When a toilet or drain becomes clogged and liquid cannot move through the pipes as it should, the solution is simple – remove the blockage. Sometimes actually removing the clog is more difficult than talking about doing so, but many times one can restore the flow of liquid by using a tool like a plunger or some type of chemical.

While there are different tools and chemicals used to handle a clogged artery than a clogged toilet or drain, the solution is often the same – remove the blockage. Arteries can become clogged with hard deposits called plaque. These blockages prevent blood from moving through the blood vessels as it needs to. Doctors use a procedure called angioplasty to unclog these arteries and improve blood flow throughout the body. Although angioplasty is not major surgery, there are still some risks associated with it. People who receive the procedure may also need to make some lifestyle changes to reduce the chances that they will need it again.

Angioplasty: Treatment for Atherosclerosis

When plaque composed of cholesterol, fat, and other substances builds up in the arteries over time, the condition is called atherosclerosis, which is a type of heart disease. Atherosclerosis decreases the diameter of the arteries, making it difficult for blood to flow.

Blood carries several important substances like nutrients and oxygen to tissues all over the body. When arteries become obstructed by atherosclerosis, the tissues supplied by these arteries may not get all the nutrients and oxygen that they need. This can lead to major health problems including heart attack, stroke, and tissue death.

Doctors perform angioplasties to treat atherosclerosis when medications and lifestyle changes, such as exercise and diet management, are not enough. Additionally, doctors perform angioplasties to decrease the symptoms of blocked arteries like chest pain. Doctors may also perform an angioplasty while a patient is having a heart attack to quickly restore blood flow to the heart and potentially save that patient’s life. Angioplasties are not for all patients, and may not be the best option for those with weak heart muscles, small, diseased blood vessels, or multiple artery blockages.

Before a patient has an angioplasty, a cardiologist (a doctor who specializes in the heart) will review his or her medical history, perform a physical exam, and then perform an angiogram. In an angiogram, a liquid dye is injected into the arteries so that they are visible to the cardiologist on X-rays and video monitors. This allows the cardiologist to see any blockages and determine whether or not that patient should have an angioplasty.

Cardiologists perform angioplasties in hospitals, and the procedure can take anywhere from 30 minutes to several hours depending on how many blockages are being treated. The cardiologist takes the following steps during the procedure:

• First, the cardiologist numbs an area of the body (usually the upper leg or groin) by applying a medicine called a local anesthetic. With this medicine, the patient will not feel pain during the procedure, but he or she will remain awake.

• Next, the cardiologist makes a small incision through the skin and in a blood vessel of the numbed area.

• The cardiologist then threads a thin guide wire followed by a thin tube called a catheter up through the incision to the blockage in the artery. He or she injects a dye through this catheter so that he or she can see the blocked arteries on X-rays and video monitors.

• The cardiologist positions the catheter near the blockage in the artery and inflates a small balloon at the end of the catheter. This pushes the plaque outward toward the wall of the artery and widens the artery. The balloon may be inflated for several minutes or inflated several times to try to stretch the artery open as much as possible before the balloon is removed.

• Often, the cardiologist will then place a small, wire-mesh tube called a stent around the balloon and guide the balloon and stent back up to the previously-blocked artery. The cardiologist will open the balloon again, locking the stent into place against the artery walls. This stent remains in the artery permanently and helps hold the artery open to prevent it from becoming blocked again. Sometimes stents have medication on them that also helps the artery remain open; these are known as drug-eluting stents.

• Once the stent is in place (if one is being used), the cardiologist will remove the catheter and guide wire, concluding the procedure.

An angioplasty is a common procedure with over one million performed each year in the United States. While serious complications do not happen often, an angioplasty is not without risks.

• Re-Narrowing of the arteries (restenosis): It is possible that the artery treated with angioplasty will once again become blocked with plaque. When stents are not used, there can be a 30 to 40 percent chance of this happening. Stents were designed to reduce this problem and thus decrease the risk of restenosis to around 20 percent. Drug-eluting stents reduce this risk even further to less than 10 percent.

