India’s best known Fashion Designer Rohit Bal suffered from a heart attack on Tuesday morning. He received clot busting drugs from his family physician and was later shifted to Medanta Hospital where ECG and other tests were performed which showed massive damage to his heart muscles. He was supposed to undergo Angiography on Wednesday to examine the damage and to decide whether a bypass or an angioplasty was needed, but he complained of chest pain again at night after which doctors decided to perform emergency angioplasty in which a balloon stent is inserted into the coronary artery to clear the clot and increase the blood flow to the heart.

This article published in WebMD explains the process of Angioplasty and its benefits compared to other methods of treatments,

Why is Angioplasty conducted?

Emergency angioplasty with or without stenting is typically the first choice of treatment for a heart attack.

Although many factors are involved, angioplasty is most often used if you:

  • Are having a heart attack.
  • Have frequent or severe chest pain (angina) that is not responding to medicine.
  • Have evidence of severely reduced blood flow (ischemia) to an area of heart muscle caused by one or more narrowed coronary arteries.
  • Are in good enough health to have the procedure.

It is not an option if,

  • There is no evidence of reduced blood flow to the heart muscle.
  • Only small areas of the heart are at risk, and you do not have disabling chest pain (angina).
  • You are at risk for having complications or dying during angioplasty due to other health problems.
  • The affected artery cannot be reached during angioplasty.
  • The surgeon or hospital does not have extensive experience in performing these procedures.
  • The hospital does not have access to emergency cardiac surgical facilities.

 
How is it done?

Angioplasty, also know as percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA), is a procedure in which a catheter-guided balloon is used to open a narrowed coronary artery. A stent (a wire-mesh tube that expands to hold the artery open) is usually placed at the narrowed section during angioplasty.

Angioplasty with stent placement has become the first choice of treatment for a heart attack if it can be performed in a timely manner. It is a common procedure in large medical centers.

The goal of this revascularization procedure is to increase blood flow to the heart muscle tissue by clearing out both the blood clot and cholesterol from a ruptured plaque that is blocking the blood vessel. Clot-dissolving drugs (thrombolytics) only remove the blood clot. Angioplasty/stenting is less invasive and has a shorter recovery time than bypass surgery, which requires open-heart surgery.

After you are given a sedative, a thin flexible tube (catheter) is inserted through an artery in the groin or arm and carefully guided up the aorta into the blocked coronary artery. Usually, cardiac catheterization and coronary angiography are performed first to identify any blockages by injecting a dye that contains iodine. The dye makes the coronary arteries visible on a digital X-ray screen.

If there is a blockage, the catheter is advanced to the narrowed portion. Then a small balloon at the end of the tube is inflated. The balloon may stay inflated from 20 seconds to 3 minutes, then it is deflated and removed. The pressure from the inflated balloon presses the plaque against the wall of the artery, making more room for blood to flow. See a picture of a balloon angioplasty .

In most cases, a small, expandable wire-mesh stent is permanently inserted into the artery during angioplasty. The balloon is placed inside the stent and inflated, which opens the stent and pushes it into place against the artery wall to keep the narrowed artery open. Because the stent is like woven mesh, the cells lining the blood vessel grow through and around the stent to help secure it. See a picture of stent placement. This procedure is designed to:

  • Open up the artery and press the plaque against its walls, thereby improving blood flow.
  • Keep the artery open after the balloon is deflated and removed.
  • Seal any tears in the artery wall.
  • Prevent the artery wall from collapsing or closing off again (restenosis).
  • Prevent small pieces of plaque from breaking off, which might cause a heart attack.

 
Risks and Benefits

Studies show that angioplasty with stent placement, compared with angioplasty only, reduces the chance that the artery will renarrow and possibly reduces the risk of death. Drug-eluting stents further reduce the chance that the artery will renarrow. But experts do not know yet how safe the drug-eluting stents are over the long term or how well they work over the long term.

Angioplasty does not require open-chest surgery and has less risk for immediate complications. Long-term outcomes of bypass surgery versus angioplasty are similar. But bypass surgery may be a better option for some people, such as those with diabetes.

Bypass surgery may also be better for people who have extensive coronary atherosclerosis. Also, bypass surgery may be the best option when there are blockages in the coronary arteries that cannot be reached during angioplasty or when angioplasty was tried but did not widen the blood vessel enough.

If you smoke, the benefits of angioplasty are much greater if you quit smoking.

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