Coronary angioplasty and stents (PCI)

What is a stent? What is angioplasty? 

Angioplasty is a common, generally painless procedure that is used to open up narrowed or blocked arteries (the vessels that supply blood to your heart muscle). You’ll be given local anaesthetic at the start of the procedure. A narrow flexible tube (called a catheter) is put into your wrist or groin (the area of your hip between your stomach and thigh) and pushed up to the coronary artery. A small balloon at the end of the tube is blown up to widen the narrowed part of your artery.

Sometimes if the artery is so narrow that the balloon cannot pass through it, a tiny drill might also be used (this is called rotablation) to chip away at the fatty deposits and gradually widen the narrowing.

Most of the time angioplasty is combined with putting in a small metal mesh tube (called a stent). When the balloon is deflated and the catheter tube and balloon are removed, the stent stays in place, acting like a scaffold to keep your artery open.

You may hear your doctor call coronary angioplasty with stenting a PCI. PCI is a medical abbreviation (name) for percutaneous coronary intervention. 

Why would you need a stent in your heart?

Your coronary arteries play a vital role in keeping your heart healthy. But in some people, fatty deposits can build up and narrow or block the coronary arteries (this is called atherosclerosis, which can cause coronary heart disease). If not enough blood is flowing through the coronary arteries, this can lead to angina or a heart attack.

Coronary angioplasty widens narrowed coronary arteries. This procedure is used:

• in severe cases of angina, where medicine is not working
• as an emergency treatment for people during a heart attack.

Angioplasty is not for everyone. Depending on your health and individual heart conditions, you may be advised that you need coronary artery bypass surgery.

• Angioplasty vs. bypass: discover the differences

How successful is angioplasty and stenting?

In most cases coronary angioplasty and stenting improves the blood flow through the treated artery. Many people find their symptoms get better and they’re able to do more.

Sometimes the artery can become narrowed again (restenosis), causing angina symptoms. But advances in stent technology mean that the risk of this happening is getting lower. Many people are now symptom-free for a long time.

You can improve your chances of long-term success by making healthy lifestyle changes, including:

• eating more healthily
• getting more physically active
• giving up smoking
• cutting down on alcohol
• taking prescribed medicine.

A small number of people may have coronary angioplasty complications. The risk varies depending on your overall health and your individual heart condition.

What are the benefits of coronary angioplasty and stents?

The benefits and risks of angioplasty and stenting are different for everyone and depend on the seriousness of your heart disease, your age, and your overall health. The benefits of angioplasty and stenting can include:

• relief from or less pain
• relief from or less breathlessness
• relief from or less tiredness
• more energy – with better blood flow to your heart, everyday tasks and physical activities become easier and more enjoyable
• better mood and mental health
• a reduced risk of heart attack and stroke.

Have a chat with your doctor about the benefits and possible risks of having an angioplasty and make sure to mention any concerns you may have.

What are the risks of coronary angioplasty and stents?

All types of medical procedures come with risk. With angioplasty and stenting, common complications can include:

• bleeding, bruising, or an infection where the catheter tube is put into the body (in the wrist or groin)
• blood clots – these can form within stents even after the procedure, so it’s important to take any prescribed medicine such as aspirin and anti-platelet drugs such as clopidogrel.

The risk of major complications during an angioplasty is usually less than one percent. Rare risks of angioplasty and stenting include:

• complications after or during the procedure, such as a heart attack or stroke
• an allergic reaction to the contrast dye used during the procedure
• very rarely damage to the coronary artery during the procedure.

If you’re worried or have more questions, we encourage you to ask your doctor. They’ll be able to answer any questions specific to you and your procedure. You can also download or order our booklet, Understanding coronary angioplasty.

What happens during an angioplasty?

An angioplasty normally takes between 30 minutes and 2 hours, although it can take longer in some cases. You’ll usually be awake during the procedure but you should not feel any pain.

• You’ll be asked to not eat or drink for 4 to 6 hours before the angioplasty.
• You'll change into your gown and will be asked to remove any jewellery that might get in the way.
• You will usually be awake and lying on your back for the angioplasty. You may be given a sedative (a medicine) to help you relax – talk to your doctor about this if you are nervous.
• You’ll be given a local anaesthetic injection in your wrist or groin. A thin tube (the catheter) is then passed into your artery through the numbed area.
• A special dye (called a contrast dye) is injected into the tube so that your coronary arteries can be seen on an X-ray screen. This part is called an angiogram. It’s normal to feel a flushing sensation when the dye enters your bloodstream – for some people, this might feel as though they are peeing themselves.
• During your procedure, you’ll be attached to a heart monitor that records your heart rate and rhythm and you’ll have a clip measuring your oxygen levels on your finger. You’ll also have your blood pressure checked regularly.
• Many people experience a feeling of pressure during the angioplasty. If you feel unwell, or have chest pain at any time, tell your doctor.
• After the procedure, the thin tube is removed and there may be a small amount of bleeding when it is taken out.
• You’ll then come back to the recovery room where you’ll be monitored by nurses.
• If you had the tube put into your wrist, you’ll be sat upright and if everything is okay, you could be ready to leave the hospital as little as 2 hours later.
• If you had the tube put into your groin, you’ll need to lie on your back at first and stay longer recovering in hospital, around 5 to 6 hours.
• If you’ve come in for an emergency angioplasty – for example, following a heart attack – you may be kept overnight.

Your angioplasty and stent procedure will take place in a cath lab – a sterile room in the hospital that looks like an operation room.

