By Richard N. Fogoros, MD 

 Medically reviewed by Richard N. Fogoros, MD

Angioplasty is a minimally invasive surgical procedure used to open block blood vessels that travel to the heart. Also called a percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI), the procedure is often performed after an episode of chest pain or a heart attack and typically involves the placement of a stent.

Javier Larrea / age fotostock / Getty Images

What Is Angioplasty?

Angioplasty is a catheterization procedure that opens arteries blocked or narrowed by a sticky material called plaque.

The surgery involves passing a long, thin, flexible tube called a catheter across the atherosclerotic plaque that is causing the blockage. Then, a deflated balloon attached to the catheter is inflated to open up the narrowed artery wall. A stent—an expandable mesh tube-shaped device—is placed, if needed, and left behind as a "scaffold" to help support the wall of the artery and keep it open.

Angioplasty is performed in a hospital cardiac catheterization laboratory and, in a non-emergency setting, patients may be discharged home the same day as the procedure. In some cases, it may require an overnight hospital stay. Angioplasty is typically a scheduled procedure, though it may be used as an emergency treatment during a heart attack.

Contraindications

Angioplasty may not be right for everyone. Patients with several blockages, blockages in certain places, or total occlusion of the artery may need coronary bypass instead. 

The procedure is also contraindicated for people with certain bleeding and coagulation disorders and those who may be allergic to contrast dye.¹

Potential Risks

Like any procedure that requires the insertion of a catheter into a blood vessel, angioplasty carries some risks including:²

• Damage to the blood vessel being used for the procedure

• Bleeding

• Infection

• Thrombosis (blood clots)

Other complications that can occur during angioplasty include damage to the organ being supplied by the blood vessel being treated (including heart attack, kidney damage or stroke) and cardiac arrhythmias.

Purpose of Angioplasty

Plaque build-up in the arteries—known as atherosclerosis—leads to coronary artery disease (CAD). Left untreated, it can lead to chronic chest pain (angina), heart attack, or stroke.³

Healthcare providers can diagnose atherosclerosis and CAD using imaging tests, such as echocardiography, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET), or angiography.

Mild cases are typically treated with statins and heart-healthy lifestyle changes to lower cholesterol.⁴

More severe cases of atherosclerosis require surgery, and angioplasty is the most common procedure used to treat clogged arteries and improve blood flow to the heart. In fact, it is one of the most common procedures performed in the United States each year.⁵

Angioplasty does not correct atherosclerosis; it only relieves related blockages.

Angioplasty is quite effective in reducing the symptoms of stable angina and is often used in treating coronary artery disease in people who have acute coronary syndrome (ACS).

In ACS, acute blockage of a coronary artery occurs due to a ruptured plaque that has formed a clot within the artery. When this happens, a heart attack is very likely unless the artery is opened. Angioplasty and stenting can help during such an event to improve overall cardiac outcomes.

Other surgical options for treating atherosclerosis include coronary artery bypass grafting (CABG) and carotid endarterectomy.

How to Prepare

Before you have an angioplasty, your healthcare provider will perform a full medical history and physical exam. A chest X-ray, electrocardiogram, and blood tests will also be performed.

In assessing the appropriate course of treatment for your condition, your cardiologist may perform an angiogram—a procedure that uses contrast dye and X-ray to visualize arterial blockages. This test is used in determining if one or more stents may be required.

If angioplasty is performed as an urgent procedure during an acute or impending heart attack, an angiogram will be done in conjunction with the angioplasty as a single procedure.

Talk to your healthcare provider about the potential risks and benefits for you personally, as well as other potential treatment options.

Location

Angioplasty is performed in a cardiac catheterization laboratory located in a hospital. For planned procedures, you are typically asked to arrive at the hospital a few hours before the scheduled procedure time.

What to Wear

You will need to change into a hospital gown for the procedure, so wearing something that is easy to take off is best.

You will not be allowed to wear jewelry during the procedure and you should leave anything of value at home.

Food and Drink

You will need to stop eating and drinking for up to eight hours before the procedure. If your angioplasty is planned, follow related instructions provided by your healthcare provider.

If the surgery is an emergency, the practitioner will talk to you about when you last ate and will decide when it is reasonably safe to proceed.

Medications

Tell your healthcare provider about all prescription and over-the-counter medications and supplements you use. Certain drugs may interfere with sedation, alter your heart rate and blood pressure, or cause problems with blood clotting during surgery, as is the case with blood thinners.⁶

If your procedure is scheduled in advance, your healthcare provider will give you guidance on what you might need to stop taking before surgery and when.

What to Bring

Be prepared to possibly spend at least one night in the hospital. Prepare what you will need the night before your procedure, especially if you have an early start time.

Be sure to pack your insurance documents and identification along with personal necessities and comfort items.

You may not be allowed to drive upon hospital discharge, so you should arrange in advance for someone to bring you to the hospital and drive you home again.

Pre-Op Lifestyle Changes

Prior to angioplasty, your healthcare provider will likely recommend you begin following a low-cholesterol diet and avoid drinking alcohol.

