Angioplasty

Angioplasty is a procedure used to widen narrowed or blocked arteries and improve blood flow. A thin catheter with a small balloon is inserted into the artery and inflated to open the blockage. In most cases, a stent is placed to keep the artery open. This helps restore circulation and reduce symptoms such as chest pain or shortness of breath.

Dr. Kua Jieli

Senior Consultant
Cardiologist (Intervention)

MBBS (SG) | MRCP (UK) | MMed (Internal Med) (SG) | FAMS (Cardiology, SG)

Indications Benefits Techniques Preparation Procedure Recovery Risks FAQ

Indications for Angioplasty

Angioplasty is considered when medication alone does not provide sufficient symptom relief from artery blockages. It may be recommended for individuals with:

Coronary Artery Disease (CAD): Plaque build-up in the coronary arteries reduces blood flow to the heart, leading to chest pain (angina) or shortness of breath.
Heart Attack: A blocked artery disrupts blood flow to the heart muscle, requiring urgent intervention to restore circulation.
Peripheral Artery Disease (PAD): Narrowed arteries in the legs, arms, or other areas restrict blood supply, causing pain, numbness, or mobility issues.
Renal Artery Stenosis: Narrowing of the kidney arteries affects blood pressure regulation and kidney function.

Benefits of Angioplasty

As a minimally invasive procedure, angioplasty effectively restores blood flow in narrowed or blocked arteries and offers multiple advantages.

Quick Recovery

Most patients are discharged within 24 hours and can return to normal activities within a week, making it a convenient option compared to traditional surgery.
Symptom Relief

Helps reduce chest pain (angina) and improves breathing, allowing patients to engage in daily activities with greater ease.
Sustained Improvement

When combined with stent placement, angioplasty helps maintain blood flow for years, particularly when supported by prescribed medication and a heart-healthy lifestyle.
Minimally Invasive

The procedure is performed through a small incision, reducing the risk of complications, scarring, and extended hospital stays.

Surgical Techniques

Balloon Angioplasty

A catheter with a small balloon at its tip is guided to the blockage site. Once in place, the balloon inflates, compressing plaque against the artery wall to widen the artery and restore blood flow. This technique serves as the foundation of most angioplasty procedures and may be used alone in select cases.

Stent Placement

Following balloon inflation, a small mesh tube (stent) is inserted to keep the artery open. Over time, the stent integrates with the artery wall, helping to prevent re-narrowing. The choice of stent depends on the severity of the blockage and individual patient factors.

Drug-Eluting Stents

These stents are coated with medication that is gradually released to prevent excessive tissue growth, reducing the risk of artery renarrowing (restenosis). This option is particularly beneficial for patients at higher risk of recurrence.

Preparing for Surgery

Medical Assessment: A thorough review of the patient’s medical history, physical examination, and necessary blood tests or imaging studies will be conducted to assess the severity of the blockages and evaluate overall health before the procedure.
Medication Adjustments: Blood-thinning medications may need to be paused or adjusted. Certain medications may be temporarily discontinued, while others could be introduced. Specific instructions will be provided based on the patient’s current prescriptions.
Fasting Guidelines: Eating and drinking must stop several hours before the procedure, typically starting after midnight. Clear liquids may be permitted until a specified time, as per medical instructions.

Step-by-Step Procedure

Local Anaesthesia

The insertion site, usually in the groin or wrist, is numbed with a local anaesthetic to prevent discomfort. Patients remain awake throughout the procedure while vital signs are closely monitored.

Catheter Insertion

A small incision is made to access the artery. A short, hollow tube (sheath) is inserted, allowing a thin, flexible catheter to be guided through the blood vessels with the aid of X-ray imaging.

Blockage Identification

A contrast dye is injected through the catheter, making narrowed or blocked areas visible on X-ray images. This helps assess the severity and exact location of the blockage.

Balloon Inflation

Once the catheter reaches the blockage, a small balloon at its tip inflates, compressing plaque against the artery wall to widen the passage. Multiple inflations may be needed. Temporary chest discomfort may occur but usually subsides when the balloon deflates.

Stent Placement

If required, a stent (a small mesh tube) is positioned at the treated site. It expands as the balloon inflates, then remains in place to keep the artery open once the balloon is deflated and removed. X-ray imaging is used to ensure correct positioning.

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Post-Surgical Care and Recovery

Immediate Monitoring and Activity Resumption

The first 6–24 hours require bed rest with continuous monitoring for bleeding or complications. The affected limb must remain straight during this period. Walking usually begins within a day, with light activities resuming within a few days and moderate activities within a few weeks, depending on recovery progress.

Medication and Stent Care

Blood-thinning medications are often prescribed to prevent stent-related clots. The duration of medication depends on the type of stent used and individual risk factors.

Follow-Up and Long-Term Recovery

Regular check-ups monitor recovery and stent function, with an initial review typically within a week. Additional visits are scheduled as needed, and cardiac rehabilitation programmes may be recommended for long-term heart health.

Potential Risks and Complications

Although angioplasty is generally safe, complications can occur. These may include bleeding at the insertion site, blood vessel damage, or an allergic reaction to the contrast dye. Less common risks include heart attack, stroke, or kidney issues. In some cases, the treated artery may narrow again (restenosis) within six months. Emergency bypass surgery is rarely needed. Patients with drug-eluting stents require ongoing anti-clotting medication to prevent blood clots.

Frequently Asked Questions (FAQ)

How long does the procedure take?

Angioplasty usually takes one to two hours. However, if multiple blockages need treatment or complications arise, the procedure may take longer. Most patients stay in the hospital overnight, but some may require a hospital stay of two to three days for observation and recovery.

What precautions should be taken after angioplasty?

Following the procedure, it is necessary to take prescribed medications as directed, attend follow-up appointments, and adopt a heart-healthy lifestyle. This includes regular exercise, a balanced diet, and avoiding smoking to reduce the risk of future blockages.

Are there alternatives to angioplasty?

In some cases, medication or lifestyle changes can be an alternative to improve symptoms and manage plaque build-up in arteries. However, for some severe cases, coronary artery bypass surgery is recommended. The best approach is to discuss with your cardiologists the treatment plans based on the severity of blockages, symptoms, and overall health.

Dr. Kua Jieli

Senior Consultant
Cardiologist (Intervention)

MBBS (SG)|MRCP (UK)|MMed (Internal Med) (SG)|FAMS (Cardiology, SG)

A Senior Consultant Cardiologist specialising in interventional cardiology and serves as the Medical Director at Carrington Cardiology, located at Mount Elizabeth Medical Centre in Singapore.

Dr. Kua obtained his MBBS from the National University of Singapore. He furthered his medical education by earning an MRCP in the UK and an MMed in Internal Medicine from NUS. He completed advanced training in interventional cardiology at Hammersmith Hospital in London.
Dr. Kua’s international training at Hammersmith Hospital provided him with extensive experience in complex coronary interventions and exposure to advanced cardiovascular research. He served as an International Cardiology Fellow and Honorary Consultant during his tenure there.

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