Angioplasty is a procedure to open blocked coronary arteries caused by coronary artery disease. It restores blood flow to the heart muscle without open-heart surgery. It can be done in an emergency setting, such as when a heart attack has happened. Or it can be done as elective surgery if your doctor strongly suspects you have heart disease. Angioplasty is also called percutaneous coronary intervention.

For angioplasty, a long, thin tube (catheter) is put into a blood vessel. It's then guided to the blocked coronary artery. The catheter has a tiny balloon at its tip. Once the catheter is in place, the balloon is inflated at the narrowed area of the heart artery. This presses the plaque or blood clot against the sides of the artery. The result is more room for blood flow.

The doctor uses fluoroscopy during the surgery. Fluoroscopy is a special type of X-ray that's like an X-ray "movie." It helps the doctor find the blockages in the heart arteries as a contrast dye moves through them. This is called coronary angiography.

Your doctor may decide that you need another type of procedure. This may include removing the plaque (atherectomy) at the site of the narrowing of the artery. In atherectomy, the doctor uses a catheter with a rotating tip. The plaque is broken up or cut away to open the artery.

Coronary stents are now used in nearly all angioplasty procedures. A stent is a tiny, expandable metal mesh coil. It's put into the newly opened area of the artery to help keep the artery from narrowing or closing again.

Tissue will start to coat the stent like a layer of skin once the stent has been placed. The stent will be fully lined with tissue within 3 to 12 months. It depends on whether the stent has a medicine coating or not. You may be prescribed medicines called antiplatelets to decrease the "stickiness" of platelets. Platelets are special blood cells that clump together to stop bleeding. The medicine can also prevent blood clots from forming inside the stent. Your health care team will give instructions on which medicines you need to take and for how long.

Most stents are coated with medicine to prevent scar tissue from forming inside the stent. They are called drug-eluting stents. They release medicine inside the blood vessel to slow the overgrowth of tissue within the stent. This helps prevent the blood vessel from becoming narrow again. Some stents don't have this medicine coating and are called bare metal stents. They may have higher rates of stenosis. But they don't need long-term use of antiplatelet medicines. This may be the preferred stent in people who are at high risk of bleeding.

Stents can become blocked. It's important to talk with your health care team about what you need to do if you have chest pain after a stent placement.

You may need a repeat procedure if scar tissue forms inside the stent. It may be using either balloon angioplasty or putting a second stent in. In rare cases, radiation therapy may be given through a catheter placed near the scar tissue to stop the growth of scar tissue. It also opens up the vessel. This is called brachytherapy.

Angioplasty is done to restore coronary artery blood flow. It's done when the narrowed artery is in a place that can be reached in this way. Not all coronary artery disease (CAD) can be treated with angioplasty. Your doctor will decide the best way to treat your CAD based on your condition.

Possible risks linked to angioplasty, stenting, atherectomy, and related procedures include:

• Bleeding at the site where the catheter is put into the body (usually the groin, wrist, or arm).
• Blood clot or damage to the blood vessel from the catheter.
• Blood clot within the treated blood vessel.
• Infection at the catheter insertion site.
• Abnormal heart rhythms.
• Heart attack.
• Stroke.
• Chest pain or discomfort.
• Rupture of the coronary artery or complete closing of the coronary artery. This may require open-heart surgery.
• Allergic reaction to the contrast dye used.
• Kidney damage from the contrast dye.

You may want to ask your health care team about the amount of radiation used during the procedure and the risks related to your situation. It's a good idea to keep a record of the radiation exposures you've had so you can tell your health care team. This includes previous scans and other types of X-rays. There may be risks linked to radiation exposure in the total number of X-rays or treatments you've had over a long period.

For some people, having to lie still on the table for the length of the procedure may cause some discomfort or pain.

There may be other risks depending on your own health condition. Discuss any concerns with your health care team before the procedure.

