Centres/Interventional Cardiology/Angioplasty + stent

Coronary angioplasty with stent placement

Percutaneous procedure to widen a coronary artery narrowed by atherosclerosis and place a stent (a small metal mesh tube) to keep the artery open.

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What is it?

Coronary angioplasty with stent placement is an interventional cardiology procedure that aims to restore normal blood flow in a coronary artery narrowed or blocked by atheromatous plaques. The procedure is performed percutaneously, that is, without surgically opening the chest, by inserting a catheter through a peripheral artery. The technique involves positioning a catheter fitted with an inflatable balloon at the site of the coronary stenosis previously identified by coronary angiography. The balloon is inflated at high pressure to press the atheromatous plaque against the artery wall and restore a normal caliber to the vessel. A stent, a small cylindrical metal mesh, is then deployed at this site to keep the artery open and prevent restenosis (re-narrowing). The stents currently used are mostly drug-eluting stents (DES), coated with an antiproliferative medication that is released gradually and considerably reduces the risk of restenosis compared with bare-metal stents. After placement of a drug-eluting stent, dual antiplatelet therapy (usually aspirin + clopidogrel, prasugrel or ticagrelor) is essential for 6 to 12 months to prevent stent thrombosis. At the Clinique Pasteur in Tunis, angioplasties are performed by experienced interventional cardiologists using the latest generations of drug-eluting stents and the most modern techniques (intracoronary imaging with IVUS or OCT if necessary). The success rate of the procedure exceeds 95%.

When is it indicated?

Acute coronary syndrome (myocardial infarction, unstable angina)

In the event of a heart attack, quickly reopening the artery responsible and placing a stent is the standard treatment: every minute gained preserves heart muscle.

Stable angina with a significant coronary lesion and documented ischemia

When a proven arterial narrowing causes exertional pain, angioplasty restores good blood flow and makes the symptoms disappear.

Tight, symptomatic coronary stenosis despite optimal medical treatment

If medications are no longer enough to relieve the pain caused by a severely narrowed artery, mechanically opening the vessel becomes the most effective solution.

In-stent restenosis

A stent that has already been placed can sometimes narrow again over time; a new procedure then restores blood flow.

Multivessel coronary disease as an alternative to bypass surgery (Heart Team discussion)

When several arteries are affected, a team of cardiologists and surgeons reviews each case to choose between stents and bypass surgery, whichever solution is most suitable.

Unprotected left main stenosis (selected cases)

Narrowing of this main artery of the heart can, in certain carefully selected cases, be treated by angioplasty rather than surgery, after thorough evaluation.

Preparation

1Fast strictly for at least 6 hours

2Complete prior blood tests (full blood count, creatinine, coagulation, blood group)

3Take a prior antiplatelet treatment (loading dose prescribed by the cardiologist)

4Report any allergy, particularly to aspirin, anticoagulants or contrast agents

5Report any history of bleeding or clotting disorders

6Report any kidney failure

7Hospitalization is required (minimum 24 to 48 hours)

8A signed informed consent form is mandatory before the procedure

9Bring all the results of previous cardiology examinations

Procedure

Positioning in the catheterization room under continuous monitoring

Disinfection and local anesthesia of the arterial puncture site (wrist or groin)

Arterial puncture and placement of the introducer sheath

Diagnostic coronary angiography to confirm the lesions to be treated

Administration of intravenous heparin to prevent clot formation

Advancement of a fine guidewire through the coronary stenosis

Pre-dilation of the stenosis with a balloon if necessary

Positioning and deployment of the stent at the lesion site

Post-dilation with a high-pressure balloon to optimize stent expansion

Final angiographic check to verify the result

Intracoronary imaging (IVUS/OCT) if necessary to optimize the result

Removal of the equipment and hemostasis of the puncture site

Transfer to a continuous care unit for post-procedure monitoring

Duration

45 minutes to 2 hours depending on complexity; hospitalization for 24 to 72 hours

Results

The result of the angioplasty is visible immediately on the control images. The cardiologist discusses the result with the patient and their family as soon as the procedure ends. Strict medical treatment is prescribed on discharge, with scheduled cardiology follow-up.

Risks and side effects

Hematoma or vascular complication at the puncture site

Coronary dissection (treated by placing additional stents)

Acute occlusion of the treated vessel (requiring immediate treatment)

Distal embolization of atherosclerotic-thrombotic material

Periprocedural myocardial infarction (enzyme elevation)

Coronary perforation (rare, requiring urgent treatment)

Stent thrombosis (rare, prevented by antiplatelet treatment)

Kidney failure due to the contrast agent

Allergic reaction to the contrast agent or the stent materials

Stroke (exceptional)

Death (exceptional, less than 0.5% in scheduled procedures)

These risks remain rare. Your physician will inform you in detail before the examination.

Book an Appointment

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At a glance

Duration: 45 minutes to 2 hours depending on complexity; hospitalization for 24 to 72 hours

Preparation: Required

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