Balloon Angioplasty: Procedure, Cost, and Complications

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What is balloon angioplasty?

Balloon angioplasty is a minimally invasive procedure to open narrowed coronary arteries to restore proper blood flow to the heart. In this procedure, a specially designed tiny balloon attached to a guidewire is inserted into the narrowed section of coronary artery to compress the plaque which in turn opens up the arteries and allows free flow of blood.

The procedure can take anywhere from 30 mins to 3 hours depending on the patient’s medical condition. The cost of this procedure may range from Rs. 1,00,000 to Rs. 3,60,000 in India.

Generally, mild sedation is used for the procedure, though in some cases general anesthesia may be used.

Overnight hospitalization may be required for a few patients, depending on the recovery post the procedure. Hospitalization is generally 2 days or less for patients undergoing balloon angioplasty.

Am I eligible for balloon angioplasty?

Physical symptoms may interfere with the quality of your life due to coronary artery narrowing such as, shortness of breath, profound weakness when exerting yourself physically and continuous discomfort in the chest.

You are eligible for balloon angioplasty if:

the narrowing of arteries have led to reduced blood flow, resulting in poor heart function, and chest pain.
your left coronary artery is narrowed by more than 70%, in which case, you need to opt for angioplasty or a surgery.
reduction of more than 50% in blood flow in the left main coronary artery, or more than 70% to the epicardial (a branch blood vessel, also called epicardial coronary artery, that lies on the surface of the heart) vessel.

Not every narrowing can be treated with angioplasty, especially if you have multiple narrowed segments in the arteries or the location of the narrowing is inaccessible by the balloon catheter.

It can be performed only if the blockage is severe or the blockage cannot be resolved with medicines.

Also, you need to inform your doctor if you are pregnant.

Please Note: Eligibility criteria for various medical procedures differs from patient to patient and depends on their general health, medical history, and medical conditions. Please consult a doctor to know more about your eligibility or ineligibility for any medical procedure.

How is the balloon angioplasty procedure performed?

A balloon angioplasty procedure involves the following steps:

You are positioned on an operating table.
Digital monitors are connected to track your heart rate, blood pressure, and pulse during the procedure.
An intravenous (IV) line is inserted into a vein in your hand or arm so that medication can be administered to you intravenously.
Depending on your medical condition, an appropriate type of anesthesia is administered.
Disinfectants are applied on the area of your body (the upper leg or the wrist) where the catheter (a thin flexible tube) is to be inserted. The area is then covered with a surgical drape.
Once the anesthesia takes effect, the cardiologist begins the angioplasty procedure by making a very small skin incision at the site (upper leg or the wrist).
If the upper leg is chosen, the cardiologist inserts a thin tube called catheter through the femoral artery. (The femoral artery is the second largest artery in the body and is located in the thigh. The primary function of this artery is to supply blood to the lower section of the body.)
If the wrist is chosen, the cardiologist inserts the catheter through the radial artery. (The radial artery is a major artery in the forearm. It supplies oxygenated blood from the lungs to the arm and hand.)
The cardiologist carefully guides the catheter through the arteries into the narrowed part of the coronary artery.
(As arteries have no nerve endings you will not feel any unpleasant sensation while the catheter is inserted through the artery.)
Once the catheter reaches the narrowed artery, the cardiologist injects a special dye (also called radiographic contrast agent) through the catheter, which highlights the arteries. The X-ray machine is used to capture the images of the outlined arteries which reveal the location of the narrowing. (This special dye shows the shape and size of the blocks in the arteries prominently in an x-ray camera, which keeps projecting the live images of the arteries onto a monitor.)
The cardiologist then inserts an X-Ray guided wire with an attached deflated balloon through the catheter into the narrowed area.
He inflates and deflates the balloon several times. This repetitive action opens up the narrowed artery and the plaque is compressed against the arterial walls. The inflated balloon also expands the artery wall, improving the blood flow.
The injected contrast indicates the rate of blood flow through the now widened artery. When your cardiologist is satisfied with the blood flow, he deflates and removes the balloon, guidewire, and catheter.

Laser-Assisted Balloon Angioplasty

Balloon angioplasty may be combined with laser angioplasty for optimum results and if the cardiologist deems it fit. To know more please see Laser Angioplasty.

Balloon Angioplasty with Stent Insertion

Depending on the requirement, the doctor may suggest a stent be inserted after the balloon angioplasty procedure. This is to keep the keep clogged arteries open and prevent reclosure. To know about stent insertion please see the Coronary Stenting procedure.

