In today’s fast-paced life, where humans are functioning almost like a robot and where the virtual world has empowered the real sense of living, feelings and humanities virtues, health is always being compromised. The increasing stress, depression, dissatisfaction, and illusory lifestyle expectation have coerced our youth towards the perilous addiction of smoking, tobacco, drugs, and alcohol. These are the primary risk factors of Coronary Artery Diseases (CAD). The risk factors of CAD are not only limited to addictions, but they are inclusive of high blood pressure, high blood cholesterol, diabetes, obesity and overweight, physical inactivity, age, gender, and heredity.
What is Coronary Artery Disease (CAD)?
Coronary Artery Disease is the narrowing or blocking of the Coronary Artery, which normally carries oxygen-rich blood to the heart. This narrowing or blocking of the coronary artery is attributed to the buildup of fatty deposits and cholesterol, called “Plaques”. This condition is medically defined as “Atherosclerosis”. Owning to the narrowing or blocking of the coronary artery, the blood flow to the heart is stalled. In the lack of adequate blood supply, the heart cannot receive oxygen and nutrients, which it needs to work properly. Eventually, the portion of the heart muscle begins to die and this causes angina (chest pain) or heart attack.
How to treat Coronary Artery Disease (CAD)?
There are several alternative medical procedures for treating CAD. However, here, only one such option is discussed.
For adequately treating the CAD, it is vital to treat the core cause of CAD, which is, narrowing of the coronary artery. The minimally surgical procedure which re-opens the blocked or narrowed artery is known as “Coronary Angioplasty” or it is also known as Percutaneous Transluminal Coronary Angioplasty (PTCA). This procedure opens the clogged heart arteries and restores the blood flow to the heart.
PTCA uses a tiny balloon catheter that is inserted in the blocked artery, where the balloon is inflated to help widen the narrowed artery.
Depending upon the clinical circumstances and patient’s condition, PTCA is often combined with the placement of a Coronary Stent in the narrowed artery.
A Coronary Stent is a tiny metal mesh/scaffold, that is placed into the culprit artery to help the artery open and reduces the chances of re-narrowing (restenosis) of the artery. Often the coronary stents are coated with antiproliferative drugs which help the artery to remain open by inhibiting cell proliferation. Bare-metal stents may also be used. Angioplasty helps to relieve the symptoms of blocked arteries like chest pain and shortness of breath. Angioplasty is a commonly used procedure for treating a patient suffering from a heart attack.
What to expect during the Angioplasty Procedure?
- Your doctor will review your medical history and will perform routine tests like chest X-rays, electrocardiograms, and blood tests. You will be needed to undergo a coronary angiogram, i.e., an imaging test, which helps the doctor to see your heart and arteries, to know the exact location of the blockage in the artery. So that an adequate and appropriate treatment plan can be scheduled.
- You will be instructed to adjust or stop certain medicines before the procedure, like aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners. You need to tell your doctor clearly regarding all the medicines you take routinely, including any supplements.
- You will be asked to stop eating or drinking, 6 to 8 hours before the angioplasty procedure.
- The Angioplasty procedure requires 2-3 days stay at the hospital, hence carry your necessities accordingly.
During the Procedure (Coronary Stent Placement)
- During the angioplasty procedure, you will need to remove your jewellery and other things that may interfere with the angioplasty procedure. Follow the doctor’s instructions.
- You will be needed to wear the hospital gown and will be asked to empty your bladder.
- The hair in your groin area (i.e., the catheter insertion site) will be shaved off
- You will be asked to lie on your back on the operation table and will be connected to an electrocardiogram (ECG) monitor. This monitor records the electrical activity of your heart. Your vital signs like blood pressure, oxygen level, heart rate, etc. will be monitored during the procedure.
- You will be injected with Local anesthesia at the insertion site. This may give a stinging feeling for few seconds.
- Once the anesthesia is effective, a plastic tube-like device, called a sheath or introducer will be kept into your blood vessel (at the groin area). Through this introducer, the catheter will make its way into the blood vessels, till the heart. This advancement of the catheter will be visualized through Fluoroscopy aid.
- Once your catheter is in place, an imaging dye, often know as contrast dye will be injected through your catheter into the coronary arteries, which would help to see the narrowed area of your artery. This injection of contrast media will cause brief (for few seconds) sensations of flushing, salty taste in the mouth, or pain in the head.
- Your doctor will locate the narrowed artery through a series of X-ray images.
- The PTCA Balloon Catheter, tipped with a tiny balloon, mounted with a crimped stent, will be advanced to the target location. Once the catheter reaches its location, the balloon will be inflated, and along with it, the stent, which is mounted on the balloon, will also expand.
- This stent expansion will push the plaque build-up towards the vessel wall and will open the narrowed artery.
- Once the stent is in place, the balloon catheter will be deflated and removed.
- The sheath or introducer will be removed and the site will be closed by sutures or bandages.
- You will be shifted to the recovery room by the hospital staff. You may be asked to restrict your leg moments for few hours.
After the Procedure:
- You will be asked to take rest for several hours after the procedure.
- Your vital signs will be monitored and recorded.
- Tell the nurse or doctor if you feel chest pain or pain in any other body parts, or if there is any bleeding from the insertion site.
- After 2- 4 hours, you may be given a light meal.
- You may have the urge to urinate more often, because of the injection of contrast dye and more amount of fluids administration in the body.
- Once your condition is stable, you may be given a normal diet. You will be encouraged to drink more water to flush out the contrast dye.
- You may be asked to stay in hospital for a day or two, depending upon your clinical condition.
- You will be discharged from the hospital with the doctor’s instructions and medication prescription.
- You need to strictly follow these instructions.
- You may be called by the doctor for post-procedure follow-up, to check your health after stent implantation.