Surgery - What to Expect

Your balloon angioplasty or stenting procedure will be performed in the hospital, in a specially-equipped room called a catheterization ("cath") lab. The procedure will be done by a physician who specializes in angioplasty and stenting. Your care team will also include nurses and cath lab technicians.

Before the Procedure

Your doctor will decide which site on your body would be the best place to access one of your arteries – typically your groin area, arm, or foot. The selected area will be cleaned, shaved and numbed with a local anesthetic.

Your doctor needs to know what other medications you are taking. In most cases, you should take any medications that you usually take, especially blood pressure medications. Check with your doctor about which ones to take and which ones not to take.

Also, be sure to tell your doctor if you:

• Cannot take aspirin
• Have any allergies
• Have a history of bleeding problems
• Are planning to have any other surgeries or dental work soon

Your doctor may instruct you take aspirin and other medications for several days before your procedure. These medications will help prevent blood clots from forming during the procedure.

You may be asked not to eat or drink anything for a period of time before your procedure. If your doctor wants you to take your regular medications, you may take them with a little water.

During the Procedure

Angioplasty balloons and/or stents are inserted into an artery through a catheter. You will lie flat on your back on a table during the procedure. Devices will monitor your heart rate and blood pressure.

Your procedure will begin with an angiography test to determine the number and exact location of blockages.

After your doctor has determined which, if any, blockages need treatment, he or she will proceed with your treatment:

1. With X-ray guidance, your doctor will advance a thin wire through the catheter to the treatment site of the artery to penetrate the blockage and provide support for the therapy delivery system.
2. A tiny deflated balloon will be advanced to the blockage along the wire that is already in place. Once the balloon is inside the blockage, the balloon will be inflated. Inflating the balloon squeezes the plaque against the wall of the artery, widening the artery opening. (It is common for patients to feel some mild discomfort when the balloon is inflated, because the artery is being stretched. Your discomfort should disappear as the balloon is deflated.)
3. If you are receiving a drug-coated balloon angioplasty, your physician will repeat the previous step, but this time, insert a deflated drug-coated balloon into your leg. Once the drug-coated balloon is inside the area with the blockage, the balloon will be inflated. Inflating the balloon squeezes the plaque against the wall of the artery, and also allows the medication coating the balloon to come into contact with the vessel wall. The physician will wait for a few minutes to allow for the transfer of medication into the surrounding tissue. Once complete, your physician will deflate the balloon, and remove it.
4. Next, if a stent is required, another tiny catheter with a stent mounted on it will be advanced to the blockage. Once the stent is inside the blockage and properly placed, it will be deployed into the artery. The stent locks in place against the artery wall, forming a scaffold to help keep the artery open.
5. After the stent is fully expanded, additional X-ray pictures will be taken to determine if the stent is fully open and how much blood flow has improved.
6. When your doctor is satisfied that the stent is fully open and adequate blood flow has been restored, the balloon catheter, guidewire, and guide catheter will be removed.

After the Procedure

Immediately after your procedure, you will rest in a special care unit where nurses will monitor your heart rhythm and blood pressure. At this time, the sheath (a catheter introducer tube) may be removed, and pressure will be applied to the puncture site until the bleeding has stopped.

The catheter insertion site may be bruised and sore. If the catheter was inserted into your groin, you may need to lie in bed with your leg straight for several hours. In some cases, your doctor may use a device that seals the small hole in the artery; this may allow you to move around more quickly. The place on your body where the catheter was inserted will be monitored for any changes in color, temperature or sensation.

At first, you may feel groggy from the sedative. Your doctor will let you know when you can get out of bed and walk around. You will typically be able to walk within 2 to 6 hours following the procedure.

Usually, patients only stay in the hospital for several hours and some may even go home the same day. The amount of time you stay in the hospital will depend on whether there were any difficulties during the procedure and how well the catheter insertion site is healing.

You'll need to make arrangements to have someone drive you home when you're ready to leave. Be sure to follow your doctor's instructions about taking your medications.

After you return home, you should rest and continue to drink plenty of fluids. You should not lift heavy objects, exercise strenuously or smoke for at least 24 hours.

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