What risks will I face while undergoing the balloon angioplasty procedure?

The risks while undergoing balloon angioplasty include:

Injury to the artery while inserting the catheter.
Excessive bleeding at the catheter insertion site that may require special medication or a blood transfusion.
Risk of stroke during the procedure.
Irregular heartbeat (arrhythmias)

After the procedure is over, there may also be the risks of infection and blood clotting.

How will I benefit from undergoing a balloon angioplasty procedure?

A few of the benefits of balloon angioplasty include:

Relatively low risk and less invasive procedure compared to surgical interventions such as bypass surgery.
This is a minimally invasive procedure in which only a minor cut on the skin is required which does not even require suturing.
The recovery time is far less than any surgical procedure. An extended stay at the hospital is not required for this procedure.

What are my alternatives to balloon angioplasty?

Alternatives to balloon angioplasty include:

Medications and lifestyle changes: if your condition isn't immediately life-threatening. Your doctor may prescribe medications, such as beta blockers, nitrates, calcium channel blockers, and lifestyle changes, such as quit smoking, a heart-healthy diet and regular exercise. These changes can effectively alleviate your heart condition.
Inserting bare-metal stents or drug-eluting stents
Laser Angioplasty
Coronary Artery Bypass Surgery

What are the pre-procedure guidelines I should follow for balloon angioplasty?

The usual pre-procedure guidelines followed are:

The doctor will ask for your complete medical history prior to the procedure which includes your current medication and any known allergies.
You may be asked to stop taking certain medication (especially blood thinners) for a specified duration before the procedure.
A complete physical examination by your doctor to ensure your fitness to undergo the procedure. You may have to undergo blood tests or other diagnostic tests.
Some tests are performed which include:
- chest x-ray
- electrocardiogram (ECG)
- blood tests
- imaging procedures such as coronary angiogram
You'll be advised not to take anything orally (food, liquids or tablets) 6 to 8 hours before the scheduled procedure.
Woman need to inform the cardiologist and X-ray technologist if she is pregnant or likely to be pregnant. (It is not advisable to take an X-Ray or undergo any radiological testings during pregnancy. Additional care will be provided for pregnant women, so as to not expose the fetus to radiation).
If you are a smoker or consume alcohol, you will be advised to not to do so, for at least a week or two prior to the procedure. In fact, the doctor will advise you to quit smoking altogether as this is a major cause of atherosclerosis.

What are the complications of balloon angioplasty?

Balloon angioplasty is generally safe, however, in some cases, complications may occur. Some of the complications are:

The artery narrowing may recur.
A relatively rare complication associated with balloon angioplasty called occlusion or abrupt vessel closure may occur at the area treated. This narrowing may occur within 24 hours of the procedure. In certain cases, emergency bypass surgery may be needed.
Damage to the blood vessel through which the catheter is guided, as well as bruising or bleeding at the puncture site.
Damage to a heart valve.
Damage to a blood vessel.
The contrast dye used during this procedure may cause renal failure, though your cardiologist generally checks your renal function before performing this procedure.
Heart attack.
Irregular heartbeat (arrhythmias)
Stroke (rarely occurs)

Please consult your cardiologist to know all the possible complications that may occur.

What are post-operative guidelines I need to follow after undergoing a balloon angioplasty procedure?

Once the procedure is over, you can return home and take post-procedure care which includes:

taking plenty of rest and drinking plenty of fluids.
avoid any form of strenuous exercise or lifting heavy objects till your doctor tells you it is safe.
avoiding sexual activities upto 5 days.
quit smoking (permanently).
promptly reporting to your doctor if you see a change in skin color in your leg, pain or warmness in the area where the catheter was inserted.
taking your medicines without fail, especially the medicines given to prevent clotting of blood. Do not stop taking the anti-clotting and antiplatelet medicines without consulting your doctor. They are highly essential to keep strokes and heart attacks at bay.
changing to a healthy diet post the procedure and inculcating healthy lifestyle changes which include avoiding smoking and drinking.
limit usage of any staircase for the first 2 to 3 days (if possible avoid it altogether).
ensure the area where the catheter was inserted does not get wet for 48 hours after the procedure.
maintain regular follow-ups as advised by your doctor.
report to the doctor immediately if you experience pain in the chest or in the leg or wrist, allergic reaction to medications, experiencing dizziness or weakness, fever, and chills.

To take care of the incision site:

follow the directions of your doctor on how often the dressing needs to be changed.
if sudden bleeding occurs at the site of the incision, lie down and gently put pressure on your incision site for about 30 minutes. If the bleeding does not stop, return to the hospital or call the medical emergency service.

