When arteries become clogged or narrow, it is often necessary to reopen them to prevent pain and further complications. Angioplasty and atherectomy are common non-surgical methods of opening the arteries.
According to data from the Healthcare Cost and Utilization Project, angioplasties were among the top ten most commonly performed medical procedures in the U.S. between 2003 and 2012. After reading this guide, you will be more familiar with what these procedures involve, when they are performed, and the recovery process that follows.
What Is An Angioplasty?
During an angioplasty procedure, a thin tube with a small balloon attached to the end is inserted into the affected artery. The balloon is then inflated, widening the artery and allowing blood to flow normally. This procedure is also known as a percutaneous transluminal coronary angioplasty (PTCA).
Often, an angioplasty procedure also involves the placement of a stent. Stents are small steel tubes placed in an affected artery. This tube stays in the artery after the balloon is removed to help the artery remain open. Stents are placed in about 70% of angioplasty procedures.
What Is An Atherectomy?
During an atherectomy, a plaque that is blocking an artery is cut or scraped away to open the artery. Plaque is a substance that forms when cholesterol and fats combine together in the bloodstream causing the arteries to harden and narrow.
With a directional atherectomy, a small catheter with a sharp blade on the end is threaded into the affected artery to perform the procedure. The directional atherectomy blade slices or cuts away the plaque, and the catheter collects the plaque that has been removed.
Another type of atherectomy, known as rotational atherectomy, involves a small drill that is placed on the tip of a catheter. This drill rotates to remove plaque in an artery and the catheter then collects the plaque.
Reasons An Angioplasty Or Atherectomy May Be Needed
The goal of angioplasty and atherectomy procedures is to restore the function of arteries. The procedure that is performed will depend on the individual and the type of blockage they have. Generally, angioplasty procedures are performed on central or coronary arteries that supply blood to the heart. Atherectomy procedures are generally performed on peripheral arteries in the extremities, such as the legs.
When arteries anywhere in the body become narrow and hardened, this occurs due to atherosclerosis. In atherosclerosis, cholesterol and fatty deposits build up in arteries causing them to narrow. This results in a lack of oxygen to the area the artery serves, which may result in pain and other symptoms.
Plaque buildup in arteries may cause blood clots to form. These blood clots may cause a complete or partial blockage of the affected artery. The plaque may also break off and travel through the bloodstream until it becomes stuck, resulting in a blockage. Either of these events may lead to heart attack, stroke, or tissue death.
Arterial Diseases Related To An Angioplasty Or Atherectomy
Atherosclerosis occurs in multiple diseases that affect arteries. These diseases may result in a doctor recommending that an individual have an angioplasty or atherectomy performed.
Some common arterial diseases that may result from atherosclerosis include:
- Coronary heart disease – In coronary heart disease, plaque builds up in the arteries leading to the heart muscle. The term coronary heart disease is often used interchangeably with coronary artery disease (CAD), but CAD is actually the disease that leads to coronary heart disease. Healthy lifestyle habits, medications, and other therapies may keep CAD from developing into coronary heart disease.
- Carotid artery disease – The carotid artery is a large artery that runs up the neck and supplies blood to the brain. In carotid artery disease, plaque builds up in this artery. This may lead to a small stroke called a transient ischemic attack (TIA) or to a full stroke.
- Peripheral artery disease (PAD) – In PAD, plaque builds up in arteries that supply blood to the body’s extremities. This most commonly occurs in the legs and often results in leg cramps or pain during activity. If PAD is left untreated, it may result in sores, difficulty walking, or the loss of the affected limb.
- Angina – Angina is chest pain that is caused by reduced blood vessel flow in the arteries that supply blood to the heart muscle. Angina chest pain may be chronic, making it difficult for affected individuals to maintain their quality of life.
- Chronic kidney disease – Chronic kidney disease is sometimes caused by atherosclerotic renovascular disease (ARVD). In ARVD, the arteries that lead to the kidneys narrow. People with ARVD are likely to have other arteries of the body affected by atherosclerosis as well.
