At the outset of the operation, before the special catheters are put into your wrist or upper leg area (groin), you will be covered with a sterile sheet. A local anesthetic is injected into the skin in the groin or wrist area to make it numb. A plastic sheath is then inserted into the artery of your arm or leg. The doctor works through this sheath and inserts catheter tubes to your heart artery. When the X-ray dye is injected into your coronary artery the cardiologist views this on the television monitor, and a permanent record is kept on a movie film, video, or CD-ROM.
Once the narrow area is identified in your coronary artery, the doctor will pass a tiny guiding wire across it, over which a second, small catheter will be passed to the narrow part in your artery. This catheter carries a deflated balloon and special markers, which can be seen under X-ray in order to help place the inflated balloon in the exact position. The balloon is then inflated. This opens up the narrowed artery and cracks the plaque or compresses it "like footprints in the snow"; this could cause you some pain. It is important to tell the nurse if you have pain. They may grade the severity of pain on a scale of 0 to 10. The balloon inflation may be from 15 to 60 seconds and could be inflated several times until the artery has been opened optimally.
If the open artery does not look ideal, the doctor may decide to insert a stent. This stent is crimped onto a deflated balloon catheter, placed in the culprit area, and inflated.
As the balloon expands, the metal mesh expands and is pushed against the plaque and, like a scaffold, is left inside the coronary artery. All patients who have coronary angioplasty should receive one aspirin a day and if a stent is implanted also take another medicine that makes platelets less sticky. These blood thinners are important to prevent a clot forming on the stent.
The procedure will usually take 45 to 90 minutes. The sheath will remain in your groin for 3 to 4 hours. It is then removed with pressure applied by someone from the medical team or by a mechanical clamp. This insures that the bleeding stops. After the procedure you will be observed in a special cardiac care unit, where your heart rhythm will be monitored and blood pressure checked. You will be encouraged to drink fluids since that helps flush the X-ray dye through your kidneys. While you are in the recovery area you are encouraged to lie flat and remain still.