What is the recovery period after undergoing a balloon angioplasty procedure?

In general, patients are able to walk around within a few hours after undergoing the angioplasty procedure, depending on how the procedure went and where the catheter was placed.

Complete recovery takes about 5 - 7 days.

Are the results of balloon angioplasty permanent?

Angioplasty can prevent heart attacks or strokes for a long period of time; however, some people do experience recurring narrow arteries again. Then, repeat angioplasty procedures will be required.

If angioplasty is coupled with healthy lifestyle changes, then there is a less likelihood of recurrence.

How do I know if the balloon angioplasty procedure I underwent is a success?

The imaging tests taken during post-procedure follow-up visits will clearly show the volume of blood flow in the artery. Normal/adequate blood flow is indicative of a successful outcome of the procedure. Repeat procedures may be necessary if indicated.

References

1. Rivers-Bowerman MD, e. (2018). Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: New Horizons in the Interventional Management of Pulmonary Embolism. - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29029716?_ga=2.110568133.1304300378.1518492937-1119665951.1516249862 [Accessed 22 Feb. 2018].

2. Byrne R A, Kastrati A. Nature.com. (2018). A history of balloon angioplasty

Available at: https://www.nature.com/nrcardio/posters/balloonangioplasty/nrcar_balloonangioplasty_poster_web.pdf [Accessed 22 Feb. 2018].

3. Serruys PW, Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G, Emanuelsson H, Marco J, Legrand V, Materne P, Belardi J, Sigwart U, Colombo A, Goy JJ, Heuvel P, Delcan J, Morel M, (2018). [online] Available at: http://www.nejm.org/doi/full/10.1056/NEJM199408253310801

[Accessed 22 Feb. 2018].

4. Sinaga DA, Hee Hwa H, Zeymer U, Waliszewski M, Jafary FH, Yau Wei Ooi, Jason K. K. Loh, Julian K. B. Tan, Paul J. L. Ong. Drug-coated balloon angioplasty in elderly patients with small vessel coronary disease. 2018. Available at: http://journals.sagepub.com/doi/full/10.1177/1753944715598714. Accessed February 23, 2018.

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Questions answered by trusted doctors

Verified User

Regarding Angioplasty

We want to get the Angioplasty done for my mother. Just wanted to understand how safe is the procedure and what is the cost of the same if this is done in Pune?

Dr. Prabhakar C Koregol

Cardiologist, Bangalore

Angioplasty is very safe procedure and except in unusual cases when done by a experienced doctor should carry overall risk. Risk goes slightly up if the location is in left main or too much of calcium requiring additional procedure called rotaablation. As I am in bangalore I wouldn't know exact cost, but should be between 1.5 to 2lakh

Verified User

Diet after angioplasty

Recently my uncle driver age of nearly 60 ...got a severe heart attack n hv gone with angiogram after that stent procedure have done ....he is fine recovering but he needs a diet chart to recover soon ...he want the list of food to be taken n avoided to recover soon .. My self is doing bsc Nutrition my uncle wants me to make diet chart for his driver but still I am graduate n does not have exposure ..so please I need a help of any dietitian or nutritionist

Ms. Neha Suryawanshi

Dietitian/Nutritionist, Mumbai

He needs to take high fiber low fat diet. Drink lot of water everyday. Take small and frequent meals at regular intervals of 2-3 hrs. Avoid outside food completely. Use olive oil, rice bran or coconut oil for cooking. Take almonds , walnuts everyday in the morning and fix seeds to reduce LDL cholesterol.

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Did you know?

The pressure used to inflate a balloon inside a coronary artery during angioplasty

The air pressure in a fully inflated car tires is about 2 atmospheres. By comparison, the high pressure that is used to inflate a balloon inside a coronary artery during angioplasty is between 10-20 atmospheres.

A significant coronary artery blockage is a red flag that more blockages can happen at any time

If you have a significant coronary artery blockage (more than 70% blocked), consider it a red flag announcing that more blockages can happen at any time in the future. In fact, if you are diagnosed with a critical blockage it means there is already a plaque buildup in your heart along with minor blockages in many more arteries that can significantly increase your chances of having a heart attack.

Angioplasty is not generally recommended for blockages below 70%

Angioplasty is not generally recommended for blockages below 70%. There is no proven benefit in implanting a stent in an area of blockage that does not impair blood flow to the heart muscle. These blockages require only medications and lifestyle changes to be treated successfully.

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