Cardiovascular and Thoracic Surgery

Coronary Artery Disease

Coronary Angioplasty / Stents

During coronary angioplasty, a balloon is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA).

There are several types of PCI procedures, including:

  • balloon angioplasty - a small balloon is inflated inside the blocked artery to open the blocked area or
  • atherectomy - the blocked area inside the artery is cut away by a tiny device on the end of a catheter.
  • laser angioplasty - a laser used to "vaporize" the blockage in the artery.
  • insertion of a coronary artery stent - a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open. Stents help prevent the artery from becoming blocked again, and are the most effective method for preventing re-blockage. Without the use of stents, about 30 percent of arteries become blocked again. The safety of stents has been vastly improved over the years and a wide range is also now available so the choice in device can be tailored to the patient.
Angiopolasty - image source: NIH
Stent Placement - image source: NIH

There are two basic kinds of stents:

  • bare-metal stents are metal stents with no special coating. Bare-metal stents act as simple scaffolding to prop open blood vessels after they're widened with angioplasty. As the artery heals, tissue grows around the stent holding it in place. However, sometimes an overgrowth of this scar tissue in the arterial lining increases the risk that the artery will become blocked again.
  • drug-eluting stents are coated with medication that is slowly released (eluted) to help prevent the growth of scar tissue in the artery lining. This helps the artery remain smooth and open, ensuring good blood flow through it. Drug-eluting stents were developed because in some people who get bare-metal stents, tissue growth over the stent eventually leads to re-blockage.
Many people with heart problems have been successfully treated with drug-eluting stents, preventing the need for more-invasive procedures, such as coronary artery bypass surgery. The reduced risk of re-narrowed arteries from drug-eluting stents reduces the need for repeat hospitalization and angioplasty procedures — each of which carry some risk of complications including heart attack and stroke.