CORONARY ANGIOGRAPHY OF MEDIGOCARE

OVERVIEWOF CORONARY ANGIOGRAPHY

Coronary Angioplasty, also known as Percutaneous coronary intervention (PCI), is the process of opening clogged or blocked heart arteries. This process makes use of a small balloon catheter, which is basically inserted in the blocked blood vessels to widen the vessels to improve and ease out the flow of blood to the heart. 

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Coronary Angioplasty is mostly done along with the proper placement of the stent that is a small and thin wire mesh tube. The stent actually helps to prop the arteries open, reducing the chances of the arteries narrowing down again. Most of the stents ( drug-eluting stents ) are usually coated with medications for keeping the artery open. Bare-metal stents are rarely used in this. 

This process of angioplasty ensures to improve the symptoms of blocked or clogged arteries like shortness of breath and chest pain. Angioplasty is often used in case of heart attacks to immediately open the blocked arteries, lower the risk factors, and lower the chances of creating any damage in the heart. 

Medigocare is one of the best health care services providers in India that offers extensive and advanced coronary angioplasty treatment including both surgery and medication, having the best doctors and the latest apparatus and medical facilities. 

Why it is done

Coronary Angioplasty helps in    treating the build-up of the fatty plaques in the blood vessels of the heart. This is a kind of heart disease also termed as atherosclerosis. 

Indications of the coronary angioplasty treatment: – You need the angioplasty treatment if –

• You have chest pain or angina that is worsening. 
• You have tried any lifestyle changes or medications that have actually not cured your heart condition. 
• If you get a heart-attack then this treatment can help in quickly opening up the blocked artery, thereby, reducing heart damage. 

But Angioplasty is not for everyone. And depending on for how long you are suffering from the heart disease & the overall health condition, your doctor can suggest that coronary artery bypass surgery can be a much better option for you than Angioplasty. You may need to get coronary artery bypass surgery done if: – 

• You are having diabetes and multiple severe blockages in your arteries. 
• Your heart muscles are weak. 
• The main artery which drives blood to the heart’s left side is narrow. 

In case of the coronary artery bypass surgery process, the artery’s blocked part is bypassed with a healthy blood vessel from any other part of the body. 

Types of Coronary Angioplasty: – 

Balloon angioplasty –

Balloon Angioplasty os the process or type of angiopladty treaatment that is used for opening up the blocked, clogged, or narrowed arteries of your heart using a balloon attached to the catheter.

Carotid artery angioplasty –

Carotid angioplasty is the process or type of angioplasty treatment that helps to open the blocked arteries for restoring the flow of blood to the brain. This type of angioplasty is often done to prevent or treat strokes. In this treatment, the carotid arteries the arelocated on both the sides of the neck, are considered the main arteries that supply blood to the brain.

Cerebral angioplasty: –

Cerebran angioplasty is quite similar to the cariology processand is used for opening up the partially narrowed, blocked, or clogged carotid and vertebral arteries in your neck.

Coronary artery stent: –

When coronary angioplasty is performed along with the stent placements, there is a minor risk that the treated artery may get clogged or blocked again. The risk of this renarrowing of the arteries gets higher when the bare-metal stents are being used. 

Laser angioplasty: –

Laser angioplasty is the process that helps to remove the need to get CABG surgery done to treat those clogged or narrowed arteries.

PTA of the Femoral Artery: –

PTA is the abbreviated form of Pertaneous transluminal angioplasty that is a minimally invasive process used for opening up the blocked arteries.      

Risk Factors Coronary Angioplasty: 

Although coronary angioplasty is a much less invasive method of opening the clogged or blocked arteries as compared to the bypass surgery, the process still carries a few risk factors. 

Some of the most common risks and complications of Coronary Angioplasty include: – 

Re-narrowing of the arteries.

When coronary angioplasty is performed along with the drug-eluting stent placements, there is a minor risk that the treated artery may get clogged or blocked again. The risk of this renarrowing of the arteries gets higher when the bare-metal stents are being used. 