If you are a smoker, quitting four to six weeks before surgery and remaining smoke-free for four weeks afterward greatly reduces your risk of complications and improves heart health in the long term.⁷

What to Expect on the Day of Surgery

A day or two before your scheduled procedure, you will be notified when to arrive at the facility to check-in and given any additional instructions. Arrive at the hospital early to give yourself some extra time for parking and navigating the facility.

Before the Procedure

Once checked in at the hospital, you will be taken to a room to change into a hospital gown. At this point, you will be asked to update and review your medical history, answer questions about the last time you ate or drank, and undergo a brief physical examination.

From here, you with be brought into the catheterization laboratory where the procedure will take place. The room will be set up with surgical equipment and computers that will help the surgeon find and treat the blockages. The room may be chilly, but there will be blankets to keep you warm.

You will be connected to an IV and given medications and a mild sedative to help you relax.⁸

During the Procedure

Angioplasty is performed while you are awake. The procedure is not painful and no incision will be made.

The procedure can take anywhere from 30 minutes to three hours depending on the number of blockages that need to be treated and any complications that may arise.

Once the anesthesia has taken effect, the surgical staff will sterilize the skin where the catheter will be inserted—the brachial artery in the arm, the radial artery in the wrist, or the femoral artery in the groin. The area will also likely be covered with a cellophane-like sheet.

After numbing the area, the healthcare provider will insert a needle into the artery. Using the same opening, they will then insert a catheter. Live X-rays help guide the surgeon to the heart where a contrast dye will be injected to highlight the blockages.²

To open a blocked artery, your healthcare provider will insert another catheter with a deflated balloon and, if needed, a stent. Once the catheter reaches the blockage, the balloon is inflated to compress the plaque against the wall of the artery.

The balloon is then deflated and any stents are placed.⁸ Your healthcare provider will determine the type of stent to use: either a bare-metal stent or a drug-eluting stent, which is a metal mesh coated with a slow-releasing medicine to prevent the artery from narrowing again. Different types of drug-eluting stents are coated with different medicines.⁹

After the angioplasty is finished, the surgeon will quickly remove the catheter and use a special device to close the artery.

After the Procedure

Once the surgery is complete, you'll be moved to a recovery room and kept on a cardiac monitor. Once sedation wears off—usually with a half-hour to an hour—you will be moved to a regular hospital room and allowed to eat again.

Generally, scheduled angioplasty procedures do not require an overnight stay in the hospital, but in some cases you may need to stay for additional observation. If your procedure was done as an emergency due to a heart attack or other cardiac event, you will likely need to stay in the hospital for several days for monitoring and recovery.

Upon discharge, you will be sent home with recovery instructions that should be closely followed.

Recovery

Recovery from angioplasty is typically quick. You may experience some discomfort and bruising at the site of catheter insertion, which should gradually improve over a few days.

Depending on your overall health prior to the procedure, many people are able to drive and return to work within the week. A follow-up appointment is typically scheduled for two to four weeks after an angioplasty.

Healing

In the first several days after the procedure, watch the insertion site for bleeding, swelling, redness, pain, or drainage and for any changes of color in the limb used for the procedure.

Refrain from lifting heavy objects and follow any other restrictions set by your healthcare provider.

Seek Immediate Medical Help

Thrombosis, a serious condition involving blood clots at the site of the stent, can occur in the first week or so after the procedure. This can result in a sudden catastrophic event such as a heart attack or stroke. Call 911 if you experience:

• Chest pain

• Shortness of breath

• Sudden dizziness or weakness

• Slurred speech

• Weakness on one side of the face or body

• Limb pain accompanied by its skin turning pale, blue, or cold 

Medications

After angioplasty, you will need to take blood-thinning medications (such as Plavix) to prevent blood clots from forming at the site of angioplasty. Your healthcare provider will give you a prescription before you are discharged and instruct you on side effects to watch out for. If you experience any, be sure to discuss them at your post-surgical follow-up appointment (if not sooner).

Medications may also be prescribed to treat co-occurring conditions such as hypertension, high cholesterol, and diabetes.

Cardiac Rehabilitation

Your cardiologist may recommend a course of cardiac rehabilitation. The goal of cardiac rehabilitation is to help you regain strength, develop healthy eating and exercise habits, and prevent a worsening of the condition.¹⁰

Cardiac rehabilitation consists of a customized exercise plan developed by a cardiac physical therapist. Research shows participating in a cardiac rehabilitation program reduces the risk of future heart problems and death from heart disease.¹⁰

Long-Term Care

Atherosclerosis is a progressive disease linked to diet and other lifestyle factors. While blocked arteries that result from plaque build-up can be treated with angioplasty, the surgery does not eliminate atherosclerosis itself.

Unless drastic lifestyle changes are made, plaque will continue to accumulate in the arteries and cause additional blockages that can lead to a heart attack.

You can slow the progression of atherosclerosis and reduce your risk of future cardiac events with the following positive lifestyle changes:

• Quit smoking

• Follow a low-cholesterol diet

• Reduce high blood pressure

• Control your blood sugar if you have diabetes

• Lower your cholesterol levels

• Maintain a healthy weight

• Get regular exercise

Your healthcare provider can help direct you to resources to manage these important risk factors. For example, a dietitian can teach you how to follow an appropriate diet; smoking-cessation programs can help you to quit smoking.