What To Expect During An Angioplasty Or Atherectomy
During an angioplasty or atherectomy, an individual will generally be awake. The incision area will be numbed and mild sedation may be given, but most angioplasty or atherectomy procedures require the patient to be alert and be able to follow instructions and answer questions. The arteries inside do not have nerve endings so the individual will not feel the catheter as it works.
The physician performing the procedure will be able to see the inside of the arteries they are working on through an x-ray. They will be able to see how the artery responds to the procedure.
Sometimes the balloon in an angioplasty may be inflated and deflated several times to make sure the plaque is firmly pressed against the walls of the artery. In atherectomy procedures, the physician will monitor how much plaque they have cut away and how much more still remains.
The length of the procedure will depend on the individual and how severe their blockage is. If a stent is being placed, this may increase the length of the procedure.
After the catheter is removed, the patient’s incision will be treated. The incisions made for angioplasty or atherectomy procedures are generally small and are usually closed with a few stitches or a bandage. In some cases, such as when blood thinning medications have been used, a small tube called a sheath will be placed in the artery for a short time. The sheath will be removed once blood thinners are no longer in use.
Care Needs Following An Angioplasty Or Atherectomy Procedure
Recovering from angioplasty or atherectomy is a simple process for most people. Since these procedures are nonsurgical, they do not require intensive care. An individual who has had an angioplasty or atherectomy should be able to return to their normal activities soon after the procedure. However, the diseases that angioplasty and atherectomy treat are chronic and require ongoing care and monitoring.
When an individual has an angioplasty or atherectomy, it will be part of a larger plan of care for managing the disease that caused the plaque buildup. This plan of care will likely also include lifestyle changes, medication changes, and follow-up appointments. This may be overwhelming for some individuals, especially if they are also managing other health conditions.
While angioplasty and atherectomy are used to treat these conditions, symptoms may still be present. PAD and angina may cause chronic pain.
In many people, chronic pain leads to a decreased ability to care for themselves. They may no longer be able to perform daily personal care independently. These tasks, such as bathing, dressing, and toileting, are known as activities of daily living (ADLs). When a person is no longer able to manage their own ADLs, they may need additional care and assistance.
Chronic pain may also lead to depression. When an individual is depressed, they may be overwhelmed by daily tasks.
They may find they are too tired to do the things they used to do. They may have trouble paying bills, managing medications, or cooking for themselves. These activities are referred to as instrumental activities of daily living (IADLs). These tasks may increase in complexity after angioplasty or atherectomy. An individual may need to eat certain foods, participate in physical therapy, or take an increased amount of medication.
Some people will be able to manage their ADLs and IADLs by themselves after angioplasty or atherectomy. For other individuals, it may be necessary to obtain some additional help for care needs after the procedure.
Medication Changes After An Angioplasty Or Atherectomy
After angioplasty or atherectomy, an individual may have medication changes. They may remain on previous medications for cardiovascular conditions such as high blood pressure or angina. In addition, a doctor may prescribe:
- Aspirin – Aspirin is used to help prevent blood clots.
- Clopidogrel – Clopidogrel is usually taken for a period of time following an angioplasty. It is used to prevent blood clots from forming in a stent. A doctor will monitor an individual who is taking this medication and tell them when it is safe to stop taking it.
The specific medications that are prescribed after a procedure will depend on the individual. Some medications may have interactions with medications for other conditions. The doctor will prescribe the safest and most appropriate medication routine for the affected individual based on their specific needs.
Lifestyle Changes After An Angioplasty Or Atherectomy
After angioplasty or atherectomy, lifestyle changes may be recommended. These changes will help prevent the arteries from becoming blocked again. This may prevent the need for additional procedures and reduce the risk of serious complications such as a stroke or heart attack.
The individual’s doctor will let them know the specific changes they need to make following the procedure. Often, these changes will include beginning a heart-healthy diet. Some components of a heart-healthy diet include:
- Eating more whole grains – Whole grains are rich in nutrients such as fiber and have cardiovascular benefits. They include foods such as brown rice, whole wheat, oatmeal, and barley.
