Coronary angioplasty and stenting

What is coronary angioplasty?

Coronary angioplasty, also called percutaneous coronary intervention (PCI), is a minimally invasive procedure used to open coronary arteries that have become narrowed or blocked by atherosclerosis, the gradual build-up of fatty plaque in the artery wall. A tiny balloon is inflated at the site of the narrowing to press the plaque against the artery wall, and in almost all cases a stent, a small expandable metal mesh scaffold, is placed to hold the artery open permanently.

Angioplasty is one of the most commonly performed and most effective procedures in modern cardiology. It can be carried out as a planned (elective) treatment for stable angina, or as an emergency treatment during a heart attack, where opening the blocked artery quickly saves heart muscle and lives.

When is a stent recommended?

Not every narrowing needs a stent. The decision rests on your symptoms, the severity and location of the narrowing, and how much of your heart muscle it puts at risk. A stent is usually recommended when angina persists despite well-optimised medication, when testing shows a severe narrowing in a major vessel supplying a large territory of heart muscle, or urgently during a heart attack or unstable angina.

Before any decision, we establish the full picture with tests such as a CT coronary angiogram, a stress echocardiogram or an invasive coronary angiogram, during which pressure-wire measurements can confirm objectively whether a narrowing is truly restricting blood flow. This evidence-led approach protects you from unnecessary procedures.

What happens during the procedure?

Angioplasty is performed in a specialist catheter laboratory under local anaesthetic, most commonly through the radial artery at the wrist. You remain awake, and most people are surprised by how comfortable the procedure is.

• A thin, flexible tube (catheter) is guided from the wrist to the heart under X-ray guidance.
• Contrast dye outlines the coronary arteries and confirms the exact site and severity of the narrowing.
• A fine wire crosses the narrowing, and a balloon is inflated briefly to open the artery.
• A drug-eluting stent is deployed, releasing medication over several weeks that prevents scar tissue from re-narrowing the artery.

The procedure typically takes thirty to ninety minutes. Most planned cases go home the same day or after one night of observation.

Modern stents and bioresorbable scaffolds

Today's drug-eluting stents are the product of two decades of refinement, with excellent long-term safety and very low rates of re-narrowing. In selected younger patients, bioresorbable scaffolds, devices that do their job and then gradually dissolve over a few years, may be considered. We will explain honestly whether newer technology offers you a real advantage or simply a newer name.

Benefits and risks

The benefits are immediate and often transformative: relief of chest pain, better exercise capacity and, in heart attack and high-risk settings, improved survival. Serious complications are uncommon in experienced hands, but as with any invasive procedure there are small risks, including bleeding or bruising at the wrist, allergy to the contrast dye, and rarer risks of heart attack, stroke or the need for emergency surgery. Your individual risk depends on your anatomy and overall health, and we will talk this through clearly and unhurriedly before you decide.

Recovery and life after a stent

Recovery from a wrist-approach angioplasty is quick. Most people are walking within hours, back to desk work within a couple of days and back to full activity within a week. You will take dual antiplatelet therapy, aspirin plus a second blood-thinning tablet, for a period after the procedure to protect the stent while it heals into the artery wall; do not stop these tablets without cardiology advice.

A stent treats the narrowing, not the disease that caused it. The greatest long-term gains come from what happens next: statin therapy and cholesterol targets, blood pressure control, stopping smoking, and a structured return to exercise. This is where an integrative approach genuinely changes outcomes, and we will build a prevention plan that protects every artery, not just the one that was stented.

Frequently asked questions

How long does a stent last?

A stent is permanent. Within a few months it becomes fully incorporated into the artery wall, and modern drug-eluting stents keep the treated segment open in the long term for the great majority of patients. Re-narrowing within the stent now affects only a small minority, and if it does occur it can usually be treated with a further keyhole procedure.

Will I be able to feel the stent?

No. A stent has no moving parts and generates no sensation whatsoever. It does not set off airport scanners, and modern stents are safe with MRI scanning, something we will document for you in your clinic letter.

Is angioplasty the same as bypass surgery?

No. Angioplasty opens the artery from the inside through a keyhole approach, while coronary artery bypass surgery creates new routes around blockages through open-heart surgery. Each has its place: for more extensive disease, particularly involving several vessels or in people with diabetes, surgery can offer better long-term results. Where the choice is finely balanced, your case is discussed by a heart team of cardiologists and surgeons, and we will make sure you understand the reasoning behind every recommendation.

When can I fly after angioplasty?

After a straightforward planned angioplasty most people can fly within a few days; after a heart attack we generally advise waiting longer, and we will give you personal guidance based on your recovery and destination before you travel.

What happens if my symptoms return?

Recurrent chest tightness after a stent always deserves prompt review. It may reflect re-narrowing, a new narrowing elsewhere, or a non-cardiac cause, and the right tests, often a stress echocardiogram or repeat CT imaging, distinguish these quickly. As an existing patient you will have rapid access to Dr Assomull whenever anything changes.

Why choose Dr Assomull?

Dr Assomull spent ten years practising as an interventional cardiologist before focusing on integrative cardiology. He has performed and supervised these procedures at the highest level, and that first-hand experience works in your favour twice over: you receive a genuinely informed opinion on whether a stent is right for you, and if it is, referral into a trusted network of specialist London interventional operators, with your preparation, aftercare and long-term prevention personally led by Dr Assomull at 68 Harley Street.

If angina is limiting your life, or a scan has shown a narrowing and you want a clear, honest plan, book a consultation. Appointments are usually available within one working day.