Angioplasty and stents

Coronary angioplasty is a common procedure that helps improve blood flow to the heart when the coronary arteries are narrowed or blocked. Find out more about what angioplasty is, what to expect during the procedure, possible risks, and why stents are often used.

What is coronary angioplasty?

Coronary angioplasty is a treatment for coronary artery disease (CAD) that helps to reduce blockages in your coronary arteries and increase the blood flow to your heart. It is also called percutaneous coronary intervention or PCI. 

CAD occurs when fatty deposits (called plaque) build up inside the arteries that carry blood to your heart. Over time, this narrows and stiffens the arteries, reducing blood flow and causing symptoms like chest pain (angina). CAD is also called heart disease or ischaemic heart disease. 

During angioplasty, a cardiologist uses a tiny balloon at the end of a thin flexible tube (catheter) to push the plaque against the artery wall. This widens the artery so blood can flow more easily.  

Often a stent (small mesh tube) is then placed in the artery to keep it open.  

Angioplasty is often done during a coronary angiogram. It’s also used as an emergency treatment for unstable angina or a heart attack, to quickly restore blood flow to the heart muscle.

How is angioplasty different from an angiogram?

A coronary angiogram (angiography) is a test. It uses x-rays and contrast dye to show where an artery is narrowed or blocked.   

Angioplasty is a treatment. It uses a balloon and stent to open a narrowed or blocked artery. 

What is a stent and why do I need one?

A stent is a tiny, flexible, mesh tube made of metal. It’s placed inside a narrowed or blocked artery to help hold it open. You won’t feel the stent once it’s in place.   

Many stents are coated with medicine (drug-eluting stents). The medicine is slowly released to help reduce scar tissue and lower the chance of the artery narrowing again (restenosis).   

After having a stent placed, most people notice their chest pain (angina) improves and daily activities become easier.

How are stents put in? 

Angioplasty is done in a hospital, usually in a special room called a cardiac catheterisation laboratory (or cath lab).  

How long does it take to get stents put in? 

Angioplasty usually takes between 30 minutes and two hours, depending on how many stents are needed and how complex the procedure is. 

How to prepare for angioplasty with stents  

Here are some steps you’ll need to take to prepare for your procedure.     

1. Tell your medical team if you take blood thinners – you may need to stop them for a few days beforehand. 
2. Tell your medical team if you’ve had an allergy to x-ray contrast dye previously, or if you have other allergies.    
3. Have tests such as an ECG and blood tests.   
4. Check how long you should stop eating and drinking beforehand.  
5. Take your other regular medicines unless your doctor tells you not to.  
6. Arrange for someone to take you home afterwards.   
7. Plan to stay near the hospital overnight if you don’t live in the same city.  

During the angioplasty 

1. The procedure starts the same way as a coronary angiogram.  
2. A small incision (cut) is made in your groin or wrist, and a sheath (narrow tube) inserted into the artery. 
3. A thin, flexible guidewire is placed into the artery.  
4. The cardiologist uses x-ray images to guide the wire to the narrowed or blocked section. 
5. A catheter with a small balloon and stent at its tip is passed over the wire to the narrowed area.  
6. The balloon is gently inflated. This opens the artery and expands the stent, pressing the plaque against the artery walls.  
7. The balloon is then deflated and removed, leaving the stent in place. The guidewire is also removed.  

Note: You may feel some chest discomfort when the balloon is inflated. Let the doctor know if this happens.   

After the angioplasty 

If the catheter was put in your wrist: a pressure band (like an inflatable bracelet) is used to stop bleeding.  

You’ll usually be able to sit up and walk soon after.     

If the catheter was put in your groin: a tiny plug is inserted, or pressure is applied for up to 20 minutes to stop bleeding. You’ll need to lie flat for a few hours after this.

While you’re in hospital, a nurse will check your: 

• catheter site 
• blood pressure 
• pulse 
• blood flow in your arm or leg. 

You’ll be asked to drink plenty of water to help your kidneys filter the dye from your blood.

When can I go home?

