What is coronary angioplasty? How long can one live after the procedure? Post-procedure diet, risks, and side effects

Coronary artery disease (CAD) is caused by the narrowing and blockage of coronary arteries due to the accumulation of fatty plaques, which leads to insufficient blood supply to the heart. This can result in symptoms such as angina, myocardial infarction, and in severe cases, myocardial necrosis with a risk of death.

If a patient's coronary arteries are narrowed or blocked by 70% or more, or if they are admitted due to acute coronary syndrome, they may require Percutaneous Coronary Intervention (PCI). Currently, PCI is a minimally invasive procedure that involves low trauma and has a high success rate. While both PCI and coronary artery bypass surgery aim to restore blood supply to the heart, they are different approaches to treatment.

Before the balloon angioplasty procedure, the doctor must perform cardiac catheterization and coronary angiography to accurately assess the patient's vascular condition, which is considered the "gold standard" for diagnosing heart disease. Under X-ray fluoroscopy, the doctor will use a puncture method to guide a specialized catheter through a peripheral artery to reach the patient's heart and blood vessels, extracting blood and injecting a contrast agent for cardiovascular imaging.

To ensure the examination and procedure proceed smoothly, patients are usually required to fast for 4-6 hours before the surgery. This is mainly to avoid complications such as vomiting during the procedure. Additionally, for female patients, the doctor typically asks about the date of their last menstrual period and whether there is a possibility of pregnancy, in order to rule out pregnancy and take appropriate protective measures during the procedure.

Our hospital's hybrid cardiac catheterization and interventional treatment operating room is equipped with intravascular ultrasound (IVUS) and optical coherence tomography (OCT). These technologies can be widely applied before or after balloon angioplasty, assisting doctors in real-time observation of the inner vessel wall, such as identifying dangerous atherosclerotic plaques, detecting blood clots, and monitoring whether the stent adheres closely to the vessel wall after implantation, thereby reducing the risk of the patient experiencing another heart attack.

What are Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT)?

Intravascular ultrasound (IVUS) does not involve radiation and helps doctors understand the morphology and degree of narrowing of the vascular wall, with a long history of clinical application.

On the other hand, optical coherence tomography (OCT) uses infrared optical technology to produce two-dimensional or three-dimensional images during cardiac surgery, providing high image clarity that enhances the precision of the procedure.

1.    Local Anesthesia: The doctor will administer local anesthesia to the artery at the patient's wrist or inner thigh, ensuring the patient feels comfortable during the procedure.

2.    Arterial Puncture: The doctor will make a small puncture at the anesthetized site and insert a thin catheter.

3.    Guiding the Catheter: Under the guidance of an X-ray machine, the doctor will advance the catheter along the blood vessel to accurately reach the narrowed area of the coronary artery.

4.    Vessel Dilation: The doctor will send a small balloon through the catheter to the narrowed vessel, inflating it to widen the artery and restore normal blood flow.

5.    Stent Implantation: After the balloon is deflated and removed, the doctor will usually implant a stent in the widened artery to maintain its patency and prevent re-narrowing.

Typically, the entire balloon angioplasty procedure takes about 1.5 to 3 hours. However, the specific duration may vary depending on the patient's condition, the complexity of the vascular blockages, and other factors.

Balloon Angioplasty and Stent Implantation

After completing the balloon angioplasty, the doctor generally implants a mesh-like steel medical device at the affected site to prevent the artery from narrowing again. The stent has a unique structure, with a drug-coated surface that effectively slows down the proliferation of cells within the vessel wall.

Although coronary angioplasty is a relatively safe minimally invasive procedure, it still carries certain risks, including:

• Mild side effects: Allergic reactions to the contrast dye, nausea, vomiting, minor bruising, swelling, or infection at the puncture site.
• Severe complications: Heart attack, stroke, kidney failure, shock, or even death, with a mortality risk ranging from approximately 0.4% to 1.9%.

The side effects of coronary angioplasty can vary depending on individual differences, such as heart function, the degree of vascular blockage, age, and the presence of other medical conditions.

Generally speaking, patients can be discharged the day after the procedure. Most patients can resume light daily activities within about a week post-procedure, but they should avoid strenuous exercise in the short term to prevent bleeding from the wound.

After coronary angioplasty, patients must pay attention to the following matters to aid in post-procedure recovery:

• Follow the doctor’s instructions regarding medication, wound care, and attending follow-up appointments on time.
• Maintain healthy lifestyle habits, such as getting adequate sleep, resting appropriately, and quitting smoking and alcohol.
• Under the doctor’s advice, engage in light exercise, such as walking, to help improve blood circulation.
• Post-angioplasty diet should be light, focusing on vegetables and fruits while reducing intake of high-salt, high-fat, and high-cholesterol foods. Additionally, lowering salt intake can help control blood pressure.

Hong Kong Adventist Hospital offers a wide range of conditions and treatment services targeting specific parts of the body, including cardiology, general medicine, orthopedics, oncology, gynecology, urology, neurosurgery, ophthalmology, and respiratory medicine, among others. The cardiology department, staffed by specialist doctors and a dedicated medical team, is committed to providing comprehensive and compassionate one-stop cardiac care services for those in need. These services include cardiac examinations, outpatient care, treatments, surgeries, and rehabilitation. For more information, please click here.