After Angioplasty - Procedures
Most angioplasty patients remain in the hospital overnight—usually in the cardiac care unit (CCU)—or a special unit for patients undergoing cardiac catheterization and angioplasty. They should arrange for someone to drive them home from the hospital.
After the procedure, the sheath or sheaths are removed and pressure is applied to the area—usually for 5 to 15 minutes—to close off holes in the arteries made by insertion of the sheaths. A gauze dressing is taped to the area and the patient must lie on their back for 4 to 6 hours, while normal blood clotting seals the holes in the arteries.
Alternatively, holes made in the femoral artery can be sealed immediately after catheterization by stitching them closed or plugging them with collagen. If either of these methods is used, the patient may be able to sit up within an hour of the procedure and begin walking within several hours.
During this time, patients are monitored for recurring chest pains, which could indicate the treated artery is re-closing; bleeding at the insertion site; and signs of dye-induced kidney damage. Certain medications may be given intravenously.
Before leaving the hospital, patients receive information about long-term therapy that may help prevent future coronary artery disease, and instructions regarding when and to what extent they can resume normal activity. Heavy lifting and vigorous activity should be avoided for several days to ensure that arteries heal properly. Other recommendations depend on the success of the procedure and whether there are other blockages.
Patients who have undergone angioplasty continue treatment with aspirin or another antiplatelet medication indefinitely after the procedure. The number of medications that the patient must take, particularly those previously taken to treat chest pains caused by the blockage, usually decreases.
Studies have shown that some patients are resistant to the effects of aspirin therapy. Regular blood tests may be performed to monitor the patient's response; the results of these tests can be used to adjust the aspirin dosage or change the medication.
If a stent has been implanted, clopedigrol (Plavix®) is usually prescribed to be taken once a day for 2 to 4 weeks. Clopedigrol is a potent aspirin-like medicine that reduces the risk for development blood clots inside the stent during the first few weeks after implantation.
Because clopedigrol is critically important in preventing potentially life-threatening complications, patients should receive this medication when they leave the hospital and take it as prescribed.
In July 2009, the U.S. Food and Drug Administration (FDA) approved prasugrel (Effient® tablets) to reduce the risk for blood clots in angioplasty patients. This medication can reduce the risk for heart attack or stroke during or following angioplasty. Prasugrel, which carries a black box warning indicating that the drug can cause serious, sometimes fatal, bleeding, should not be used in patients with a history of stroke, transient ischemic attack (TIA), or uncontrolled bleeding.
For several weeks following angioplasty, patients may have a small and relatively painless bruise or lump where the sheaths were inserted. If pain or tenderness develops, the physician should be notified immediately. This may be a sign of infection or bleeding where vessels have not sealed properly. Other symptoms that warrant prompt medical attention include the following:
- Pain or discoloration in the leg
Although angioplasty is relatively safe, complications such as the following are possible.
- Allergic reaction to iodine-based dye
- Bleeding at the insertion site
- Heart attack, stroke
- Infection at the insertion site
- Kidney failure
- Ruptured artery (dissection)
Allergic reactions to iodine-based dye range from hives to anaphylactic shock, which can involve hives, rash, edema, vascular collapse, shock, and respiratory distress. Anaphylactic shock is life threatening and requires immediate medical attention.
Patients with diabetes or pre-existing kidney disease also do not tolerate iodine-based dye and are at risk for kidney damage or failure.
Rarely, an inflated angioplasty balloon can tear the vessel wall (dissection). If this occurs, emergency bypass surgery is performed.
The risk for death during angioplasty depends several factors including the following:
- Location of the blockage in the coronary artery
- How difficult the blockage is to treat
- Other blockages
- Patient history of heart attacks
- How well the heart is functioning