• Your health care team will explain the procedure to you and ask if you have questions.
• You'll be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
• Tell your health care team if you've ever had a reaction to any contrast dye, or if you're allergic to iodine.
• Tell your health care team if you're sensitive to or are allergic to any medicines, latex, tape, and local or general anesthesia.
• Follow any directions you're given for not eating or drinking before surgery.
• Tell your health care team if you're pregnant or think you could be. Radiation exposure during pregnancy may lead to birth defects.
• Tell your health care team if you have any body piercings on your chest or belly (abdomen).
• Tell your health care team about all prescription and over-the-counter medicines, vitamins, herbs, and supplements that you're taking.
• Tell your health care team if you have a history of bleeding disorders or if you're taking any blood-thinning medicines (anticoagulant or antiplatelet), aspirin, or other medicines that affect blood clotting. You may need to stop some of these medicines before the procedure. But for planned angioplasty procedures, your doctor may want you to continue taking aspirin and antiplatelet medicines, so be sure to ask.
• Your doctor may request a blood test before the procedure to find out how long it takes your blood to clot. Other blood tests may also be done.
• Tell your health care team if you have a pacemaker or other implanted device.
• You may get a sedative before the procedure to help you relax.
• Based on your health condition, your doctor may give you other instructions on how to get ready.

Angioplasty may be done as part of your stay in a hospital. Procedures can vary based on your condition and your doctor's practices. Most people who have angioplasty and stent placement are watched overnight in the hospital.

Generally, angioplasty follows this process:

1. You'll be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aid if you use either of them.
2. You'll be asked to remove your clothing and will get a gown to wear.
3. You'll be asked to empty your bladder before the procedure.
4. If there is a lot of hair at the area of the catheter insertion (often the groin area), the hair may be shaved off.
5. An I.V. (intravenous) line will be started in your hand or arm before the procedure. It will be used for injection of medicine and to give I.V. fluids, if needed.
6. You'll be placed on your back on the procedure table.
7. You'll be connected to an electrocardiogram (ECG) monitor that records the electrical activity of your heart. It keeps track of your heart rate using electrodes that stick to your skin. Your vital signs (heart rate, blood pressure, breathing rate, and oxygen level) will be tracked.
8. There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through your body into your heart, and the structures of your heart as the dye is injected.
9. You'll get a sedative in your I.V. line to help you relax. But you'll likely stay awake during the procedure.
10. Your pulse below the catheter insertion site will be checked and marked so the circulation to the limb below the site can be checked during and after the procedure.
11. Local anesthesia will be injected into the skin at the insertion site. This may be in your leg, arm, or neck. You may feel some stinging at the site for a few seconds.
12. Once the local anesthesia has taken effect, a sheath, or introducer, will be put into the blood vessel (often at the groin). This is a plastic tube through which the catheter will be put into the blood vessel and advanced into the heart.
13. The catheter will be put through the sheath into the blood vessel. The doctor will advance the catheter through the aorta into the heart. Fluoroscopy ("live" X-ray) will be used to help see the catheter advance into the heart.
14. The catheter will be put into the coronary arteries. Once the catheter is in place, contrast dye will be injected through the catheter into your coronary arteries to see the narrowed area. You may feel some effects when the contrast dye is injected. They include a flushing sensation, a salty or metallic taste in your mouth, or a brief headache. They usually last only a few moments.
15. Tell your doctor if you have any breathing trouble, sweating, numbness, itching, nausea or vomiting, chills, or heart palpitations.
16. After the contrast dye is injected, your doctor will take a series of rapid X-ray images of the heart and coronary arteries. You may be asked to take in a deep breath and hold it for a few seconds during this time.
17. When the doctor locates the narrowed artery, the catheter will be advanced to that location and the balloon will be inflated to open the artery. You may have some chest pain or discomfort at this point. That's because the blood flow is temporarily blocked by the inflated balloon. It should go away when the balloon is deflated. But tell your doctor right away if you notice any continued discomfort or pain. These include chest pain, neck or jaw pain, back pain, arm pain, shortness of breath, or breathing trouble.
18. The doctor may inflate and deflate the balloon several times. The decision may be made at this point to put in a stent to keep the artery open. In some cases, the stent may be put into the artery before the balloon is inflated. Inflating the balloon will open the artery and fully expand the stent.
19. The doctor will take measurements, pictures, or angiograms after the artery has been opened. Once the artery is opened, the catheter will be removed.
20. The sheath or introducer is taken out and the insertion site may be closed. Your doctor may use a closure device that uses collagen to seal the opening in the artery, stitches (sutures), or manual pressure over the area to keep the blood vessel from bleeding. Your doctor will decide which method is best for you.
21. If a closure device is used, a sterile dressing will be applied to the site. If manual pressure is used, the doctor (or an assistant) will hold pressure on it so a clot will form. Once the bleeding has stopped, a very tight bandage will be placed on the site.
22. Staff will help you slide from the table onto a stretcher so you can be taken to the recovery area. Note: If the insertion was in the groin, you will not be allowed to bend your leg for several hours. If the insertion site was in the arm, your arm will be kept elevated on pillows and straight. A plastic band that works like a belt around the waist may also be put around your arm near the insertion site. The band will be loosened from time to time and then removed when the pressure is no longer needed.

