Angioplasty is a procedure to improve blood flow in coronary arteries that have become narrow or blocked. Your coronary arteries supply oxygen-rich blood to the heart. If you have coronary artery disease, a sticky material called plaque builds up in the coronary arteries. Plaque is made of cholesterol, calcium, and other substances in your blood. Over time, it can narrow your arteries or fully block them. When this happens, some parts of your heart don't get enough blood.

Angioplasty widens the blocked part of the artery so more blood can get through. It is also called percutaneous coronary intervention (PCI).

Doctors use angioplasty to:

• Reduce chest pain from blockages in the coronary arteries. This type of pain is called angina. There are different types of angina. Angioplasty treats certain types.
• Limit damage to the heart during or right after a heart attack. In this case, angioplasty is an emergency treatment.

Angioplasty does not cure coronary artery disease. To help prevent more plaque blockages, you'll need to take any prescribed medicines, eat healthy foods, and get regular exercise.

If you have symptoms or risk factors for heart disease, your doctor can use different tests to evaluate heart function and detect blockages. Electrocardiograms, or EKGs, can show if the heart has been damaged. Exercise tolerance tests, also known as stress tests, measure the heart's ability to supply the body with oxygen.

But for pinpointing blockages, X-ray images called angiograms are essential. Angiograms use an iodine-based X-ray contrast dye and a camera to take pictures of blood flow in a vessel. The patient is usually awake for the procedure and is given a local anesthetic. A guide wire is threaded into an artery, usually near the patient's groin, and guided up into the heart until it reaches a blockage. Then a tiny, flexible hose called a catheter is threaded over the wire; the patient does not feel the catheter moving through the body.

When an angiogram reveals a blockage in a coronary artery, the doctor may decide to perform an angioplasty, sometimes directly following the angiogram. Angioplasties may be done to expand a partially blocked artery or during or after a heart attack when the need to open blocked vessels is critical.

During an angioplasty, a small balloon at the end of the catheter is inflated, sometimes several times, to widen the artery. This typically reduces blockage from 70-90% to about 20-30%. When the artery is widened, a stent, a tiny coil of wire mesh, only about three quarters of an inch long, is often inserted into the artery to keep it from narrowing again. The balloon is again inflated and the stent springs open. The balloon catheter is removed and the stent remains permanently in place. Drug-eluting stents are coated with medication and may be used to prevent clot formation and restenosis (renarrowing of the artery).

Most angioplasty patients stay in the hospital overnight. Typically, aspirin or another medication is prescribed to keep the blood from clotting. If a stent has been implanted, clopidrel will usually be prescribed to keep clots from forming inside the stent.

A successful angioplasty will immediately relieve chest pain, increase blood flow to your heart and throughout your body, and give you more energy. But angioplasty is only one alternative for treating blocked arteries. Other options are drug therapy to dissolve clots, or coronary artery bypass graft surgery, especially for patients with small arteries or with multiple or severe blockages.

Most people have angioplasties in a hospital in a special room called a cardiac catheterization, or cath, lab. You will be awake and lying down. You'll get medicine to help you relax through an intravenous (IV) line. This is a small tube that goes into a vein in your hand or arm.

Angioplasty is done through a blood vessel in your arm, wrist, or groin. Your doctor will:

• Make a small opening in that area to insert a thin tube (a catheter) into a blood vessel.
• Thread the tube through the vessel to your heart, using x-rays as a guide.
• Inject contrast dye inside your arteries. The dye highlights your heart and blood vessels in the x-rays.
• Replace the first tube with another one that has a small, deflated balloon on the end.
• Guide the balloon inside the blockage and inflate it to push the plaque flat against the artery wall. This makes the artery wider and improves blood flow.
• Sometimes put a small, mesh tube into the artery to help keep it open. The tube is called a stent. Some stents have a coating of medicine that helps prevent blood clots from forming.

If you had an angioplasty for chest pain, you'll go to a recovery room for a few hours. You may stay in the hospital overnight. Your doctor will probably prescribe medicines to prevent blood clots. Most people can return to their usual activities after a week.

If you had an emergency angioplasty for a heart attack, you'll need to stay in the hospital for about a few more days.

Angioplasty is very safe. You may get a bruise, feel sore, or have some bleeding where the tubes were inserted. More serious problems don't happen very often, but they are possible. They can include serious bleeding, blood clots, and narrowing of the artery again.

Angioplasties are considered procedures, not surgeries. Major complications are uncommon, but as with all medical procedures, there are a number of possible risks and complications.

The risk involved in an angioplasty also depends on where in the body the procedure is performed. An angioplasty in the carotid arteries can pose the very serious risk of embolisms: tiny blood clots, traveling to the smaller blood vessels of the brain, becoming lodged there, and causing a stroke. For this reason, embolic protection devices have been created. These filtering devices are coated with anticlotting medication and fitted with an umbrella-like filter on one end. The filter captures the tiny emboli while the device's tiny holes permit blood to flow through. At the end of the stenting procedure, the filter and its captured debris are removed from the artery.

Other possible risks and complications of angioplasty include:

• allergic reaction to the iodine-based dye,
• bleeding or infection at the catheter insertion site,
• damage to a heart valve or blood vessel,
• kidney failure (higher risk in those with existing kidney problems),
• irregular heart beats (arrhythmias),
• blockage of blood flow to an area of the heart.