• Blood clots: There is a risk of a blood clot forming within a stent in as little as a few weeks after an angioplasty. If this blood clot cuts off the blood supply to the heart, the patient could have a heart attack. It is important to take blood-thinning medications like aspirin to prevent such blood clots as directed by a doctor.

The following are also possible risks associated with angioplasty, but they are rare.

• Bleeding: It is possible to have severe bleeding at the incision site.

• Heart attack: If blood clots form on the catheters and block blood flow to the heart, the patient can have a heart attack. A heart attack can also occur if catheters cause plaques to break loose and cut off blood flow to the heart when they are threaded through the blood vessels.

• Stroke: Strokes can occur during angioplasty when blood clots on catheters or plaques block blood flow to the brain.

• Blood vessel damage: The catheters used to insert dye into the arteries and place the balloon at the blockage site can tear the blood vessels.

• Kidney damage: The dye used during an angioplasty to make the arteries visible to doctors can cause kidney problems. This is more likely to occur in people who have preexisting kidney problems.

• Irregular heartbeat: If the heart becomes irritated during an angioplasty, it may beat too slowly or too quickly. Even in the rare cases when this happens, the irregular heartbeat typically does not last for a long time.

Recovering after an angioplasty is typically not painful or drawn out over a long period of time. Patients are usually hospitalized for one night after they undergo an angioplasty. While they are in the hospital, their doctors prescribe medications called anticoagulants that decrease the risk of blood clots. Often, patients who have had angioplasties will also need to take a blood thinning medication like aspirin for the rest of their lives to prevent blood clots.

For the first few days that a patient is home after an angioplasty, he or she should avoid strenuous exercise and lifting heavy objects. There should not be bleeding, swelling, or pain at the site where the cardiologist made his or her incision. A patient should monitor the incision site for those signs, as they may be an indication that something is wrong. Most patients can resume working and their normal routines the week after they have an angioplasty.

Although an angioplasty increases blood flow through previously narrowed or blocked arteries, it does not cure atherosclerosis or heart disease. In order to lower the risk of developing other artery blockages, one should stick to the following lifestyle guidelines:

• Avoid/quit smoking: The chemicals in tobacco smoke damage blood vessels and make them more vulnerable to atherosclerosis. Also, nicotine and carbon monoxide, two chemicals found in cigarette smoke, make the heart work harder to pump blood. Nicotine narrows the blood vessels. Carbon monoxide replaces some of the oxygen in the blood so that the heart has to pump more blood to ensure that tissues receive adequate amounts of oxygen.

• Exercise regularly: Being physically active for 30 minutes on most (if not all) days makes the heart stronger, helps someone achieve and maintain a healthy weight, decreases stress, and reduces the risk of developing conditions like high cholesterol, high blood pressure, and diabetes that strain and weaken the heart.

• Eat a healthy diet: Eating a healthy diet means eating fruits, vegetables, lean meats, whole grains, and high-fiber foods and avoiding foods that are high in cholesterol, saturated fat (which is found in animal products), and trans fats (which are found in fried foods, packaged snack foods, and baked goods). A healthy diet can help a person achieve and maintain a healthy weight, lower cholesterol levels, lower blood pressure, and ultimately lower the risk of developing heart disease.

Summary

An angioplasty is a procedure used to treat atherosclerosis. The procedure involves inserting a tiny balloon up through a blood vessel to the area of an artery that is blocked with plaque. When the balloon inflates, it pushes the plaque against the artery wall, increasing blood flow through the artery. Stents are placed in the artery to help it stay open.

Although the procedure is not a very invasive type of surgery, there are still risks associated with angioplasty, such as blood clots and re-narrowing of the treated arteries. Recovering from the procedure is generally not painful, and patients can typically resume their normal routines after a week. Patients should make lifestyle changes after they have an angioplasty, including exercising and eating healthy, to try to prevent other artery blockages. As is the case with toilets and drains, it is possible to remove the clogs, but the ideal situation is to never have to deal with blockages in the first place.