What Are Angioplasty And Stents?

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Overview

Angioplasty is a medical procedure used to open clogged or blocked coronary arteries, which feed your heart muscle with blood that contains nutrients for life. If your arteries are blocked this is commonly caused by atherosclerosis. It can be done with or without using stents.1

Understanding angioplasty

When having an angioplasty, thin, flexible tubes known as catheters are used to help reopen your blocked artery/arteries. The catheter will have an un-inflated balloon on its tip and will be navigated through your body until it reaches your blocked artery. At this point, the balloon will be inflated, which will widen your narrowed artery. Any cholesterol plaques in your artery, that are causing the blockage, will be pressed up against the wall of your artery.1 Angioplasty widens the artery, allowing more blood flow through your artery to your heart muscle.

Indications for angioplasty

Blocked arteries

Blocked arteries are caused by a condition known as atherosclerosis, where a plaque forms in the inner lining of the artery where blood flows. The plaque is formed of fats and cholesterol which have built up in your arteries. The plaque limits the amount of blood that flows through your arteries. The plaque may also burst and lead to a blood clot forming in your arteries.

Coronary artery disease (CAD)

The coronary arteries are the arteries that provide your heart muscle with blood, which contains nutrients, such as oxygen and glucose needed for survival. When these arteries become blocked with cholesterol plaques this results in CAD. The cholesterol plaque causes your blood vessels to have a smaller lumen; therefore, less blood can flow through your coronary arteries. This results in less blood reaching your heart muscle. This could potentially result in a heart attack. This is where part of your heart muscle dies due to the heart muscle receiving less blood and nutrients needed for survival.2

Angina

Angina is a chest pain that is caused due to less blood reaching the heart muscle, due to blocked arteries. When treating angina with medication becomes ineffective, a coronary angioplasty may be required to restore the blood supply to your heart muscle.

Importance of blood vessel clearance

Improved blood flow

Angioplasty improves blood flow, especially if one of the coronary arteries is blocked, which supplies the heart with blood. This allows normal blood flow to be restored to the heart muscle, preventing a possible heart attack.

Alleviation of symptoms

After having an angioplasty you may experience the following:

  • Relief from pain
  • Less breathlessness
  • Feeling less tired than what you did before
  • Feeling as though you have more energy
  • Improved mental state and mood
  • Reduced risk of having a heart attack (if you have had angioplasty in your coronary arteries)

Stents in angioplasty

Stents are small mesh tubes which can be used to open blocked arteries that have been narrowed by having a cholesterol plaque in their inner lumen. Typically, stents open your coronary arteries, providing your heart muscle with nutrient-rich and oxygen-rich blood. As well as treating blockages in your arteries to improve blood flow, stents can also be used to treat an aneurysm. This is where there is a bulge in your blood vessel, which occurs when the blood vessel has become weakened, and the high pressure of the blood flowing through your arteries causes a part of the blood vessel to bulge outwards.

Is having stents an invasive surgery?

Stenting is not a major surgery and is described as minimally invasive to you, which uses much smaller cuts and carries less risk than major surgery.

What happens after you have had stents?

After you have had stents you may be prescribed medications by your cardiologist, including aspirin and antiplatelet medicines, which will prevent the formation of blood clots. Blood clots can lead to blocked arteries and less blood flow.

Types of stents

Bare-metal stents

Bare-metal stents are made of a mesh of wire and are placed inside the artery wall. A few weeks after the stents have been placed into your artery wall a new layer of endothelial cells, will cover the metal mesh, securing it to your artery wall. However, bare-metal stents can be recognised by your body as a foreign object, which can cause the immune system to attack the stent and scar tissue may develop. This may lead to you needing restenosis in the artery.

Drug-eluting stents

Drug-eluting stents have a coating of slow-release antiplatelet medication, which prevents blood clots from forming in the stent. Drug-eluting stents also slow down the formation of scar tissue in the stent, preventing the artery from becoming narrow again, which is an advantage over bare metal stents.

Compared to bare metal stents, drug-eluting stents are less likely to develop restenosis.

Stent placement process with angioplasty

Stents are placed using a catheter, a long narrow tube, which can be inserted into either your wrist or your groin. The catheter is guided to the blocked artery using X-rays. The catheter has a very thin wire through it and an uninflated balloon on the end. The uninflated balloon has a squashed-down stent on it. Once the catheter is in the right position the balloon will be inflated, widening the previously blocked artery. The balloon will also expand the stent so that it fits against the artery wall. The catheter, wire and balloon will then be removed, leaving behind the stent in your artery.4,5

Preventing re-blockage

What does re-blockage in your arteries mean?

Re-blockage in your arteries is also known as restenosis, which is where the arteries become blocked again, impairing blood flow. Restenosis is typically seen in the first 6 months after having stents in your arteries. If you have balloon angioplasty, with no stents, your chance of restenosis is 40%. However, if you have stents, as well as balloon angioplasty, the chance of restenosis is reduced to 25%.3 Therefore, the majority of patients who have angioplasty, to treat blocked arteries, usually have stents too.3

How can blocked arteries be prevented?