Blood clotting:

Blood may get clotted from within the stents even after the process. The clots can even close the arteries, resulting in a heart attack. It is essential to take aspirin along with clopidogrel or Plavix, prasugrel or Effient, or any other medication that helps to reduce the risks of blood clots as prescribed to lower the chances of the formation of clots stents. Talk to the doctor about for how long you will have to continue to take the medication as stopping the medication without a doctor’s consultation is not what you should do. 

Bleeding is another risk factor:

You may face things like bleeding in the leg or the arm where the catheter was inserted. Generally, this results in bruising. But in some cases, serious bleeding may also occur and that may need a surgical treatment or blood transfusion. 

Some other risks of angioplasty are: – 

Heart attack:-

Though very rarely does it happen, you may get a heart attack while carrying out the process. 

Coronary artery damage: –

The coronary artery can get ruptured or torn during the process. And such complications may need bypass surgery or coronary angioplasty operation. 

Kidney problems:-

The due that is used during the stent placement and angioplasty may result in kidney damage in some cases, especially in those who are already suffering from kidney problems. In such cases, the doctor may take precautionary steps like restricting the amount of the contrast dye and ensuring that you are hydrated enough during the process. 

Stroke.

During the angioplasty process, you may get a stroke if plaques are found to break loose at the time when the catheters were being threaded via the aorta. You may also get blood clots in the catheters that can even move to the brain in case they break loose. Stroke rarely occurs in angioplasty treatment but if such things happen, blood thinners can be used during the angioplasty process for reducing the risk. 

Abnormal heart rhythms: –

During the angioplasty process, your heart may start beating too fast or too slow. Such heart rhythm issues are short-lived but may need a temporary pacemaker or medications sometimes. 

What you can expect

Pre-procedure of the Coronary Angioplasty

Before your scheduled angioplasty, the doctor will first review your past medical records. Then the doctor will do a physical examination of your body and heart specifically. You may need to go for a chest x-ray along, with an electrocardiogram, with some other blood tests prior to the procedure. The doctor will also perform an aging test known as the coronary angiogram in order to see if your heart arteries are blocked and whether they can be treated with the angioplasty process. 

If the doctor finds any blockage during the angiogram treatment, the doctor may decide to proceed with angioplasty treatment and stenting just after the angiogram procedure while your heart still gets catheterized. 

The doctor will give you all the instructions to prepare. 

• The doctor can instruct you to stop taking or change the medications before your angioplasty like nonsteroidal anti-inflammatory drugs, aspirin, or blood thinners. Make sure to tell the doctor about all the medicines you take along with herbal treatments. 
• Generally, you need to stop drinking or eating 6 to 8 hours prior to your angiography. 
• Take approved or prescribed medications with small sips of water in the morning of the process. 
• Collect all the medicines and take all of them to the hospital. 
• Ensure to arrange for transportation to get back to your home. This process of angioplasty usually needs an overnight stay at the hospital. It is not possible to go home on the same day after the procedure. 

During the process.

Angioplasty treatment is performed by a cardiologist or heart specialist with a team of specialized technicians and nurses in a cardiac catheterization laboratory. 

The angioplasty process is performed through the artery in the ground, wrist, or arm area. General anaesthesia is not required. You will receive a sedative that will help you to relax but you may remain awake during the process depending on how much you are sedated. 

• You will receive medications and fluids to relax as well as blood-thinning medications or anticoagulants through the IV catheter in your arm or hand. 
• Your pulse rate, heart rate, oxygen level, and blood pressure level will get monitored during the process. 
• The doctor will prepare an area in your arm, wrist, or leg using an antiseptic solution and then will place the sterile sheet on your body. 
• The doctor will use any local anaesthesia to make the area numb where the small incision will be made. The small and thin guidewire will be then inserted into the blood vessel. 
• Using live X-rays, the doctor will thread the catheter or thin tube through your artery. 
• The contrast dye will be injected through the catheter or tube once it is in place. This will allow the doctor to see the internal condition of the blood vessels and identify the blockage that was seen on the x-ray images known as angiograms. 
• A small balloon without or with a stent at the catheter’s tip is inflated at the blockage site, broadening the blocked artery. And once the artery is stretched, that balloon is then deflated and then the catheter is then removed. 
• And if you have multiple blockages then the process will be repeated for every blockage. 

