Coronary Angioplasty and Stenting - nuhcs

What should I do?
1. Please inform your doctor of any allergy, particularly allergies to
seafood, iodine, X-ray contrast medium, and pain relieving medications.
2. Please inform your doctor if you have a history of peptic ulcer disease,
recent strokes, bleeding tendencies or planning surgery within the
year.
3. If you are suffering from diabetes mellitus and are taking a medication
called metformin, please inform your doctor as you may need to stop
this medication before the procedure.
4. Upon discharge, you will usually be given two blood clotting medications
– aspirin and either ticlopidine, clopidogrel or prasugrel. The latter
medicines may be discontinued after 1 month or a year depending on
your situation. Your cardiologist will determine the optimal duration
for you. You should however continue to take aspirin indefinitely to
prevent future heart attacks, unless instructed by your doctor.
What is the likelihood of a successful procedure?
The likelihood of success depends on the nature of your coronary narrowing,
and is usually 95%. In about 5% of cases, the procedure may be unsuccessful
and the artery remains narrowed. In very few patients (less than 1%),
urgent bypass surgery may be required if the procedure is complicated.
Narrowing of the coronary artery may recur, usually in the 12 months
following initial successful angioplasty or stenting. This usually manifests
as a recurrence of chest discomfort. You should seek medical attention
or inform your doctor immediately if you have a recurrence of chest pain.
What are the potential risks/complications?
In general, major complications which include heart attacks, abnormal
heart rhythm, stroke and death, occur in less than 1% of patients undergoing
PTCA. This risk depends on the complexity of coronary narrowing and the
patient's underlying medical conditions. Other less serious complications
occur in 1-3% and include bleeding from the puncture site, bruising and
swelling of the puncture site, and blood clot formation in the artery where
the sheath is inserted. Overall, the procedure is very safe and well tolerated.
Contact information
NUH Angiography Centre
Main Building 1, Level 2
Opening Hours: 8.30 am - 5.30 pm (Mon - Fri)
(except on Public Holidays)
For appointments, please contact
Tel: (65) 6772 2002
Email: appointment@nuh.com.sg
For International Patients And Visitors
The International Patients Liaison Centre (IPLC) is a one-stop service centre to support
all the medical needs of our foreign patients
Tel
: (65) 6779 2777 (24-Hours Helpline)
Fax : (65) 6777 8065
Website : www.nuh.com.sg/iplc.html
National University Hospital
5 Lower Kent Ridge Road, Singapore 119074
Tel: 6779 5555 Fax: 6779 5678 Website: www.nuh.com.sg
Location
Free Shuttle Bus Service
Free Shuttle Bus Service from Dover MRT Station to NUH
Operation hours
: 8.00 am – 8.30 pm (Mondays – Fridays)
8.00 am – 2.00 pm (Saturdays)
Not available on Sundays and Public Holidays
Dover/NUH : 1. Dover MRT Station (opposite Singapore Polytechnic)
passenger pickup/ 2. Main Building, Lobby Entrance (near roundabout)
drop off point 3. Kent Ridge Wing, Level 3, South Entrance
For more information on Shuttle Bus schedule, you may go to NUH internet website
at www.nuh.com.sg
Coronary Angioplasty
and Stenting
Information in this brochure is given as a guide only and does not replace medical advice from your
doctor. Please seek the advice of your doctor if you have any questions related to the surgery, your health
or medical condition.
Information is correct at time of printing (Aug 2009) and subject to revision without notice.

What is Coronary Angioplasty and Stenting?
The coronary arteries supply blood to the heart muscles. When they are
narrowed by a process called atherosclerosis (blood vessel wall hardening),
the heart’s blood supply may become insufficient, especially during periods
of physical exertion or stress. This frequently causes chest discomfort (angina
pectoris) but may also manifest as breathlessness, irregular heart rhythm,
fatigue and even heart attack.
Coronary artery narrowings may be treated using medications that reduce
the heart’s demand for blood, or by procedures aimed at restoring the
heart’s blood supply. The two most common methods to increase blood
supply are coronary artery bypass surgery and coronary angioplasty, sometimes
abbreviated as PTCA (Percutaneous Transluminal Coronary Angioplasty). In
PTCA, a balloon mounted on a thin tube (catheter) is advanced into your
heart artery until it lies within the narrow area. The balloon is then inflated
to dilate the narrowing. Upon balloon deflation, the arterial narrowing is
often significantly reduced. This is usually followed by another procedure
called stenting where a small metal coil is placed.
100%
Blockage
Balloon
Wire
Coronary arteriogram showing
complete occlusion of the right
coronary artery
After insertion of a wire, a
balloon is inflated at the site
of the blockage
A thin balloon at the end of a catheter is inflated to compress plaque.
This procedure is often used instead of bypass surgery.
The stent provides support to the narrowed segment of the coronary artery
after angioplasty, preventing the artery from collapsing and reducing the
likelihood of repeat narrowing. Modern stents are made of stainless steel
or a cobalt chromium alloy and are inert to the body. Some stents also have
a medication coating and these may be preferred in certain situations to
further reduce the chance of repeat narrowing of the heart arteries. In some
situations, stents can be placed directly over the narrowed segments (direct
stenting) without prior balloon dilatation.
Arterial
Flow
Restored
Following successful stenting,
normal blood flow is restored
What can I expect?
Undergoing PTCA (percutaneous transluminal coronary angioplasty) is very
similar to having a coronary angiogram. After injection of a local anaesthetic,
a plastic tube called a sheath is inserted in a large artery in the groin or
wrist. Through this sheath, a long and narrow tube (catheter) is advanced
to the mouth of the narrowed coronary artery. A coronary angiogram is
done first to provide a “road map” for the PTCA. A fine wire is then threaded
through the catheter and advanced into the coronary artery. This wire serves
as a rail over which the balloon catheter is finally delivered into the artery
and the balloon positioned over the area of narrowing. Stenting is similarly
carried out. The procedure may take from 1 /2 to 2 hours, depending on the
complexity of the diseased artery.
Following successful PTCA, you will be monitored in a special monitoring
ward. During this period, the sheath may be kept in your groin artery for
4 to 6 hours. Alternatively, the sheath may be removed in the laboratory
immediately after the procedure if the situation allows. Upon removal of
the sheath, the puncture site will be compressed for about 30 minutes to
ensure that there is no bleeding. You will have to remain in bed for several
hours or until the following day following a groin puncture to ensure
sufficient healing of the puncture site before walking. Your cardiologist
will determine how long you need to be in bed before ambulation. Some
blood tests and ECGs may be performed to monitor your condition. If
there is no complication, most patients can be discharged on the same
day or day after.