If your doctor locates and studies a blockage, a decision is made as to what procedure will be performed to achieve the goal of opening the coronary arteries.
If the blockage is too hard or calcified for the balloon angioplasty catheter to get through, your doctor may use atherectomy to help create a pathway. The atherectomy device will be inserted to pulverize or scrape off the blockage into very small particles. These particles will either be removed or will be dissolved into your bloodstream and filtered out through the liver. If your doctor encounters a clot blocking the artery, medication will be given to dissolve the clot before continuing.
After atherectomy, your doctor may find it necessary to perform balloon angioplasty to expand your coronary artery. During angioplasty, your doctor inserts a special balloon-tipped catheter into your artery and guides it to the center of the narrowed artery. The balloon catheter is inflated and deflated several times, pushing the plaque against the artery wall to create a wider channel for the blood flow. When the balloon inflates, it briefly blocks the flow of blood. This might cause you to experience chest discomfort. If this happens, you should tell your doctor. Pain medicine can be given. With a successful angioplasty, the remaining blockage is squeezed outward against the wall of the artery and blood flow is restored.
Depending on the specifics of the blockage, your doctor may place a stent in your artery. The stent is an expandable device that is mounted onto a balloon catheter, similar to the one used for the angioplasty. The stent and balloon are advanced to the blockage area, and the stent is expanded into place. A stent supports the artery and helps it remain open for a longer period of time. After stent placement, the body will grow tissue over the stent to help maintain its position. The stent will not move around inside your body.
For an angioplasty with possible atherectomy, the procedure usually takes from one to three hours, but this varies from patient to patient. Your doctor will tell you what is happening throughout the angioplasty.