For people with blocked or narrowed arteries in various parts of the body, angioplasty is a relatively safe procedure that can restore normal blood flow and reduce the risk of stroke and other serious complications. But depending on individual circumstances, alternative surgical procedures or medication and lifestyle changes may be more appropriate than an angioplasty procedure for treating diseases of the arteries.
How Do Arteries Become Blocked?
Artery disease is caused by the stiffening and narrowing of the large vessels that carry blood throughout the body. When the arteries that carry blood to the brain become clogged the condition is called carotid artery disease. Arteries that are narrowed or blocked from carotid artery disease keep oxygen rich blood from flowing freely to the brain and can lead to a stroke.
This “hardening of the arteries” arises from the development of plaque, a fatty substance that clings to artery walls. As plaque accumulates, it can narrow or even block the artery completely.
Depending on its location, a blocked artery can cause outcomes such as stroke, heart attack or renal hypertension – elevated blood pressure from narrowing of arteries in the kidneys. Narrowed arteries in the legs and arms may also cause peripheral artery disease, a condition that can compromise circulation.
When a blocked or narrowed artery is diagnosed, doctors may opt to perform an angioplasty.
What Is an Angioplasty Procedure?
Angioplasty is a minimally invasive procedure performed to open arteries blocked by plaque and restore normal blood flow to the brain, heart and other parts of the body. An angioplasty typically takes about an hour.
Before an angioplasty procedure you can expect to receive either general or local anesthesia. Your neurosurgeon then makes an incision in the femoral artery in the leg. Aided by X-ray imaging and contrast dye to locate the blockage, the neurosurgeon guides a catheter through the artery to the affected area.
This catheter contains a tiny wire with a deflated balloon attached. Once the blockage is reached, the balloon is inflated for up to three minutes so that the plaque is pressed back against the artery wall and blood can flow more freely. Depending on circumstances, your neurosurgeon may decide to place a small mesh stent permanently in the artery to keep it open. If a stent is needed, it may be medicated to prevent blood clots from forming.
Once the artery has been opened and the stent placed if necessary, the catheter is withdrawn and the incision is closed. After angioplasty, patients typically spend one to two days in the hospital for monitoring. During that time, your medical team will monitor your progress and watch for complications.
You may be told to lie flat for several hours right after the procedure to make sure your incision does not bleed and your blood pressure returns to normal. If all goes well, you’ll be able to continue your recovery at home and return to everyday activities within a week or so.
Alternatives to Angioplasty Procedure
An angioplasty procedure is a relatively safe and minimally invasive way to treat blocked arteries in various locations. But angioplasty may not be right for everyone. Depending on individual circumstances including age, overall health, and the location of a blocked or narrowed artery, your vascular surgeon may recommend a different approach.
Medication Management
For many patients with relatively mild symptoms or other conditions that might make surgery a risky alternative, medication – along with some important lifestyle changes – may be an effective alternative to angioplasty. Because high cholesterol levels and high blood pressure play an important part in the development of artery disease, medications such as ACE inhibitors, calcium channel blockers and statin drugs can reduce or eliminate factors that contribute to artery disease.
To prevent blood clots that can develop in affected arteries and break loose, anticoagulants, or “blood thinners” such as Plavix and ordinary aspirin might also be prescribed along with other medications. Medical management of artery disease also includes controlling any other health conditions that may play a part in artery health, such as diabetes or hypertension.
Healthy Lifestyle Changes
Whether in combination with medication or as part of an aftercare plan for those who have had endarterectomy, artery bypass grafting or angioplasty, lifestyle changes that contribute to overall health can help to lower the risk of plaque formation in the arteries. Consider the following lifestyle changes:
Stop Smoking
Smoking plays a major role in the development of arterial disease. Tobacco constricts artery walls and reduces the flexibility of blood vessels throughout the body. Smoking raises blood pressure and is a major contributor to atherosclerosis.
Adopt a Healthy Diet
Arterial plaque is made primarily of waxy cholesterol deposits. A diet rich in saturated fats and harmful trans fats can raise the levels of cholesterol in the blood and contribute to unhealthy weight gain. Switching to a diet that’s rich in fruits, vegetables and low-fat proteins can help prevent plaque buildup and prevent weight gain.
Lose Weight If Necessary
Being overweight or obese can contribute to artery disease and plaque buildup. Making the necessary lifestyle changes to shed excess pounds can help to keep arteries flexible and free of blockages. Nutritionists, dietitians and other kinds of practitioners can work with vascular specialists to develop a plan that accommodates each individual’s unique needs.
Exercise
Movement of any kind can lower blood pressure and help keep arteries flexible and free of plaque. Exercise improves circulation and contributes to weight loss, so working out most days of the week can help to reduce the risk of new artery blockage.
Carotid Endarterectomy
Endarterectomy is a surgical procedure that can be used to restore blood flow in carotid arteries – the large arteries in the neck that supply the brain with blood. In this procedure, the plaque is “peeled” away from the artery wall, so that the blood can flow normally again.
Carotid angioplasty can be an effective procedure to clear blocked or narrowed arteries and reduce the risk of serious complications, but it may not be appropriate for everyone who has artery disease. Depending on your individual circumstances, your doctors may recommend one of the many alternatives to angioplasty as the right choice for treating your artery disease.
Other Surgical Options
In some situations, other surgical procedures might be used instead of an angioplasty procedure, such as artery bypass which restores blood flow to the brain by bypassing blocked arteries altogether. During bypass neurosurgery, an artery that ordinarily supplies blood to the scalp gets connected through a small opening in the skull with an artery inside the brain, thereby bypassing the occlusion in the neck and yet supplying the brain with arterial blood. The scalp is usually not an issue as it will get supply from adjacent smaller arteries.
Another procedure which is less invasive, but has a very complicated and long name, is called EDAS which stands for encephaly-duro-arterio-synangiosis. This is an indirect method of providing blood supply to the brain. In this procedure a hole is cut in the skull and a scalp artery is then sutured to the surface of the brain and the bone is replaced. You can discuss those options with your neurosurgeons.
