2nd part

[Guest guest]

he went over this real fst so i came home and looked it up!!

Surgery Overview

What to Expect After Surgery

Why It Is Done

How Well It Works

Risks

What to Think About

References

Credits

Angioplasty for coronary artery disease

Surgery Overview

Angioplasty is a revascularization procedure during which a coronary

artery is opened to increase blood flow to the heart muscle. This procedure is

also called percutaneous transluminal angioplasty, or PCTA. Angioplasty uses a

catheter to reach the coronary artery, so the procedure is less invasive and has

a shorter recovery time than bypass surgery, which requires open heart surgery.

During the angioplasty procedure, a thin flexible tube (catheter) is

inserted through an artery in the groin or arm and carefully guided into the

narrowed coronary artery. Once the catheter reaches the narrowed portion of the

artery, a small balloon at the end of the tube is inflated. The balloon may

remain inflated from 20 seconds to 3 minutes. The pressure from the inflated

balloon presses the plaque against the wall of the artery, creating more room

for blood to flow.

Stents

A small, expandable wire tube called a stent is often permanently inserted

into the artery during angioplasty. The balloon is placed inside the stent and

inflated, which opens the stent and pushes it into place against the artery

wall. Because the stent is meshlike, the cells lining the blood vessel grow

through and around the stent to help secure it. This procedure is designed to:

a.. Open up the artery and press the plaque against the artery's walls,

thereby improving blood flow.

b.. Keep the artery open after the balloon is deflated and removed.

c.. Seal any tears in the artery wall.

d.. Prevent the artery wall from collapsing or closing off again

(restenosis).

e.. Prevent small pieces of plaque from breaking off, which might cause

a heart attack.

Reclosure (restenosis) of the artery is much less likely to occur after

stenting than with angioplasty alone. Stent placement is standard during most

angioplasty procedures. In addition, promising new research indicates that

experimental stents coated with certain medications may further reduce the risk

of restenosis. See an illustration of angioplasty with stenting.

What to Expect After Surgery

After angioplasty, you will be moved to a recovery room or to the coronary

care unit. Your heart rate, pulse, and blood pressure will be closely monitored

and the catheter insertion site checked for bleeding.

You usually can start walking within 12 to 24 hours after angioplasty. The

average hospital stay is 1 to 2 days for uncomplicated procedures. You may

resume exercise and driving after several days.

You are usually given aspirin after angioplasty and stenting to help

prevent the formation of blood clots. When a stent is also used, you may be

given aspirin and another platelet inhibitor (such as ticlopidine [Ticlid] or

clopidogrel [Plavix]). You will usually take the aspirin long-term; the second

platelet inhibitor usually is only given for a few weeks after the stent is

placed.

Why It Is Done

Although many factors are involved, angioplasty with or without stenting

is usually used if you have:

a.. Frequent or severe chest pain (angina) that is not responding to

medication.

b.. Evidence of severely reduced blood flow (ischemia) to an area of

heart muscle caused by one or more narrowed coronary arteries.

c.. An artery that is likely to be treated successfully with angioplasty

whether or not stenting is also used.

d.. The region of narrowing in the coronary artery does not involve the

left main coronary artery or the proximal left anterior descending artery.

e.. You are in good enough health to undergo the procedure.

Angioplasty may not be a reasonable treatment option when:

a.. There is no evidence of reduced blood flow to the heart muscle.

b.. Only small areas of the heart are at risk, and you do not have

disabling chest pain (angina).

c.. You are at risk of complications or dying during angioplasty due to

other health problems.

d.. The anatomy of the artery makes angioplasty or stenting too risky or

will interfere with the success of the procedure.

e.. The surgeon or hospital does not perform enough procedures to ensure

competency.

f.. The hospital does not have access to emergency cardiac surgical

facilities.

How Well It Works

Angioplasty relieves chest pain and improves blood flow to the heart. If

restenosis occurs, another angioplasty or bypass surgery may be needed.

Angioplasty combined with stenting and certain medications (glycoprotein

IIb/IIIa platelet receptor antagonists, such as abciximab show improved

long-term outcomes compared to angioplasty alone, with short-term success rates

of 96% to 99%.1, 2 Long-term outcomes of angioplasty on single-vessel disease

are similar to those of coronary artery bypass surgery.2

Angioplasty is considered very effective for reestablishing blood flow

during a heart attack.2 Angioplasty is at least as effective as (and possibly

superior to) thrombolytics in the treatment of heart attack in medical centers

where many procedures are performed.3

Bypass surgery may be considered a better option for some people, such as

those with diabetes. Generally, the greater the extent of coronary

atherosclerosis, the greater the benefits of bypass surgery over angioplasty.2

Stents are now used routinely during angioplasty and other

revascularization procedures. Restenosis is less likely when compared to

angioplasty without stenting.1However, additional medications (glycoprotein

IIb/IIIa platelet receptor inhibitors) are usually needed to help thin the blood

and prevent blood clots following the placement of a stent.4

Medical researchers are studying additional techniques to help prevent

restenosis after angioplasty with stenting:

a.. Intracoronary radiotherapy. This is a newly approved therapy in

which radiation is applied to the stented portion of the artery. Although this

technique has shown positive results for preventing restenosis, the long-term

effectiveness of the approach needs further research.5, 6

b.. Coated stents. Stents that are coated with a special medication

(rapamycin) may almost completely prevent restenosis. These stents may replace

radiation stents in the future.

Risks

Risks of angioplasty may include:

a.. Sudden closure of the artery.

b.. Heart attack.

c.. Need for additional procedures. Angioplasty may increase the risk of

needing urgent bypass surgery. In addition, restenosis may necessitate a repeat

angioplasty.

d.. Reclosure of the grafted blood vessel (restenosis).

e.. Death. The risk of death is higher when more than one artery is

involved.

What to Think About

Early invasive treatment (such as angioplasty or bypass surgery) reduces

symptoms and promotes early discharge from the hospital but does not reduce

rates of death and heart attack.7

Angioplasty does not require open chest surgery and has less risk of

immediate complications. Evidence suggests that the long-term outcomes of bypass

surgery and angioplasty are similar.8

Coronary artery bypass surgery appears to be a better option than

angioplasty for people with diabetes, especially when multiple coronary arteries

are affected.8

The benefits of angioplasty are much greater for a smoker if he or she

quits smoking. A smoker's quality of life after angioplasty usually improves

significantly after the procedure only if the smoking stops.9

CAROL

I am not senile!!!!my mind is a filing cabinet.

The more information that I put in the longer it takes

to sort through it and retrieve a specific file!

Old people are not senile - it just takes

us longer to process all those files