After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. If the catheter was put in a blood vessel in your groin or leg, you will stay flat in bed for several hours after the procedure. A nurse will keep track of your vital signs, the insertion site, and circulation and sensation in the affected leg or arm.

Tell your nurse right away if you feel any chest pain or tightness, any other pain, or feelings of warmth, bleeding, or pain at the insertion site.

Bed rest may vary from 4 to 6 hours depending on your condition. If your doctor placed a closure device, your bed rest may be shorter.

In some cases, the sheath or introducer may be left in the insertion site. If so, the bed rest will last until the sheath is removed. After the sheath is removed, you may be given a light meal.

You may feel the urge to urinate often because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bed rest so your affected leg won't be bent.

You may get out of bed after the period of bed rest is over. The nurse will help you the first time you get up. The nurse will also check your blood pressure while you are lying in bed, sitting, and standing. Move slowly when getting up to prevent dizziness.

You may be given medicine for pain at the insertion site or from having to lie flat and still for a long time.

You'll need to drink water and other fluids to help flush the contrast dye from your body.

You may go back to your usual diet after the procedure unless your doctor decides otherwise.

You may be able to go home the same day. Or you may spend the night in the hospital. Your stay may be longer. It depends on your condition and the results of your procedure. You'll get detailed instructions for your discharge and recovery period.

Arrange to have someone drive you home from the hospital. Once at home, keep track of the insertion site for bleeding, unusual pain, swelling, abnormal discoloration, or temperature change. A small bruise is normal. Tell your health care team if you notice a constant or large amount of blood at the site that's too much for a small dressing.

If your doctor used a closure device at your insertion site, you'll get information about which one was used and how to take care of the site. There will be a small knot, or lump, under the skin. This is normal. It should slowly go away over a few weeks.

Keep the insertion site clean and dry. Your health care team will give you instructions on bathing. In general, don't use a bathtub or hot tub or go swimming until the skin has healed.

Don't lift anything heavy, and limit how many stairs you climb. You may be advised not to do any strenuous activities. Your health care team will tell you when you can return to work and resume normal activities.

Ask your doctor when it's safe to resume driving.

Tell your health care team if you have:

• Fever or chills.
• Increased pain, redness, swelling, bleeding, or other drainage from the insertion site.
• Coolness, numbness or tingling, or other changes in the affected arm or leg.
• Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness, or fainting.

Your doctor may give you other instructions after the procedure.

Before you agree to the procedure make sure you know:

• The name of the procedure.
• The reason you are having the procedure.
• What results to expect and what they mean.
• The risks and benefits of the procedure.
• What the possible side effects or complications are.
• When and where you are to have the procedure.
• Who will do the procedure and what that person's qualifications are.
• What would happen if you did not have the procedure.
• Any alternative procedures to think about.
• When and how you will get the results.
• Who to call after the procedure if you have questions or problems.
• How much you will have to pay for the procedure.