Angioplasty Procedure - Uses, Indications, Surgery & Cost
PACE Hospitals is one of the best hospital for angioplasty in Hyderabad. The department of Cardiology offers a wide range of cardiac procedures, including angioplasty surgery. The hospital is equipped with state-of-the-art facilities and The next generation image-guided therapy platform - a
Philips Azurion Cath Lab
for outstanding interventional cardiac, electrophysiology, neuro and vascular performance.
Our team of the best cardiologist in Hyderabad, Telangana, India are having extensive experience in performing angioplasty procedure.
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What is angioplasty procedure?
Angioplasty meaning
Angioplasty procedure, also called balloon angioplasty or percutaneous transluminal coronary angioplasty, is a minimally invasive endovascular procedure, either with or without placing an angioplasty stent, used to widen the blocked or narrowed blood vessels (stenosis), as a result of underlying atherosclerosis (blockage due to formation of plaque in the arteries). These blockages can occur at any place in the arteries of the pelvis, neck, arms, legs, and kidneys.
During the angioplasty surgery, a catheter with an inflatable balloon tip is inserted through the access site, and the balloon is inflated once the catheter has passed through the stenosed artery site. It restores the luminal diameter, forces the atherosclerotic intraluminal plaque toward the artery wall, and normalises blood flow. In order to prevent the reformation of obstruction, the interventional cardiologist places an angioplasty stent between the walls of the blood vessels.
Types of Angioplasty Procedure
The following are the different types of angioplasty procedures based on the anatomical location or area of the body being treated with the help of the balloon technique, with or without the placement of a stent.
- Coronary Angioplasty
- Cerebral Angioplasty
- Peripheral Angioplasty or Peripheral Artery Disease Angioplasty
- Renal Artery Angioplasty
- Pulmonary Angioplasty
- Carotid Angioplasty
- Aroto Angioplasty
- Coronary Angioplasty: It is the procedure used to widen the blocked narrowed coronary arteries (that supply oxygenated blood to heart muscles). It is used to treat coronary heart disease, emergency heart attack and angina.
- Cerebral Angioplasty: It is used to dilate or open partially blocked carotid blood vessels (that supply oxygenated blood to the brain), vertebral arteries and blood vessels inside the brain.
- Peripheral Angioplasty or Peripheral Artery Disease Angioplasty: It is used to treat narrowing or blockage of major blood vessels supplying blood to the lower extremities of the body such as hip, knee, ankle, thigh, leg and toes.
- Renal Artery Angioplasty: It is used to treat obstructed blood vessels that supply blood to the kidneys.
- Pulmonary Angioplasty: It is used to clear multiple blood clots that appear on the pulmonary arteries that supply blood to the heart.
- Carotid Angioplasty: It is used to treat blockages in the blood vessels of the carotid artery that supply blood to the brain.
- Aroto angioplasty: It is used to treat the stenosis or blockages that appear in the aorta (main artery) that carry oxygenated blood to the lower body.
Angioplasty Methods
Depending on the method used to dilate the blood vessel or remove the stenosis (obstruction), they are two different methods of angioplasty.
- Balloon angioplasty with or without stent placement:
- Laser Angioplasty
Balloon angioplasty with or without stent placement: Balloon angioplasty (BA) involves removing the blocked plaque by applying pressure through an inflated balloon. In some patients, the angioplasty stent (made up of wire mesh) exists around the balloon, placed between the walls of the blood vessel, with the help of the inflated balloon technique, to prevent the recurrence of plaque formation.
Laser Angioplasty: A laser (ultraviolet cool beam) will be used that works on a principle of photochemical action, breaks the carbon bonds in the blood clots, and creates a local heat (photothermal). This heat forms bubbles that vaporise the blockage or stenosis in the blood vessels.
Angioplasty indications
Angioplasty surgery is a minimally invasive procedure performed by interventional cardiologists to remove the stenosis in the blood vessels, thereby improving the blood flow. It is used to treat the following conditions:
- Narrowing of large arteries
- Peripheral vascular disease
- Renal vascular hypertension
- Carotid artery obstruction
- Coronary artery disease
- Venous narrowing
- Narrowing in dialysis fistula or grafts
Angioplasty contraindications
The following are the general contraindications of angioplasty in patients with:
- Presence of small blood vessels
- Posterior calcification
- Hematoma of blood vessels
- Intolerance to dual antiplatelet therapy
- Allergy to angioplasty stent components
- Age more than 80 years (in case of carotid angioplasty) due to a high risk of stroke
Angioplasty stent types
An angioplasty stent is a small, wire mesh tube that functions like a scaffold to assist in keeping the arteries wide open. The selection of an angioplasty stent depends on various factors such as plaque complexity, access site, stent availability, lesion location, blood vessel anatomy, and operator experience.
