Coronary angioplasty is a procedure to surgically repair or unblock one of the two vital arteries that supply the heart muscle with blood – the coronary arteries. The purpose of coronary angioplasty is to widen coronary artery branches that have become narrowed by atherosclerosis together with clotting of blood (thrombosis)

There are actually only two coronary arteries, right and left, but the left coronary artery divides into two large trunks near its origin, so there may seem to be three.

How is it performed

A fine ‘steerable’ guide-wire is first passed, under radiographic guidance, into the diseased artery. The wire is carefully pushed into and through the narrowed segment. A small-gauge tube (catheter) with a sausage-shaped balloon segment near one end (a balloon catheter) is now threaded along the wire until the balloon lies exactly in the narrowed part of the artery. The balloon is now inflated to stretch the constriction.

If adequate widening is not achieved, the balloon can be reinflated using higher inflation pressures. If the catheter is too large to pass through the narrowed segment, it can be exchanged for a smaller one without removing the guide wire. Catheters as small as 0.4 mm diameter are used with guide wires of only 0.3 mm.

Why it should be done

The procedure has a success rate of 70-80% in relieving heart pain (angina) and increasing the ability to take exercise. Surprisingly, the widening remains effective in most cases. The operation works very well in people with soft clots that are partially blocking the coronary artery branch. However, it may not work at all if the plaque of atheroma is too hard and rigid to stretch, or if the artery has been completely blocked by thrombosis for more than three months.