Most people can go home the same day or the next day. If you had an emergency angioplasty, you may need to stay in hospital longer. 

Before you go home, a nurse will show you how to check your catheter site for any bleeding and tell you what to do if this happens. If your groin was the entry site, you may be advised to avoid heavy lifting, bending or straining for a week to prevent bleeding.   

Make plans for someone to drive you home and stay with you the first night.    

Feeling tired afterwards is normal, so rest and get plenty of sleep.

What medicines will I need?

Before leaving hospital, you'll be prescribed medicine to help prevent a blood clot forming on the stent. This medicine works best when you take it exactly as prescribed, and at the same time each day. Missing doses increases your risk of a clot forming.  

Don’t stop taking your medicine without talking to your doctor first.  

Continue your usual heart and other medications unless your doctor tells you otherwise. 

Talk to your doctor or pharmacist before you take any over-the-counter (without a prescription) medicines or herbal remedies. Some may interfere with your heart medicines or cause side effects.    

Explore our tips for taking your heart medicine 

When can I drive?

After angioplasty, most people need to wait at least 48 hours before driving. This allows time for the effects of the medicines used during the procedure to wear off.   

You’ll need medical clearance from your cardiologist before you can drive, if: 

• your stent was placed after a heart attack or unstable angina 
• there were complications during the angioplasty procedure 
• you are using a commercial or heavy vehicle licence. 

For more information, contact NZTA: phone 0800 822 422 or visit www.nzta.govt.nz.

When can I return to work after stents?

Many people can return to work two to five days after the angioplasty procedure.  

It’s important to check with your doctor about when you can return to work if: 

• your stent was placed after a heart attack or unstable angina 
• there were complications during the procedure 
• your job involves heavy lifting.    

Always follow the advice of your doctor.

Exercising after angioplasty

For the first week after your procedure, avoid heavy lifting or strenuous activity until your wound has healed.  

If your stent was placed after a heart attack, focus on gentle activity for the first four to six weeks, then gradually increase intensity (how hard you exercise). 

If you get chest pain, stop, rest and take your GTN (angina) spray.  

Always follow the advice of your doctor. 

Angina action plan 

Learn more about exercising after a heart attack

Cardiac rehabilitation

You may be invited to join a cardiac rehabilitation programme to support your recovery and wellbeing. It’s a proven way to speed recovery, improve quality of life and lower your risk of future heart problems.   

Explore cardiac rehab options  

What are the risks of angioplasty (stents)?

Angioplasty is a very common and generally safe procedure. Like all medical procedures and tests, it has both risks and benefits.   

Minor complications include: 

bleeding under the skin, which usually improves within a few days but occasionally may take a few weeks to heal 

allergy to the contrast dye, which can cause a rash, hives or itching. Tell your cardiology team before the procedure if this has happened previously, or if you have other allergies.  

More serious complications are uncommon but can include:  

• serious bleeding – this is an emergency, call 111 
• damage to the artery in the arm or groin, possibly affecting blood supply 
• heart attack or stroke 
• kidney damage from the contrast dye  
• tissue damage from x-ray radiation if the test takes a long time 
• severe allergic reaction to the contrast dye resulting in difficulty breathing and a fall in blood pressure 
• risk of death.  

Complications with stents also include:  

• stent thrombosis – where a blood clot forms within the stent weeks or months after the procedure. To reduce the chances of this you must continue blood thinning medications as prescribed by your doctor   
• in-stent restenosis – where the artery re-narrows inside the stent over time. This is much less common with modern drug-coated stents. 

Your risk of complications may be higher if you:   

• are older – risk increases with age, especially if you have other health conditions   
• had angioplasty as an emergency treatment    
• have kidney disease, as the contrast dye can occasionally cause further damage to your kidneys 
• have a history of serious heart disease.

Living well with angioplasty and stents

Angioplasty can ease symptoms like chest pain, but it’s not a cure for heart disease. To lower your risk of future heart issues, it’s important to keep taking your medicines and make heart-healthy lifestyle changes.   

Learn more about managing your risk