An intravenous (IV) line will be inserted into your arm so that you can be given a mild sedative and other medication necessary during the procedure. Although this sedative will make you feel relaxed and drowsy, you will probably remain awake during the procedure. Devices to monitor your heart rate and blood pressure will be attached to your body.
Next—depending on which artery your physician is using for the procedure—your groin area, wrist, or arm will be cleaned, shaved and numbed with a local anaesthetic. A short tube called a sheath is commonly inserted into the artery. Next, the physician will insert a catheter (a long, flexible tube) through the sheath and advance it to the site of the blockage. An x-ray camera connected to a video monitor will help the physician guide the catheter. You may experience a dull pressure where the physician is working with the catheters, but no pain.
Once the catheter is in place, a contrast material may be injected into the artery and an angiogram will be taken of the blocked artery to help identify the site of the blockage. With x-ray guidance, a guide wire will then be advanced to the site, followed by the balloon-tipped catheter. Once it reaches the blockage, the balloon will be inflated for several seconds to several minutes. The same site may be repeatedly treated or the balloon may be moved to other sites. It is common for patients to feel some mild discomfort when the balloon is inflated because the artery is being stretched. Your discomfort should disappear as the balloon is deflated.
Additional x-ray pictures will be taken to determine how much the blood flow has improved. When your physician is satisfied that the artery has been opened enough, the balloon catheter, guide wire and guiding catheter will be removed. The entire procedure usually lasts between 30 minutes and two hours. The length of the procedure varies depending on the time spent evaluating the vascular system prior to any therapy, as well as the complexity of the treatment.
When the procedure is completed, you will be moved to a recovery room or your hospital room. You may feel groggy from the sedative. The catheter insertion site may be bruised and sore. If the sheath was inserted into your arm or wrist, it will be removed and the site will be bandaged. If the catheter was inserted into your groin, you may need to lie in bed with your legs straight for several hours. In some cases, your physician may use a device that seals the small hole in the artery; this may allow you to move around more quickly.
For several hours, your catheter site will be checked for bleeding or swelling and your blood pressure and heart rate will be monitored. Your physician may prescribe medication to relax your arteries, to protect against spasm of the arteries and to prevent blood clots. If a contrast material was used during the procedure, you will urinate often to rid your body of this material. You may be asked to drink extra fluids.
Commonly, patients stay overnight and return home the day after the procedure. You will typically be able to walk within two to six hours following the procedure.
After you return home, you should rest and drink plenty of fluids. You should avoid lifting heavy objects, strenuous exercise and smoking for at least 24 hours (and smoking you should avoid permanently since this is a major cause of atherosclerosis). If bleeding begins where the catheter was inserted, you should lie down, apply pressure to the site and call your physician. Any change in color in your leg, pain, or a warm feeling in the area where the catheter was inserted should be reported to your physician.
You should be able to return to your normal routine by the following week.
If a stent was placed in your artery, you will be asked to take aspirin or another anti-platelet drug daily; in some cases you may be given another blood-thinning medication in addition to the anti-platelet medication. Blood tests will be done at frequent intervals during this period to make sure you are being treated but not over treated. Magnetic Resonance Imaging (MRI) can probably be done immediately following stent placement, but make sure that you notify the MRI department that you recently had a stent. Metal detectors will not affect a stent.