Angioplasty may take up to many hours even, depending on the number of blockages, the difficulty level, and the complications that may arise. 

You may also feel a little or more pressure in that area where the thin tube or catheter is inserted. Also, you might feel a little discomfort when the artery is stretched and the balloon is inflated, but typically, you should not feel any such pain during the entire process. 

Stent placement. 

Most people who go through angioplasty treatment also get a stent placed in the clogged artery during the angioplasty treatment process. A stent that looks quite similar to a small coil of meshed wire, provides support to the artery walls and prevents them from getting re-narrowed after angioplasty. 

Here’s what is done during the stent placement. 

• The stent that is collapsed around the balloon-like structure at the catheter’s tip, is guided through your artery to the area of blockage. 
• And at the blockage, that balloon is then inflated and then the spring-like stent will expand and will get locked into place inside your artery. 
• The stent remains permanently in the artery for holding it open and improving blood flow to the heart. In some rare cases, more than 1 stent may be required to open the blockage. 
• Once the stent has been placed rightly, the balloon catheter will be then deflated and then removed. 
• More angiograms or x-rays are taken to check how well the blood is flowing through the newly broadened artery. 

Most stents that are implanted during the angioplasty process are drug-coated. And the medication given in this condition is slowly released for preventing any future plaque build-up and renarrowing of the blood vessels. After the stent placement, the doctor prescribes medication like aspirin, clopidogrel, prasugrel, etc., to reduce the chances of any formation of blood clots on the stent. 

Post-procedure of Coronary Angioplasty  

If you had gone through a non-emergency process, then you will probably have to stay in the hospital for one night while your heart will be monitored and the medications will be adjusted accordingly. You will most probably be able to get back to work and your normal routine a week after the angioplasty. When you will return home, you will need to drink plenty of water and fluids to help in flushing out the contrast dye from your body. Avoid doing any strenuous exercise and heavy lifting for at least a couple of weeks. Ask the doctor about the other restrictions you will have to follow. 

Make sure to call the doctor if: – 

• The site where the catheter was inserted suddenly starts to bleed or gets swelled up
• You get sudden chest pain or shortness of breath
• If you feel weak or fainting
• There is a change in the temperature or the colour of your arm or leg that was treated
• You get signs of infection like redness, drainage, fever, or swelling
• You develop pain or any discomfort at the site where the catheter was inserted

Blood Thinners

It is crucial to closely follow the doctor’s recommendations about the treatment with blood-thinning medication like prasugrel, clopidogrel, and aspirin. 

Most people who have gone through angioplasty without or with the stent placement are prescribed aspirin. Also, those who gave got a stent placed will need blood-thinning medications like clopidogrel for at least 6 months to at least a year. 

Results 

Coronary angioplasty increases blood flow to a great extent through the previously blocked or narrowed coronary artery. The chest pain usually will decrease. 

But having stent placement and angioplasty does not mean that your heart problem is completely gone. You will have to maintain a healthy lifestyle and habits & take medications exactly as prescribed by the doctor. 

Some habits you have to adopt and maintain are as follows: – 

• Quit smoking
• Maintain a healthy weight
• Lower the cholesterol levels
• Eat healthy
• Do exercise regularly
• Take medicines properly
• Control your blood pressure 

If you again find symptoms like shortness of breath or chest pain, immediately     contact the doctor. 

Cost of Angioplasty in India

• The coronary angioplasty cost in India may range somewhere between 3500-4200 USD for 10 days. The Coronary angioplasty surgery cost in India may vary the cost of the entire process.
• The hospital stay may be for 2-5 days depending on your health condition. 
• Tests like CT scans, MRI, ECG, echocardiogram, angiography, cardiac catheterisation angiography, nuclear technology, exercise stress test, and electrophysiology testing, all may add to the cost of Coronary Angioplasty in India.