The following are the types of stents used in angioplasty surgery:
For coronary angioplasty
- Bare metal stent
- Drug-eluting stent
- Early-generation drug-eluting stents
- Durable polymer drug-eluting stents
- Bioabsorbable polymer drug-eluting stents
- Polymer-free drug-eluting stent
For carotid angioplasty
- Self-expanding stents
- Hybrid nitinol stent
- Alloy braided mesh stent
- Nitinol open-cell and closed cells stents
- New hybrid carotid stent
For peripheral arteries
- Bioabsorbable vascular scaffold
- Bioengineered stent
- Balloon-expandable stents
- Covered stents
- Drug-eluting stents
- Dual therapy stents
- Drug-coated balloon stent
- Self-expandable stents
The major disadvantage of bare metal stents is that, in some patients, they can cause the arteries to re-constrict. The body's immune system mistakes the stent for a foreign body and mounts an attack, leading to tissue swelling and excessive tissue growth around its vicinity. By employing drug-eluting stents, this issue can be avoided. These are coated with medications that inhibit excessive tissue growth and aberrant responses in the body.
As per National Institute for Health and Care Excellence (NICE), drug-eluting stents are recommended when the diameter of the affected section of the artery is longer than 15 mm and the treated artery is less than 3 mm. This recommendation is based on evidence the risk of re-narrowing is higher in such cases.
The choice of stent depends on the availability and expertise of the interventional cardiologist. Durable polymer drug-eluting stents and bioabsorbable polymer drug-eluting stents are usually the first choice. A bare-metal stent is best when the patient is actively bleeding or when dual antiplatelet therapy can't be used for more than 30 days.
The goal of angioplasty treatment:
The goal of the angioplasty procedure is as follows:
- To widen the damaged blood vessel in order to restore normal blood flow.
- To prevent the expanded artery from collapsing or recurrence of narrowing by placing stents, a metal-mesh tube.
Angioplasty preparations
The angioplasty patient preparation includes the following.
- A hospital visit may be required for an angioplasty surgery eligibility check. Depending on the patient’s condition, the interventional cardiologist assesses the patient’s chances of having the following course of treatment, such as
- Plain angioplasty (balloon angioplasty)
- Stent placement and its type
- During the initial assessment, the interventional cardiologist assesses more about the patient's medical, pregnancy, and medication history, including the use of over-the-counter and herbal supplements.
- People on oral hypoglycaemic agents for diabetes, antiplatelet or anticoagulant medicines, and patients with a history of hypersensitivity to iodinated contrast dye would be carefully examined before the angioplasty procedure to prevent complications.
- The physician prescribes a renal examination, as the angioplasty procedure requires considerable contrast material for clear visibility. Appropriate renal function plays a vital role in the excretion of contrast dye.
- The patient should not consume anything orally for 8 to 12 hours before the angioplasty procedure.
- The entire angioplasty procedure and the risk (if any) involved will be explained clearly to the patient, and the patient will be provided with a consent form to sign, which permits the interventional cardiologists to do the angioplasty procedure. It is important for the patient to read the consent document carefully and ask any questions they may have before signing.
- Nephrotoxic drugs such as non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, loop diuretics, and anti-oral hypoglycaemics may be stopped before the angioplasty procedure.
- The patient will be provided with a surgical gown, and their vitals, such as blood pressure, blood sugar levels (if diabetic), and electrocardiogram, will be checked before inserting the intravenous line. The blood pressure and heart rate will be continuously monitored throughout the angioplasty procedure.
- The target area will be shaved, an antiseptic will be put on it, and drapes will be put around the target access site to prepare it for the angioplasty procedure.
During Angioplasty procedure
The angioplasty procedure steps are as follows:
- The patient will be given general anaesthesia, and a small incision will be created to have access site in order to administer the catheter. A local anaesthetic is given to numb the area before making an incision in the skin over one of the arteries (radial or femoral).
- Radial artery access will be avoided in patients with chronic kidney disease who might need haemodialysis for End-Stage Renal Disease condition, where a potential future fistula will be installed.
- The cardiologist will insert a guide wire into the patient's blood vessel through the wrist or groin.
- A flexible balloon-tipped catheter (tube) is threaded by an interventional cardiologist into the patient’s arteries and guided by X-rays to the blocked or restricted artery. The guide wire will be removed, and contrast dye or angioplasty dye will be released through the catheter to improve blood vessel visibility; the patient might feel warm during this period.
