2023-04-19 16:22:00
L’angioplasty (also called “dilatation“) is a technique that consists of restoring blood circulation in a vessel by dilating its narrowing (stenosis) using an inflatable balloon. This method can be used both to treat damage to a peripheral vessel and to a coronary artery (which surrounds the heart).
L’coronary angioplasty falls under interventional cardiology (since it does not require the opening of the thorax, unlike cardiac surgery). She remains one invasive act since it requires the introduction of a catheter in the femoral artery (at the level of the thigh) or radial (at the level of the wrist) in order to reach the narrowed or obstructed artery.
Indications: why do cardiac angioplasty?
Angioplasty is used when an artery is blocked or narrowed by a deposition of atherosclerotic plaques. Excess LDL cholesterol (or “bad” cholesterol) is responsible for the formation of these plaques. Over time, atheroma plaques become impregnated with elements present in the blood (fibrinogen, platelets, blood cells, calcium) and solidify. We talk aboutatherosclerosis.
Coronary angioplasty targets the coronary arteries that surround the heart when they are prone to atherosclerosis. It is preceded by a diagnostic phase (via a coronary angiography) which makes it possible to perfectly locate the areas of obstruction or stenosis requiring revascularization by angioplasty.
There are two main indications for angioplasty:
- At a severe acute coronary syndrome : and myocardial infarction or a unstable uncontrolled angina pectoris (angina)by drugs. The objective is to reopen the coronary arteries that are blocked or are becoming blocked in order to reduce the size of the infarction or to prevent it from occurring. That’s what we call salvage angiography.
- In patients with angina pectoris pain not controlled by medication or with severity criteria during noninvasive examinations (stress test, scintigraphy, stress echography). The objective is to eliminate the pain of angina pectoris and to protect the heart from ischemia, that is to say from the lack of blood supply linked to the narrowing of the coronaries.
Are there any contraindications to this dilation of the coronary arteries?
There are two absolute contraindications to the practice of angioplasty:
In addition, the existence of significant atherosclerotic plaques (atheromatosis) in the femoral arteries or the aorta are a complicating factor for performing angioplasty. In this case, it will be necessary to go through a “high”, humeral or radial approach.
Coronary angioplasty: how to prepare for this procedure?
Before the procedure, the patient must present with:
- the prescription who prescribes the intervention as well as its vital card ;
- blood test results prescribed to assess coagulation (haemostasis), complete blood count (NFS) and renal formula.
It must also be treated with antiplatelet drugs (aspirin, clopidogrel, etc.) and other drugs specific to the disease. coronary disease, during the intervention or before the intervention. Finally, the patient must report a possible allergy to the iodinated contrast product.
Balloon angioplasty: how does it work?
For this procedure, the patient is installed in a room equipped with radiology and imaging equipment.
Angioplasty is not painful and requires a local anesthesia with sometimes administration of a tranquilizer. It lasts on average 45 minutes.
A catheter is introduced at the level of the thigh or the wrist (femoral or radial artery). It then goes up to the heart, at the level of the vessel to be treated.
The doctor then places an inflatable balloon over the narrowed area. This balloon is inflated in order to crush the atheroma plaque at the origin of the stenosis (arterial narrowing). This increases the diameter of the artery. The balloon is then deflated to restore blood circulation.
Finally, the cardiologist completes the angioplasty by placement of a stent (a sort of mini-spring), to prevent the artery from clogging up again.
Stenting in the heart: what is it? For what ?
The stent (also called stent, vascular expander or vascular tutor) is a prosthesis with a metal platform and coated with a specific drug. Coronary stents are placed to allow proper healing of the artery and to prevent the rapid appearance of new narrowing. Thus, the risk of occurrence of a new narrowing after angiography is less than 8% thanks to the placement of a stent.
The stent generates a risk of clot formation inside the latter as long as healing is not complete. A blood-thinning treatment (for platelet aggregation inhibitors) must therefore be prescribed for several months in order to avoid such a complication.
Angioplasty: what happens after the operation?
After the angioplasty, the patient is hospitalized for 24 to 48 hours under surveillance. In the absence of symptoms and/or bleeding at the puncture site, the patient can go home the day after his intervention. He is not allowed to drive home. The duration of his work stoppage is to be discussed with the doctor.
Angioplasty: what are the risks of complications?
Complications usually reported are:
– allergic complications most often linked to the use of iodinated radiological products or local anesthetics.
– complications at the puncture point of the artery such as:
- formation of a bruise or hematoma at the puncture site which may persist for several days. Be careful, the increase in volume in the days following the examination should lead you to consult quickly ;
- of the vascular injuries requiring surgical repair and/or blood transfusion;
- the unhooking of a fragment of atheroma responsible for a embolism.
– Cardiac and vascular complications: discomfort, chest painof the palpitations related to arrhythmia.
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