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Stanford Health Care

During Your Angioplasty

During the Procedure

A PTCA may be performed as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.

A PTCA may be performed as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices

Generally, a PTCA follows this process:

  1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.
  2. You may wear your dentures or hearing aid if you use either of these. 
  3. You will be asked to remove clothing and will be given a gown to wear.
  4. You will be asked to empty your bladder prior to the procedure.
  5. An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed. 
  6. You will be placed in a supine (on your back) position on the procedure table. 
  7. You will be connected to an ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes.
  8. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure. 
  9. There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through the body into the heart, and the structures of the heart as the dye is injected. 
  10. You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure.
  11. Once the local anesthetic has taken effect, a sheath, or introducer, will be inserted into the blood vessel. This is a plastic tube through which the catheter will be inserted into the blood vessel and advanced into the heart.
  12. The angioplasty catheter will be inserted through the sheath into the blood vessel. The physician will advance the catheter through the aorta into the heart. Fluoroscopy will be used to assist in advancing the catheter to the heart.
  13. The catheter will be advanced into the coronary arteries. Once the catheter is in place, contrast dye will be injected through the catheter into your coronary arteries in order to see the narrowed area(s). 
  14. You should notify the physician if you feel any breathing difficulties, sweating, numbness, itching, nausea and/or vomiting, chills, or heart palpitations.
  15. After the contrast dye is injected, a series of rapid, sequential x-ray images of the heart and coronary arteries will be made. You may be instructed to take in a deep breath and hold it for a few seconds during this time.
  16. When the physician locates the narrowed artery, the catheter will be advanced to that location and the balloon will be inflated to open the artery. It is possible to experience some chest pain or discomfort at this point as a result of blood flow being temporarily blocked by the inflated balloon. Any chest discomfort or pain should go away when the balloon is deflated. However, if you notice any continued discomfort or pain, such as chest pain, neck or jaw pain, back pain, arm pain, shortness of breath, or breathing difficulty, tell your physician immediately. 
  17. The physician may inflate and deflate the balloon several times. The decision may be made at this point to insert a stent in order to maintain the artery's opening. In some cases, the stent may be inserted into the artery before the balloon is inflated. The inflation of the balloon will open the artery and fully expand the stent.
  18. The physician will take measurements after the artery has been opened. Once it has been determined that the artery is opened sufficiently, the angioplasty catheter will be removed.
  19. The insertion site may be closed with a closure device that uses collagen to seal the opening in the artery, by the use of sutures, or by applying manual pressure over the area to keep the blood vessel from bleeding. Your physician will determine which method is appropriate for your condition.
  20. If a closure device is used, a sterile dressing will be applied to the site. If manual pressure is used, the physician (or an assistant) will hold pressure on the insertion site so that a clot will form. Once the bleeding has stopped, a very tight bandage will be placed on the site. A small sandbag or other type of weight may be placed on top of the bandage for additional pressure on the site, especially if the site is in the groin.
  21. Your physician may decide not to remove the sheath, or introducer from the insertion site for approximately four to six hours, in order to allow the effects of blood-thinning medication given during the procedure to wear off.
  22. You will be assisted to slide from the table onto a stretcher so that you can be taken to the recovery area. NOTE: If the insertion was in the groin, you will not be allowed to bend your leg for several hours. To help you remember to keep your leg straight, the knee of the affected leg may be covered with a sheet and the ends tucked under the mattress on both sides of the bed to form a type of loose restraint. If the insertion site was in the arm, your arm will be kept elevated on pillows and kept straight by placing your arm in an arm guard (a plastic arm board designed to immobilize the elbow joint). In addition, a plastic band (works like a belt around the waist) may be secured around the arm near the insertion site. The band will be loosened at given intervals and then removed at the appropriate time determined by your physician.