After you have had stents once you should ensure you are leading a healthy lifestyle to prevent your arteries become re-blocked, and limiting blood flow to your tissues. This can be done by adhering to the following:3

  • Having a diet that is low in animal fat
  • Stopping smoking after having stents, if you were a previous smoker, and not starting smoking after having stents
  • Limiting your alcohol intake
  • Taking any medications that have been prescribed to you
  • Having follow-up appointments with your cardiologist after having stents

Candidates for angioplasty and stents

Diagnostic tests will be conducted to see if you have an issue with your heart and blood supply that may require you to have angioplasty and possibly stents. These tests may include the following:

  • Echocardiogram
  • Electrocardiogram (ECG)
  • Stress test or treadmill test
  • Tilt test
  • Magnetic resonance imaging (MRI
  • Cardiac computed tomography
  • Thallium scan
  • Coronary angiogram
  • Blood tests

These tests are explained in more detail here.

Signs and symptoms warranting the procedure

Signs and symptoms that may indicate that you need angioplasty include the following:

  • Chest pain and shortness of breath, which may be caused by angina
  • If you have atherosclerosis, where the arteries have hardened
  • If you are having a heart attack or are at risk of having a heart attack, blood vessel clearance is needed to improve blood flow to your heart muscle

Risks and complications

Potential complications of angioplasty

The potential complications of angioplasty include the following:

  • Bleeding under the skin where the catheter was inserted
  • Bruising under the skin where the catheter was inserted
  • Damage to the artery where the catheter was inserted
  • Damage to arteries in your heart
  • Excessive bleeding, requiring a blood transfusion
  • Allergic reaction to a contrast agent, that is used during the procedure
  • Having a heart attack
  • Having a stroke
  • Possible death

Risks associated with stent placement

The risks associated with stent placement are listed below:

  • Stent thrombosis, where blood clots form on the stent, limiting blood flow. Drug-eluting stents prevent the risk of stent thrombosis
  • Restenosis, where the inner artery wall grows new cells around the stent forming blockages in the artery, which require stenting to be done again 

Recovery and aftercare

Immediate post-procedure care

This includes the following:

  • Avoiding driving a week after an angioplasty
  • Avoiding any heavy lifting
  • Avoiding work for at least a week after the procedure, unless advised otherwise.

Monitoring

Approximately 6 to 8 weeks after the procedure you may need cardiac rehabilitation. The cardiac rehabilitation team can help advise on lifestyle changes that you need to make.

Medication

You may need to take blood-thinning medications for a year after the procedure in conjunction with aspirin.

Long-term lifestyle changes

These include the following:

  • Regularly exercising
  • Stopping/avoiding smoking
  • Losing weight if you are overweight
  • Adhering to a healthy and balanced diet

Summary

  • Angioplasty widens the arteries that have been narrowed due to a blockage such as an atherosclerotic plaque
  • Angioplasty involves a catheter with an uninflated balloon being navigated to the blocked artery, and the balloon is inflated to widen the blocked artery
  • A stent may also be required when having an angioplasty and drug-eluting stents are preferred as they prevent stent thrombosis
  • You may need angioplasty if you have atherosclerosis, angina or have had a heart attack
  • There are potential complications of having an angioplasty, such as bleeding and bruising under the skin which are common complications
  • Restenosis may be needed if blood clots form in the stent
  • Lifestyle changes will need to be made after the procedure, concerning diet and exercise
  • Medications such as aspirin and blood thinners may be required after the procedure

References

  1. Chhabra L, Zain MA, Siddiqui WJ. Angioplasty. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499894/
  2. Shahjehan RD, Bhutta BS. Coronary artery disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 30]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK564304/
  3. Dangas G, Kuepper F. Restenosis: repeat narrowing of a coronary artery: prevention and treatment. Circulation [Internet]. 2002 Jun 4 [cited 2023 Dec 1];105(22):2586–7. Available from: https://www.ahajournals.org/doi/10.1161/01.CIR.0000019122.00032.DF
  4. Brami P, Fischer Q, Pham V, Seret G, Varenne O, Picard F. Evolution of Coronary Stent Platforms: A Brief Overview of Currently Used Drug-Eluting Stents. Journal of Clinical Medicine [Internet]. 2023 [cited 2024 May 23]; 12(21):6711. Available from: https://www.mdpi.com/2077-0383/12/21/6711.
  5. Ahadi F, Azadi M, Biglari M, Bodaghi M, Khaleghian A. Evaluation of coronary stents: A review of types, materials, processing techniques, design, and problems. Heliyon [Internet]. 2023 [cited 2024 May 23]; 9(2):e13575. Available from: https://www.sciencedirect.com/science/article/pii/S240584402300782X.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Alisha Solanki

BSc Biomedicine, Lancaster University

Current biomedical science student with a keen interest in medical communications. I have a passion for producing scientifically correct articles in plain language, and communicating advances in the biomedical field to the public.

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