Fat and cholesterol can accumulate on the inside of arteries and form deposits called plaque. This disease process is called atherosclerosis. The arteries that supply blood to the heart itself (called the coronary arteries) can be narrowed or blocked by this accumulation.

If the blockage is not too severe, a balloon catheter may be used to open the heart artery as an alternative to open heart surgery. The catheter is a small, hollow, flexible tube that has a balloon near the end of it.

The procedure starts with the patient lying on a padded table. Local pain medicine is given, and the catheters are then inserted in an artery (usually near the groin). The patient is awake for the procedure, but pain medicine can be given as needed.

The heart and heart arteries are then visualized by using X-rays and dye, and blockages in the heart vessels are identified. A balloon catheter is then inserted in or near the blockage and inflated, thus widening or opening the blocked vessel and restoring adequate blood flow to the heart muscle.

Occassionally, blood thinning medicines are also given to prevent formation of a blood clot. In almost all cases, a device called a stent is also placed at the site of narrowing or blockage in order to keep the artery open. A common type of stent is made of self-expanding, stainless steel mesh.

Angioplasty may be performed to treat:

• Persistent chest pain (angina)
• Blockage of one or more coronary arteries
• Residual obstruction in a coronary artery during or after a heart attack

The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

The risks for any surgery are:

• Bleeding
• Infection

Additional risks include:

• Complete obstruction of blood flow to an area of the heart (a small risk, less than 1%; a heart surgery team is on standby)
• Damage to a valve or blood vessel
• Stroke
• Arrhythmia
• Bleeding in the groin (or other catheter access site)
• Kidney failure
• Allergic reaction to the X-ray dye
• Death

This procedure greatly improves blood flow through the coronary arteries and to the heart tissue in about 90% of patients and may eliminate the need for coronary artery bypass surgery (CABG).

The result is relief from chest pain, and improved exercise capacity. In 2 out of 3 cases, the procedure is considered successful with complete elimination of the narrowing or blockage.

This procedure treats the condition, but does not cure the cause, and recurrenct narrowing can be expected in 17-25% of cases over a 6 month period. However, this recurrent narrowing may or may not require a repeat procedure.

Patients should diet, exercise, abstain from smoking, and reduce stress in order to lower the chances of recurrence. The physician may prescribe a medication, such as statin, to help lower the patient's cholesterol.

If the arteries are not sufficiently widened by angioplasty or the blockages are too severe to be treated by angioplasty, heart surgery (CABG surgery) may be recommended.