- Eating less refined grains – Refined grains are grains that have been milled or refined. This improves shelf life and makes the grain finer in texture. It also removes many of the nutrients that whole grains provide.
Refined grains are found in foods made from white flour such as white bread, cakes, cookies, bagels, biscuits, and noodles. Many of these products have whole-grain or vegetable-based alternatives available. For example, there are many varieties of bread and pasta made from whole wheat.
- Eating more fruits and vegetables – Fruits and vegetables are an essential part of any healthy diet. They provide needed vitamins and other nutrients. The American Heart Association recommends that at least half of an individual’s food on a heart-healthy diet be fruits and vegetables.
- Eating more fish – Fish is high in omega-3 fatty acids. Omega-3 acids may have several heart benefits, including reducing blood pressure and slowing the hardening of the coronary arteries.
- Eating more lean meat such as chicken – Lean, skinless meats are a good source of protein, an important nutrient for overall health. While red meats such as beef are also high in protein, they have significantly more fat and cholesterol than lean meats.
- Eating more beans, nuts, and other non-meat proteins – As with lean meats, foods such as beans, nuts, soy, and tofu are good sources of protein that are low in cholesterol.
- Eating more low-fat or nonfat dairy – Low or nonfat dairy foods provide calcium and may have anti-inflammatory benefits for some people. The American Heart Association recommends that older adults following a heart-healthy diet should aim for 4 servings of low or nonfat dairy foods a day. This includes foods such as low-fat or nonfat yogurts and reduced-fat or skim milk.
- Eating more healthy fats – Healthy fats include monounsaturated fats and polyunsaturated fats. Monounsaturated fats are found in olive oil, avocados, and some nuts. Polyunsaturated fats include omega-3 and omega-6 fatty acids which are found in foods such as fish and sunflower seeds.
- Eating less unhealthy fats – Unhealthy fats include trans fats and saturated fats. These fats may cause cardiovascular problems and inflammation. Saturated fats are found in foods such as full-fat dairy and red meat and should be eaten in limited quantities. Trans fats are found in foods such as shortening and should be eliminated completely.
- Eating less sugar – Sugar, especially added sugars, is linked to a higher risk of heart disease. Added sugars are often found in foods such as candies, pastries, fruit drinks, sodas, and other soft drinks.
- Eating less salt – Salt is known to increase blood pressure. High blood pressure is linked to a variety of cardiovascular problems including atherosclerosis.
The American Heart Association labels many foods that are part of a heart-healthy diet with a check symbol on the packaging. This is designed to help people with heart conditions and help people who are taking preventive measures against heart conditions make good food choices.
After an angioplasty or atherectomy, a dietician or other nutrition professional may be able to help an individual make meal plans and track their eating.
Depending on an individual’s specific circumstances, other lifestyle changes may be recommended as well. These lifestyle changes are associated with controllable risk factors for atherosclerosis and may include:
- Quitting smoking – Smoking is known to be a direct contributor to atherosclerosis. It also leads to higher blood pressure and increases the risk of blood clots and stroke.
- Reducing alcohol consumption – Excessive alcohol consumption may lead to stroke, high blood pressure, and other health problems. The American Heart Association recommends a maximum of 2 drinks a day for men and 1 drink a day for women.
- Lowering stress levels – Stress may lead to an increase in blood pressure and may aggravate cardiovascular conditions such as cardiac dysrhythmias.
- Losing weight – Obesity is defined as having a body mass index (BMI) over 30. Obesity may result in high blood pressure and elevated cholesterol levels. It may also increase an individual’s risk of a heart attack.
- Increasing physical activity – Physical activity may lead to a variety of health benefits including improved circulation, lower blood pressure, and lower cholesterol.
- Managing diabetes – Diabetes increases one’s risk of heart disease. This risk increases when diabetes is present in individuals who also have risk factors such as high blood pressure or obesity. Managing diabetes has a significant impact on improving overall health.
