Angioplasty and Stent Placement for the Heart

Angioplasty may be done as part of your stay in a hospital. Procedures may vary depending on your condition and your healthcare provider’s practices. Most people who have angioplasty and stent placement are kept track of overnight in the hospital.

You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aid if you use either of these.

You will be asked to remove your clothing and will be given a gown to wear.

You will be asked to empty your bladder before the procedure.

If there is a lot of hair at the area of the catheter insertion (often the groin area), the hair may be shaved off.

An IV (intravenous) line will be started in your hand or arm before the procedure. It will be used for injection of medicine and to give IV fluids, if needed.

You will be placed on your back on the procedure table.

You will be connected to an electrocardiogram (ECG) monitor that records the electrical activity of your heart and keeps track of your heart rate using electrodes that stick to your skin. Your vital signs (heart rate, blood pressure, breathing rate, and oxygen level) will be tracked during the procedure.

There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through your body into your heart, and the structures of your heart as the dye is injected.

You will get a sedative in your IV line to help you relax. But you will likely stay awake during the procedure.

Your pulses below the catheter insertion site will be checked and marked so that the circulation to the limb below the site can easily be checked during and after the procedure.

Local anesthesia will be injected into the skin at the insertion site. This may be in your leg, arm, or neck. You may feel some stinging at the site for a few seconds after the local anesthetic is injected.

Once the local anesthesia has taken effect, a sheath, or introducer, will be put into the blood vessel (often at the groin). This is a plastic tube through which the catheter will be threaded into the blood vessel and advanced into the heart.

The catheter will be threaded through the sheath into the blood vessel. The healthcare provider will advance the catheter through the aorta into the heart. Fluoroscopy (“live” X-ray) will be used to help see the catheter advance into the heart.

The catheter will be threaded into the coronary arteries. Once the catheter is in place, contrast dye will be injected through the catheter into your coronary arteries to see the narrowed area. You may feel some effects when the contrast dye is injected into the IV line. These effects include a flushing sensation, a salty or metallic taste in the mouth, or a brief headache. These effects usually last only a few moments.

Tell your healthcare provider if you feel any breathing trouble, sweating, numbness, itching, nausea or vomiting, chills, or heart palpitations.

After the contrast dye is injected, a series of rapid X-ray images of the heart and coronary arteries will be taken. You may be asked to take in a deep breath and hold it for a few seconds during this time.

When the healthcare provider locates the narrowed artery, the catheter will be advanced to that location and the balloon will be inflated to open the artery. You may have some chest pain or discomfort at this point because the blood flow is temporarily blocked by the inflated balloon. Any chest discomfort or pain should go away when the balloon is deflated. But tell your healthcare provider right away if you notice any continued discomfort or pain, such as chest pain, neck or jaw pain, back pain, arm pain, shortness of breath, or breathing trouble.

The healthcare provider may inflate and deflate the balloon several times. The decision may be made at this point to put in a stent to keep the artery open. In some cases, the stent may be put into the artery before the balloon is inflated. Then the inflation of the balloon will open the artery and fully expand the stent.

The healthcare provider will take measurements, pictures, or angiograms after the artery has been opened. Once it has been determined that the artery is opened sufficiently, the catheter will be removed.

The sheath or introducer is taken out and the insertion site may be closed with a closure device that uses collagen to seal the opening in the artery, by the use of stitches (sutures), or by applying manual pressure over the area to keep the blood vessel from bleeding. Your healthcare provider will decide which method is best for you.

If a closure device is used, a sterile dressing will be applied to the site. If manual pressure is used, the healthcare provider (or an assistant) will hold pressure on the insertion site so that a clot will form on the outside of the blood vessel to prevent bleeding. Once the bleeding has stopped, a very tight bandage will be placed on the site.

Staff will help you slide from the table onto a stretcher so that you can be taken to the recovery area. Note: If the insertion was in the groin, you will not be allowed to bend your leg for several hours. If the insertion site was in the arm, your arm will be kept elevated on pillows and kept straight by placing your arm in an arm guard (a plastic arm board designed to immobilize the elbow joint). A plastic band that works like a belt around the waist may also be put around your arm near the insertion site. The band will be loosened at given intervals and then removed when your healthcare provider decides the pressure is no longer needed.