Balloon angioplasty is a relatively quick procedure, taking only one to two hours in a cardiac catheterization laboratory. An overnight hospital stay is often required. The patient may be discharged that evening or the following morning.

The day of the procedure, patients should discuss their medical history with their physician, and inform him or her of any medications currently being taken. Certain medications (e.g., anticoagulants, antiplatelets) may need to be stopped or reduced. Patients with diabetes should consult their physician about food and insulin intake, because patients are usually asked to stop eating or drinking after midnight before the procedure.

A number of tests may be performed before a patient undergoes balloon angioplasty, including blood tests, an electrocardiogram (EKG) and a chest x-ray. These routine tests are usually performed on the day before the procedure.

On the day of the procedure, the patient is taken to a cool and sterile catheterization laboratory that may resemble an operating room with abundant monitoring devices, video display equipment and x-ray cameras. A nurse or physician will explain what is going to happen, and the patient is encouraged to ask questions.

After the patient is made comfortable, the physician inserts an intravenous (I.V.) line into the patient’s arm. The I.V. allows the physician to administer a calming medication (sedative) and other necessary medications during the procedure. Small devices will be taped to the patient’s body, which allow the physician to monitor heart rate and blood pressure.

The physician then selects the artery that will be used to deliver the balloon-tipped catheter to the clogged artery. Typically the femoral artery (in the groin or upper thigh) is chosen. However, studies have found that it is also safe and feasible to use the radial artery (in the lower arm near the wrist). Other arteries in the arm, including the ulnar (in the lower arm) and the brachial (in the upper arm) are used in some cases. Whichever area is chosen is cleaned, shaved and numbed with a local anesthetic. The catheter is then passed into the artery and up into the heart using a video monitor to guide the process. There may be some minor discomfort during this process.

When the catheter is in place, an x-ray of the coronary arteries (coronary angiogram) is taken to measure the narrowing of the arteries. This special x-ray helps the physician visualize and evaluate the extent and severity of the arterial narrowing. Once the physician has located the blockage, a guide wire is advanced to the location of the blocked artery, and a second, smaller balloon-tipped catheter is passed over the guide wire. When the balloon catheter reaches the target area, the balloon is inflated for a period of several seconds to several minutes. After deflation of the balloon, the same area may be treated with one or more other additional inflations.

To perform this procedure, the physician will choose to use either a compliant or a noncompliant balloon, depending on the type of the blockage. Balloon compliance describes the degree to which the balloon will inflate as pressure inside the balloon increases. Most balloons used in balloon angioplasty have some level of compliance. The cardiologist will match the balloon to the situation. For example, a cardiologist might use a 3-millimeter noncompliant balloon to treat a blockage in a 3-millimeter artery because he or she would not want the balloon to continue expanding to 4 millimeters in a 3-millimeter artery.

In most cases, a stent is implanted following the angioplasty. A stent is a small wire-mesh tube delivered to the artery by a catheter. Just as scaffolding supports a weak building, stents support the damaged artery walls and hold the crushed plaque in place, greatly reducing the chance that the vessel will close again (restenosis) following the angioplasty.

Stents are typically inserted on a balloon-tipped catheter. The balloon is expanded, deflated and removed, leaving the stent behind to reinforce the wall of the artery. Drug-coated (also called drug-eluting) stents were approved for clinical use by the U.S. Food and Drug Administration (FDA) in 2003. These stents have been shown to significantly decrease the chance of restenosis. However, both traditional and drug-eluting stents may cause the formation of blood clots. Research continues into medications and other substances (e.g., antibodies) that can be used with stents.