Care Provider Options When Recovering From An Angioplasty Or Atherectomy
Many people find they are able to care for themselves at home following an angioplasty or atherectomy. However, in some cases, an individual may find they need some help managing their health condition going forward. If a person needs some help with angioplasty and atherectomy recovery, some important questions to consider include:
- Does the individual live alone?
People who live with a spouse, adult child, or another caregiver may be able to stay in their home longer than people who live alone. Caregivers may be able to help with ADLs and IADLs and may be able to help the individual live safely at home.
- Is the individual able to cook for themselves?
Care for conditions that are treated by angioplasty or atherectomy often requires lifestyle changes. These changes may include a heart-healthy diet. If an individual is not able to cook for themselves and was eating food from restaurants or fast food establishments prior to the procedure, they may no longer be able to eat this way.
If the individual lives alone, other meal services may need to be considered. These may include paid services, community delivery services, or meal preparation done by a home care agency.
- Is the individual’s home safe?
All seniors are at a heightened risk of falling. For seniors managing a chronic condition, this risk may increase. Home hazards such as poor lighting, carpets, wiring, and large furniture may cause falls. An individual and their family should ensure the home environment is as safe as possible when deciding on care after a procedure.
- Does the individual have any cognitive or memory impairments?
Memory and cognitive impairments, such as dementia, may make it harder for an individual to manage their care needs and live safely in their own home independently. Home health care is usually not a 24-hour service and may not be the most appropriate choice for an individual who is in the later stages of dementia.
- Does the individual have any other health conditions that may need monitoring?
Conditions such as diabetes, high blood pressure, and high cholesterol may need additional monitoring for an individual who has had an angioplasty or atherectomy. These conditions may increase the risk of cardiovascular events such as a heart attack. Managing these conditions independently may be overwhelming for some people.
- Does the individual have chronic kidney disease?
If an individual has chronic kidney disease or is in end-stage renal disease (ESRD), they may have additional concerns to manage. They may need to eat a renal diet in addition to a heart-healthy diet. They may need to manage hemodialysis treatments several times a week. They may also have many medications to take.
- Is the individual able to manage their medications?
Medication management is sometimes overwhelming for seniors who are recovering from a procedure. It is important to take all medications exactly as prescribed to avoid potentially dangerous drug interactions and complications.
- Is the individual able to move around?
In some cases, PAD may cause pain in a person’s legs resulting in difficulty walking. If an individual is not able to climb stairs or move around independently, it may not be safe for them to live at home alone and they may need some assistance.
Home Health Care
If an individual would be safe in their own home following an angioplasty or atherectomy but requires some assistance with ADLs and IADLs, home health care may be a good option.
Home health care agencies send a team of professional providers to an individual’s home. These professionals will help the individual in their recovery and in implementing any lifestyle changes. Home health aides will be able to assist with ADLs. In some cases, they may also be able to assist with IADLs such as cleaning or meal preparation. Nurses will manage medications and any other conditions the individual may have.
Physical and occupational therapists may also come to the home. They may be able to help the individual set up an exercise plan so that they increase their physical strength and improve their heart health. A dietician might be part of the team and may help the individual with meal planning.
A home health care team may also be able to teach the individual and caregiver how to perform some tasks. They may teach the individual about their medications and how to take them on schedule or show a caregiver how to safely assist with ADLs. Knowing how to perform various tasks safely may help an individual remain in their home longer than they otherwise would have been able to without assistance.
A doctor may also recommend home health care for a person after an angioplasty or atherectomy. This may occur if the individual was required to remain in the hospital after the procedure. For example, if a patient has a sheath placed after an angioplasty, they may remain in the hospital until they have stopped taking blood thinners and the sheath is removed. In this case, a doctor may recommend home health care as part of the hospital discharge plan.
If the doctor certifies there is a need for home health care, Medicare will cover 100% of the costs for 21 days. The agency must be Medicare-certified, and the need must be part-time or less than 8 hours a day. Home health care that is needed for a longer period of time or non-skilled care that is needed such as homemaking is not covered by Medicare. For unskilled home care needs, an individual and their family will to need to pay for these costs through Medicaid, private pay, or some other means.
