. Proficient in new technologies, Dr. Praveen Chandra’s endeavors have won him awards in the field of Coronary Angioplasty. He conducts 2500 diagnostic procedures and 2000 percutaneous interventions on an average per year.

Dr. Praveen Chandra is an MBBS, MS, and MD from King George's Medical College Lucknow and a fellow of the Endovascular Intervention Society of India, Endovascular Intervention Society of India, Asia-Pacific Society of Interventional Cardiology, and the Asia-Pacific Society of Interventional Cardiology. He was the Director and Organizer of the AMI course in New Delhi for 2005, 2006, 2008, and 2010. He has penned over 100 articles and reviews in medical journals. 

Coronary Angioplasty

Coronary Angioplasty is an interventional cardiac treatment for opening blockages in the arteries of the heart. Fatty deposits or plaque caused the arteries to clog reducing the flow of the blood. 

Coronary angioplasty entails inserting a balloon catheter and widening the affected part of the artery for increased blood flow. Stents or a tiny medicated wire mesh tube may be placed to hold the blockage open. During a heart attack, coronary angioplasty can be used to open the blocked artery restoring blood flow, and reduce damage to the heart muscles. 

Angioplasty and Stent Placement

Angioplasty is a minimally invasive procedure that does not require the patient to undergo general anesthesia. A mild sedative is administered to tone down anxiety and help relax the patient for the procedure. Blood thinners are given before the procedure along with fluids to prevent blood clots.

• A tiny incision is made near the groin, arm, or wrist to insert the guidewire into the blood vessel for the procedure.

• A thin tube or catheter is inserted through the artery and a contrast dye is injected.

• X-rays or angiograms enables images of the insides of the blood vessels.

• A small balloon at the tip of the catheter is inflated at the site of the blockage in the artery. 

• Once the artery is expanded, a stent if there is one, is placed to hold the passage open.

• The stent, which has a spring-like mechanism, expands when the balloon is inflated and locks on to the artery permanently. 

• More than one stent may be required to hold the artery open. 

• Once the artery is open, with or without stents, the catheter is removed after deflating the balloon.

• The process is repeated for every blockage in the heart.

Recovery after angioplasty is fast and patients should start to show improvements almost immediately. Hospital stays are short and patients can return to their normal lives within a week. Medications may have to adjusted post-operation and it may be necessary to continue with blood thinners for life. 

Things to Remember

While it may seem to be a convenient treatment option for coronary disease, angioplasty has its limitations. It is important to remember:

• It is only recommended when heart disease progresses despite medication and lifestyle changes. 

• It is an emergency treatment if the patient is having a heart attack.

• Not everyone is a candidate for angioplasty as it is not an option for those:

  • With diabetes

  • Weak heart muscles

  • Narrowed coronary arteries

• Blockages in the heart may reappear in other arteries of the heart.

There are certain risk factors associated with angioplasty.

• Clotting may occur in the stents post-procedure.

• The coronary artery may be damaged during the procedure

• The contrast dye used for the angiogram may cause kidney problems

• Irregular heartbeats may occur when the heart beats too slowly or too fast.

• The incision site may bleed or require surgery

After angioplasty, regular follow-ups are necessary for monitoring and a regimen to keep the heart healthy be followed.

• quit smoking as an immediate measure 

• A healthy diet and regular exercise to be followed meticulously

• Control co-morbidities such as diabetes and/or hypertension  

• Aim for lower cholesterol levels

Conclusion

Coronary Balloon Angioplasty has given a fresh lease of life to many who otherwise would have to undergo open bypass surgery. Advancements in technology have made Angioplasty a safer and widely available option than it was a few years ago.