Angioplasty and Stenting

Angioplasty, formally percutaneous coronary intervention or PCI, reopens an artery narrowed by plaque. A catheter carries a tiny balloon to the blockage; inflating it compresses the plaque and stretches the artery open. In nearly all cases a stent — a small expandable mesh tube — is then deployed to scaffold the artery and keep it from narrowing again.

Most stents used today are drug-eluting: coated with medication released slowly into the artery wall to suppress the scar tissue that would otherwise regrow inside the stent.

During a heart attack, angioplasty is the treatment of choice, and the speed with which the artery is reopened directly affects how much heart muscle survives.

For stable angina, it is used to relieve symptoms when chest pain limits daily life despite medication. This is an important distinction to understand: in stable coronary disease, opening a narrowing reliably improves symptoms, but medication and risk-factor treatment are what reduce heart attack and death. A stent is not a substitute for that therapy.

The decision also depends on the pattern of disease. Blockages involving the left main artery or all three vessels — especially with diabetes — may be better served by bypass surgery, and that comparison is made deliberately rather than by default.

Angioplasty is performed the same way as a diagnostic catheterization and frequently follows directly from one in the same session. Access is through the wrist or groin, you are sedated but awake, and the procedure typically takes 30 to 90 minutes.

During balloon inflation the artery is briefly blocked, and chest discomfort at that moment is common and expected — tell the team, as it is informative. Some patients stay overnight; a straightforward planned case may go home the same day.

After a stent you will take dual antiplatelet therapy — aspirin plus a second antiplatelet such as clopidogrel, ticagrelor or prasugrel. This is not optional and not a routine prescription to lapse.

Until the stent is covered by the artery's own lining, stopping these medications early can cause the stent to clot abruptly, which typically presents as a major heart attack. The duration depends on your stent and your bleeding risk — commonly 6 to 12 months for the second agent, sometimes shorter or longer — with aspirin usually continued indefinitely.

Never stop these on your own. If any clinician, including a dentist or surgeon, asks you to hold them for a procedure, contact your cardiologist first so the timing can be coordinated.

Avoid heavy lifting and strenuous activity for about a week, keep the access site clean and dry, and drink fluids to clear the contrast. Cardiac rehabilitation is strongly recommended after PCI and is one of the better-evidenced things you can do afterward.

Call for bleeding that will not stop, an expanding lump at the site, fever, or chest pain resembling what brought you in — new chest pain after a stent needs prompt evaluation rather than watchful waiting.

Bleeding or vessel injury at the access site, contrast-related kidney injury, and less commonly heart attack, stroke, arrhythmia, or the need for emergency bypass surgery. Over time, restenosis — renarrowing within the stent — occurs in a small percentage, and stent thrombosis is uncommon but serious. Ongoing statin therapy, blood pressure and diabetes control, and stopping smoking are what protect the rest of your arteries.