When an individual and their family are researching home health care agencies, they should ensure the agency they select best suits their needs. Different agencies provide different services or may specialize in the care of certain conditions. Choosing the most appropriate care agency is an important part of recovering from an angioplasty or atherectomy at home.
If an individual has had any complications after an angioplasty or atherectomy, they may not be able to return home right away. In addition, individuals who are unable to manage chronic conditions that resulted in needing an angioplasty or atherectomy may also benefit from inpatient care after discharge from the hospital.
If it is not safe for a person to return to their home right after the procedure, it may be appropriate to consider inpatient facilities such as skilled nursing facilities (SNFs) or assisted living facilities (ALFs). Stays at inpatient facilities may be short-term or long-term depending on the needs of the individual.
Skilled Nursing Facilities (SNFs)
A stay at an SNF is generally meant to be a short-term acute stay. A doctor may order a stay in an SNF if they feel certain goals need to be met before an individual is able to return home safely. For example, if a person with PAD has had difficulty walking due to leg pain, a doctor may want the person to meet a physical therapy goal such as climbing stairs before they are discharged home.
While in an SNF, physical and occupational therapists will work with an individual in their room or in therapy suites to help them with mobility and self-care. They may be shown how to walk with a walker or how to perform ADLs as independently as possible.
Certified nursing assistants will assist the person with ADLs and monitor vital signs. Nurses will manage medication and will provide any needed treatments. Dieticians will make sure all meals meet the requirements of a heart-healthy diet. This care will be overseen by a doctor who will assess the patient in the SNF.
While in the hospital, a doctor will inform the individual and their family if they do not feel it is safe for them to return home right after discharge. Hospital staff can usually able to provide a list of local SNF facilities with available beds. A family member may be able to visit several SNFs before the individual is discharged from the hospital to help with the selection process.
When an individual has had a qualifying hospital stay and there is a skilled need, Medicare will pay for 100% of the cost of an individual’s stay at an SNF for up to 20 days. On days 21 through 100, Medicare will pay a portion of the cost.
After 100 days in an SNF, Medicare will no longer cover the costs, and an individual and their family will be responsible for paying the entire cost of SNF care. They may need to consider Medicaid or other private pay options. Many SNF facilities have social workers, financial planners, or Medicaid specialists on staff who may be able to help individuals and their families with payment options.
Assisted Living Facilities
If an individual does not need the level of care provided by an SNF but is not able to live at home safely, they may want to consider an ALF. Unlike a stay in an SNF, an ALF is meant to be a long-term choice.
At an ALF, staff can help with medication management, ADLs, and some treatments. ALFs have different requirements regarding what an individual must be able to do for themselves in order to reside in the ALF. Care in an ALF usually includes meals, activities, housekeeping, laundry, and transportation.
ALFs generally do not have physical or occupational therapists on staff. However, some ALFs work with home health care facilities to provide these services when they are needed. In these cases, an ALF resident may be discharged back to the ALF with home health care services after a hospital stay, just as they would be if they were returning to a private home. Home health care staff will work with the individual in the ALF until any health care goals identified by the doctor are met.
Some communities have both ALFs and SNFs as part of their campus. These communities are known as continuing care retirement communities (CCRCs). In a CCRC, an individual will be able to move to different levels of care depending on their care needs. They may spend time in the SNF after a procedure and then move back to the ALF when goals are met. This setting allows residents to have a consistent home and may give them a sense of security.
Selecting A Care Provider After An Angioplasty Or Atherectomy
After an individual and their family have decided what level of care is needed, they will need to choose a care provider. Some important considerations to keep in mind when selecting a care provider after an angioplasty or atherectomy include:
- Does the care provider have experience caring for people who have had an angioplasty or atherectomy?
Different care providers may specialize in different conditions. It may be helpful to select a care provider that specializes in or has experience with cardiovascular conditions and related procedures.
- Is the staff trained and able to provide appropriate care?
All staff should be CPR-certified and the facility or agency should be able to provide records of their certifications. Staff should receive regular training on conditions such as PAD or coronary artery disease including best care practices for these conditions.
