Angioplasty & Stent Placement Treatment Cost in India

?If you have coronary artery disease, the arteries in your heart are narrowed or blocked by a sticky material called plaque. Angioplasty is a procedure to restore blood flow through the artery. The doctor runs a thin tube called ‘catheter’ in the arm or groin through a blood vessel to the origin of the artery. At the end of the tube is a small balloon. The doctor inflates the balloon when the pipe is in contact and pushes the plaque against the artery wall. The heart is widened and blood flow is restored. A small wire mesh tube known as a stent is also placed permanently in the affected region to help and keep it open. The stents can be covered or bare depending on the requirement.

Coronary arteries are responsible for blood supply, nutrients and oxygen to the heart to enable it to function properly. Due to improper lifestyle like consumption of alcohol or fat laden food, a substance called plaque builds up in the walls of the arteries causing them to thicken and harden; a condition known as atherosclerosis. They considerably narrow the segment of the vessel through which blood will flow causing pain in the chest and in worse condition can lead to heart attack.

In such cases, the doctor can suggest a coronary angioplasty to help restore the supply of blood to the heart and bring down the risk of suffering from a heart attack considerably. But there are certain conditions based on which doctor will recommend a patient to undergo an angioplasty and they are listed below:

• The health of heart: whether the heart is fit to undergo the procedure, medical history whether any other surgery was done or not
• The intensity of the symptoms; if the symptoms are mild then the doctor can consider medication instead of surgery.
• Blood flow rate: if more than 50% blockage has been detected, or if the vessel is a branch vessel of a vessel connected and very close to the heart
• Presence of any other medical conditions that can complicate the procedure
• A blockage location will determine the kind of technique or blood vessel graft that must be used to treat this condition.

You will be transported to a recovery room or the coronary care unit after angioplasty. You will be carefully monitored for your heart rate, pulse, and blood pressure. At the catheter insertion site, you will have a large bandage or compression tool to avoid bleeding. Many patients can resume normal activities once they are back in their home. But ideally for a week some strenuous activities must be avoided during the heart stent recovery time. If stent has been incorporated, then for a month blood thinners have to be taken like clopidogref along with acetylsalicylic acid to prevent blood from clotting on the metal stent. The treatment has to be continued as long as a year if required. To prevent any infection in the heart (endocarditis) the patient may be required to keep plans of any dental work on hold for several months since oral bacterial infection can pose a serious threat.

Patients should also check for signs like excessive bleeding, pain or swelling at the incision site. Change in temperature or color of the leg or arm that was used for accessing the vessel, general fatigue and shortness of breath or pain in chest should be immediately notified to the healthcare provider.

Your doctor will examine your medical history and do a physical exam before a scheduled angioplasty procedure. You may need to go through routine testing before the operation, including X-ray of the chest, electrocardiogram, and blood testing. Your doctor will also perform a coronary angiogram (CA) imaging test to check if your heart's arteries are blocked and if angioplasty is possible.

If the surgeon finds that the coronary angiogram is blocked, angioplasty and stenting may be determined immediately after the angiogram because the heart is still catheterized.

In a special operating room called a cardiac-catheterization laboratory, Angioplasty is carried out by a cardiologist and a team of specialized cardiovascular nurses and technicians. A specially trained surgeon in a suite that has been designed specifically for conducting minimally invasive procedures like angioplasty and vascular stenting, will perform such a procedure.

The patient will be placed in the examining table and will be connected to monitors where blood pressure, heart rate and pulse of the whole procedure will be tracked for the patient.

An intravenous line or IV will be started by the nurse on the vein of the hand or arm for the administration of medication. General anesthesia may be employed where the patient will have no sensation throughout the surgical procedure.

The location of the body for the insertion of the catheter will be sterilized and covered and the physician can numb the region further with a local anesthetic. Now a small incision will be made at the site of entry.

A sheath is inserted into a vein or artery depending on whether the vessel that has constricted is a vein or an artery.

Slowly the catheter will make its way with the help of guided X-Rays to reach the site of the blockage. After the catheter has reached the desired location, a contrast material or dye will be injected into the vessel to get an angiogram done of the blocked vessel and clearly locate the site of the blockage.

Again with the help of X-Ray guidance a guidewire will be made to reach the blocked location which will be further followed by a catheter having a deflated balloon at its tip. Once the balloon reaches the narrowed region, it will be inflated for a short span of time. The same site can undergo repeated inflation, or the balloon can be moved to other locations where narrowing has occurred.

It is important to understand the improvement in blood flow after the above for which additional X-Rays are taken. If the physician is satisfied with the result, then the catheter and the guidewire will be gradually removed from the blood vessel.

In many surgeries, a stent is placed in the narrowed segment which is made of a flexible tube made from plastic or a wire mesh which can help in supporting the artery walls that have been damaged. Stents that are used are self-expandable, where they open automatically after deployment or can be balloon-expandable which means it needs the balloon to open. The balloon-expandable stents are mostly located over a balloon-tipped catheter so that when the balloon is inflated it propels the stent in place against the walls of the artery.  But on the deflation of the balloon, the stent remains in place permanently behaving like the artery’s frame.

Self-expandable stents are much easier to work with but may require an additional angioplasty with the balloon to get the desired opening of the affected vessel.

Stent-grafts or covered stent has the extra advantage over bare ones and are now growing popular gradually.

Nowadays drug-coated stents are available which has been approved by the FDA. These stents have medication coated on them and they are slowly released in the vessel and they help prevent the vessels from narrowing in the future, a condition called restenosis.

In directional atherectomy, a miniature rotating blade is employed to cut the fatty deposit and remove it totally from the vessel and the body of the patient.

An excimer laser angioplasty laser is used for the removal of the blockage in the vessel. The balloon is used to make the space more in the blocked zone.

A diamond-studded drill bit is used for pulverizing the tough blockage in rotational atherectomy.

Irradiation of the section of the artery after balloon angioplasty is done for preventing restenosis. This procedure is called intracoronary radiation.

The catheter is removed after the procedure and further pressure will be exerted to prevent any bleeding from the site. Without sutures, the opening in the skin is covered.

For several hours the patient may be required to lie on the bed with legs straight. With the help of a closure device, the physician may seal the small hole made in the artery. This aids in the movement of the patient quickly.

After the procedure, the patient is shifted to the recovery room and the intravenous line is removed.

The duration of the procedure is dependent on the time spent on the evaluation of the vascular system before any therapy is conducted.

It is very important to understand that before going for surgery other methods should be discussed with the healthcare provider. Alternatives to angioplasty can be medication and improvement in lifestyle to bring down the risk of angina or a heart attack.

Apart from medication, there is also a technique called the chelation therapy which aims to pull the heavy metals from the blood that is causing the thickening of the arteries. A water-soluble amino acid complex called EDTA (Ethylenediaminetetraacetic acid) is the solution that is injected in the body to bring about detoxification of the blood.

You will not be allowed to take any solid food for 8 hours prior to the operation.

If you are asked to discontinue taking your diabetic medicine, you must strictly abide by the instructions.

Approved medications that patients must have should be taken with only small sips of water.

The patient must strictly adhere to all the prescriptions and instructions given by the doctor.

Heart stent cost in India starts from $400-500 The average price of angioplasty surgery in India is almost around $3800. It is quite cheap in India as compared to other countries.