- Once the blockage area has been identified, the balloon-tipped catheter will be advanced to the area of stenosis (blockage).
- Inflation and deflation of the small balloon re-establish blood flow in the artery by pushing the vessel walls out. The deflated balloon will be withdrawn once the blocked vessel is reopened, and the same procedure is repeated in case of multiple blockages.
- In many instances, the patients might receive a stent (a small tube made of wired mesh). The stent will be placed over the deflated catheter; when inserted into the position (blockage site) and the balloon is inflated, the stent expands and locks itself at the site. The balloon will be deflated and withdrawn, leaving the stent behind to hold the artery open and prevent further blockage.
Precautions after angioplasty (Post angioplasty care)
- After the angioplasty procedure or as a part of precautions after angioplasty, the patient may be shifted to the recovery room and kept under observation. The health care staff would monitor for any bleeding at the access site and vital signs such as blood pressure and heart rate.
- Once the patient seems normal, he/she would be shifted to the general room. The patient needs to inform the health care staff if they experience any discomfort, such as chest tightness, or any pain in the leg or at the access site.
- Depending on the patient’s condition, the doctor may suggest bed rest for a few hours. In some instances, due to clinical demand, the sheath or introducer will be left at the insertion site; in such cases, the bed rest duration would increase until it is removed.
- The patient might urinate frequently due to an increased intake of water or fluids before the angioplasty procedure to excrete the contrast dye through urine. Nevertheless, the patient will be suggested to drink more fluids to expel the contrast dye through urine.
- In case of pain at the insertion site, the interventional cardiologist might prescribe pain medication.
- The patient will be provided with an "after angioplasty diet chart” that includes foods to avoid after angioplasty, such as processed meat and a diet rich in saturated and trans-fat. In addition, the patient might receive information about when to resume the halted medications (if any).
- The patient will be advised to avoid lifting heavy objects and strenuous exercises, and be adherent to further follow-ups.
Angioplasty risks
The angioplasty risks and angioplasty stent risks depend on the patient's age, as angioplasty risks for the elderly are more when compared to adults, general health, and the existence of any associated diseases.
Angioplasty complications - Side effects of angioplasty procedure
Post-angioplasty complications might include a risk of an allergic reaction to the contrast agent (dye), anaesthesia or other materials used during the angioplasty procedure. However, angioplasty risks of death are minimal. In addition, the complications after angioplasty procedure are as follows:
Local Complications
- Blood clots or Thrombosis
- Bleeding at the site of catheter insertion (access site)
Systemic Complications
- Atheroembolism
- Infection
- Radiation Exposure
- Acute Kidney Injury
- Arrhythmia (abnormal heart rhythms)
- Hypersensitivity reactions
- Coronary perforation
- Abrupt vessel closure
Angioplasty Vs Bypass Surgery - Angioplasty vs CABG (Coronary artery bypass grafting)
Both are the treatment procedures used to restore the flow of blood; however, the following are the differences:
| Angioplasty surgery | Heart Bypass Surgery (CABG) |
|---|---|
| It is a minimally invasive method | It is a open heart surgery |
| It takes much quicker than bypass surgery whereas it might take a week (for planned angioplasty) | It takes nearly three months to recover |
| It require shorter hospitalisation stay | It require longer hospitalisation stay |
| In Angioplasty procedure, a ballon catheter widens the blocked vessel and restores normal blood flow. | In Heart Bypass Surgery, creates a new path for the blood flow by taking a healthy blood vessel from the patient's leg. |
| Indicated for patients with coronary artery disease and peripheral arterial disease, however, it is not advisable for everyone with Congenital heart defects (CHDs). | Indicated for patients with diabetes or with, triple-vessel disease or a severe form of coronary artery disease. |
Frequently asked questions:
How much does an angioplasty cost in Hyderabad, Telangana?
Angioplasty cost in Hyderabad ranges varies from ₹ 1,45,000 to ₹ 2,25,000 (INR one lakh forty-five thousand to two lakh twenty-five thousand). However, price of coronary angioplasty surgery in Hyderabad depends upon the multiple factors such as patient age, condition, and CGHS, ESI, EHS, insurance or corporate approvals for cashless facility.
How much does an angioplasty cost in India?
Angioplasty cost in India ranges varies from ₹ 1,40,000 to ₹ 2,35,000 (INR one lakh forty thousand to two lakh thirty-five thousand). However, price of angioplasty procedure in India vary in different private hospitals in different cities.