- Are heart-healthy meals served or provided?
The care provider should serve or be able to serve heart-healthy meals. In a facility, staff should ensure residents are served a diet according to their doctor’s recommendations. If a home health agency will be preparing meals, staff should be able to prepare meals to meet the individual’s specific needs.
- Is the staff friendly and welcoming?
If possible, an individual and their family should watch how staff interact with other clients, patients, or residents. This will help determine if the person would feel comfortable staying in the facility or with the home health care agency being in their home.
Effects Of An Angioplasty Or Atherectomy On Caregivers
After a procedure such as an angioplasty or atherectomy, caregivers may feel anxious or even overwhelmed. They may be anxious about the care changes required for the affected individual. The American Heart Association has resources available for caregivers of individuals with cardiovascular conditions.
Some steps caregivers may want to take to help a person who has had an angioplasty or atherectomy include:
- Assisting the person to follow their new lifestyle and joining them in some of the changes, such as heart-healthy eating.
- Learning about atherosclerosis and advocating for the person at appointments and with care provider staff.
- Assisting with medication management, attendance at medical appointments, and management of other conditions.
Financial Considerations After An Angioplasty Or Atherectomy
Long-term care for an individual will have costs associated with it, regardless of the type of care a person needs. Long-term care costs may also increase as an individual’s needs change.
Different types of care providers will accept different forms of payment. It is important to note that Medicare will not cover long-term custodial care such as care in an ALF.
More detailed information on the options for covering long-term care costs may be found here, however, some payment options include:
- Long-term care insurance
- Home equity loans
- Reverse mortgages
- Immediate annuities
- Veterans Aid and Attendance Benefit
Legal Considerations After An Angioplasty Or Atherectomy
While managing a chronic health condition, an individual may want or need to have legal protections and documents in place. Legal protections that cover long-term care and other health needs are known as advance healthcare directives and include:
- Power of attorney (POA) – A POA is a person entrusted to make financial decisions for an individual who needs care. This may allow an individual to focus on angioplasty and atherectomy recovery while the POA handles needed paperwork and planning. A POA is also important to have in place when a person becomes incapacitated and can no longer communicate their wishes or make their own decisions.
- A living will – This document identifies what medical care an individual wants to receive in the event they should encounter specific medical conditions and circumstances. A living will inform care providers what medical care a person would like when they are unable to communicate.
FAQs About Recovery After An Angioplasty Or Atherectomy
1. What are the risks of an angioplasty or atherectomy?
Angioplasty and atherectomy procedures are generally considered safe. However, as with all medical procedures, there are some potential risks such as reaction to the dye or numbing agents being used. Both angioplasty and atherectomy may result in:
- Heart rhythm problems or arrhythmias
- Bleeding or bruising at the site of the catheter insertion
- Heart attack during the procedure
Specific risks associated with an angioplasty include:
- Damage to surrounding blood vessels
- Scar tissue or clot formation in a stent
- Kidney damage
Specific risks associated with an atherectomy include:
- Obstruction of the affected artery, resulting in the need for emergency bypass surgery.
- Small pieces of plaque breaking off and damaging other arteries or heart tissue.
2. Are angioplasty procedures ever done at the same time as atherectomy procedures?
Yes. While an angioplasty is generally associated with coronary heart disease and an atherectomy is associated with PAD, they are sometimes used in conjunction with one another such as procedures using a newly-developed laser atherectomy technique with a balloon angioplasty. This technique removes plaque with a laser and then opens the artery with a balloon.
3. Why does cholesterol build up in the arteries?
Cholesterol combines with fats and calcium in the bloodstream and forms plaque. This substance causes the arteries to harden. This is why it is recommended to choose foods that are low in cholesterol and in saturated fat and to avoid foods that contain trans fats.
4. Will an angioplasty or atherectomy cure atherosclerosis?
No. An angioplasty or atherectomy may open a blocked or partially blocked artery and allow for better blood flow to the affected area. However, an individual will still need to make lifestyle changes and take medications recommended by their doctor to avoid further plaque buildup and the need for a repeat procedure.