How to prepare for angioplasty and stents

If your doctor recommends having an angioplasty and stents, ask them any questions you may have about it. You can then begin to prepare for the procedure, which can help reduce any stress and anxiety you may feel. Preparation may include:

• arranging for someone to look after you during recovery
• organising transport to and from the hospital
• organising time off from work
• continuing to take medication
• eating healthy foods (use our recipe finder for tasty and heart-healthy ideas)
• managing your weight
• looking after your mental health
• staying active.

Being as prepared as possible before surgery can help speed up the time it takes to recover. It can also help you feel less worried. Read our 5 top tips on getting in shape before a procedure.

Heart stent recovery: what happens after angioplasty?

Most people can go home the same day or the next day, but if you’ve had an emergency angioplasty after a heart attack it’s likely you’ll need to stay in hospital for longer.

When you get home, check the area where the catheter tube was put in. Expect to have some bruising and tenderness, but you should contact your doctor if:

you get any pain, redness or swelling.

• the bruising worsens
• you develop a temperature.

Before you leave hospital, someone will have a chat with you about your recovery and what you can and cannot do. It’s normal to feel tired afterwards but most people find that they’re back to normal after a few days. However, if you’ve also had a heart attack, it will take longer to recover.

If you’ve had a stent fitted, you’ll be given medicines to help reduce the risk of blood clots forming in and around the stent. They may include:

• aspirin
• anti-platelet medication such as clopidogrel, ticagrelor or prasugrel.

You may also be asked to take cholesterol-lowering drugs such as statins.

If you’ve had an emergency angioplasty, you may be invited to go on a cardiac rehab programme, a course of exercise and information sessions that help you to recover as quickly as possible.

It can feel worrying to have a stent fitted, especially if you’ve had an emergency angioplasty. But many people find recovering from angioplasty is a positive moment to make healthy lifestyle changes that will improve your health and everyday life.

Before you leave hospital, someone will have a chat with you about your recovery and what you can and cannot do. It’s normal to feel tired afterwards but most people find that they’re back to normal after a few days. However, if you’ve also had a heart attack, it will take longer to recover.

Is chest pain normal after a stent placement?

It is possible that you are experiencing discomfort because the stent is taking time to settle. This is quite normal, but you may want to make an appointment to see your GP and check if they want to review your medicines.

A stent will help blood flow in the artery where it has been fitted and will usually improve symptoms of angina. But sometimes other heart arteries can be narrowed too, so you may still have some angina symptoms.

If you get chest pain, stop and rest, and take your GTN if you've been prescribed it. The pain should go away within five minutes. If it does not, take your GTN again.

If the pain has not gone away within five minutes of taking the second dose of GTN, call 999 immediately. You could be having a heart attack.

• Learn more about heart attacks.

What to avoid after a stent

How long should you rest after a stent placement?

If you’ve had a planned stent placement, it’s best to avoid doing any demanding activities, such as heavy lifting, for a week or so afterwards.

You may need longer if you’ve had an emergency angioplasty or a heart attack – chat with your doctor to find out what’s right for you.

• Get tips on rest and recovery

When can you return to work after a stent?

If you’ve had a planned angioplasty with no complications you may be able to return to work within a few days, depending on the type of work you do.

If you’ve had an emergency angioplasty or a heart attack you may need to take a few weeks off.

You should chat about your own situation with your doctor or nurse.

• Find out more about taking time off work if you’ve got a heart condition

How long after a stent can you drive?

You should not drive for at least a week after having an angioplasty and stent - longer if you also had a heart attack.

Check with your doctor to see how soon you can drive after having a heart attack and stent. You may need to wait up to 4 weeks.

If you drive a heavy vehicle for a living, such as a lorry or a bus, you must tell the Driver and Vehicle Licensing Agency (DVLA) that you've had a coronary angioplasty. They'll arrange further testing before you can return to work.

• Find out if you’ll need to tell the DVLA about your condition

How soon can you fly after having a stent fitted?

It’s not generally recommended to take a long-haul flight soon after having a stent fitted but if you are generally well, and have talked through your situation with your doctor, you may be fit to fly:

• 2 days after a planned, uncomplicated angioplasty
• 3 to 10 days after an uncomplicated heart attack
• 4 to 6 weeks after a complicated or major heart attack.

Stents are not affected by security systems at airports or MRI scans.

• Find out about travel insurance and heart conditions

Can you have sex after stents in your heart?

It's normal to feel anxious about having sex if you have a heart condition. But there's no reason why you cannot continue to enjoy a healthy sex life, once you've recovered from having an angioplasty and stent fitted.

In fact, some people who were previously affected by angina, find they are able to have a more active sex life as they have more energy after an angioplasty and stent.

Your doctor will have talked to lots of other people about sex. You will not be the first or the last person to ask. It may not be easy to talk about at first, but most people say they feel a lot better afterwards and are glad they did.

• Get tips to reduce anxiety about sex when you have a heart condition

Get support

As the day of your angioplasty and stent fitting gets closer, you may feel anxious, afraid, angry, worried about the future, or glad that you’re about to have treatment.

It’s natural to have these feelings and you may continue to have them after the procedure. It’s important to talk about your feelings with your partner, a friend, relative or healthcare professional.

You can also get support by:

• Chatting with online, emailing, or calling our expert cardiac nurses.
• Chatting with your GP about getting talking therapy, or, if you’re in England, you can refer yourself for therapy through Improving Access to Psychological Therapies (IAPT).
• Joining a support group or online community.
• Signing up to our Heart Matters magazine and email newsletter, packed with health and recovery tips.
• Joining a Heart Support Group near you.