Coronary angioplasty & cardiac stenting : Medical expertise & prices in Turkey

What is coronary angioplasty?

Also known as percutaneous coronary intervention (PCI),coronary angioplasty is a minimally invasive cardiac procedure designed to restore blood flow in narrowed or blocked coronary arteries. These obstructions are usually caused by atherosclerosis, which is the buildup of fatty deposits (cholesterol plaques) on the inner walls of the arteries.

During the procedure, a small catheter with a balloon is inserted through an artery, typically at the wrist (radial artery) or in the groin (femoral artery). Once the catheter is positioned at the site of the obstruction, the balloon is inflated to crush the plaque and restore blood flow. In most cases, a stent (a small, expandable metal coil) is inserted to keep the artery open long term.

Angioplasty is a cardiac catheterization technique. It is guided by X-ray imaging and requires the injection of a contrast medium to visualize the arteries in real time.

When is coronary angioplasty required?

Coronary arteries transport oxygen-rich blood to the heart muscle, or myocardium. The heart no longer receives sufficient oxygen when these arteries become narrowed or blocked. This can lead to serious, sometimes life-threatening, complications.

This is often due to atherosclerosis, a degenerative disease caused by the buildup of cholesterol plaque on the inner walls of the arteries. Over time, these plaques reduce or block blood flow, which prevents the heart from functioning properly.

If left untreated, the lack of oxygen can result in the deterioration of part of the heart muscle, leading to a myocardial infarction.

This is when coronary angioplasty becomes essential. It is generally indicated for:

• People with stable coronary artery disease, such as angina pectoris, which causes chest pain due to an insufficient blood supply to the heart.
• Patients who have already suffered a myocardial infarction and require restoration of blood flow to limit further damage.
• Those with severe stenosis (narrowing of an artery),as detected by specialized imaging tests, such as a coronary computed tomography scan or coronary angiography.
• In cardiac emergencies, where total obstruction of the coronary arteries threatens the patient's life.

If you experience any of the following symptoms, consult a cardiologist immediately:

• Pain or tightness in the chest, sometimes comparable to a burning sensation.
• Unusual shortness of breath, even with light exertion.
• Unexplained fatigue with exertion.
• Pain radiating to the left arm, back, or jaw.

When in doubt, seeking prompt medical advice is crucial to prevent serious complications.

Stages of coronary angioplasty in Turkey

Preparing for a coronary angioplasty involves undergoing a series of tests and analyses and following the cardiologist's instructions. Patients must not eat for eight hours before the procedure.

On the day of the procedure, the medical team prepares the operating room and ensures the patient's comfort. The procedure generally lasts around two hours and is performed under local anesthesia, meaning the patient remains awake but feels no pain.

The cardiologist inserts a very fine catheter into the affected artery, typically through an access port in the wrist or groin. The catheter has a balloon that is positioned precisely at the narrowed or blocked area. Once in place, the balloon is gently inflated to a suitable diameter (between two and five millimeters) to crush the atherosclerotic plaque, widen the artery, and restore normal blood flow. Then, the balloon is deflated and removed.

Intracoronary imaging technologies, such as OCT (optical coherence tomography) or IVUS (intravascular ultrasound),are often used to optimize the precision of the procedure. These tools enable the cardiologist to examine the interior of the artery in great detail, evaluate the extent of the plaque, and adjust the placement of balloons and stents.

In some cases, surgery involves placing a coronary stent to protect the artery and prevent blockage. After the procedure, the patient is monitored for a few hours and discharged the following day.

Risks of percutaneous transluminal dilatation

As with any medical procedure, coronary angioplasty carries risks and potential complications that are important to be aware of.

The most common risks include:

• Pain or local discomfort at the catheter insertion site (usually the wrist or groin),which typically resolves quickly with proper care.
• Bleeding, hematomas, and, more rarely, lesions of the artery at the insertion site. These complications are closely monitored and effectively treated with a strict postoperative care protocol.
• Although very rare, infections are prevented by rigorous sterilization and medical follow-up.
• Fainting, weakness, and low-grade fever can occur after the procedure and are quickly addressed by the medical team.
• A heart attack (acute infarction) is a serious but rare complication that can occur during or after the procedure. Immediate treatment at a specialized facility significantly reduces the risk of complications.

Restenosis, or the progressive narrowing of the treated artery, can occur in certain cases, generally in the months following the procedure. When this happens, further angioplasty with stenting or coronary artery bypass grafting may be required.

Follow-up and convalescence after coronary angioplasty in Turkey

Our partner clinics in Turkey are equipped with the latest interventional cardiology technologies and have highly specialized medical teams for coronary treatment. Each patient receives personalized care and rigorous monitoring before, during, and after the procedure.

Following angioplasty, most patients are admitted for an overnight stay to ensure optimal clinical follow-up. The medical team carefully monitors the patient's condition and any immediate side effects. In most cases, patients are safely discharged home or to a hotel the following morning.

When stents are fitted, combined antiplatelet treatment (usually aspirin and clopidogrel) is prescribed to prevent clots from forming on the stents. This dual therapy is essential for the first few months, after which it is reduced at the recommendation of the attending cardiologist. Regular medical follow-up is recommended to adjust the treatment as your health evolves.

Recovery from angioplasty is generally rapid. Depending on your condition, you can gradually resume daily activities, including moderate physical activity, in the days following the procedure. Whether you can return to work depends on the type of job you have and your overall health. Your doctor will tell you exactly when and how you can safely return to your normal routine.

Alternatives to coronary angioplasty in Turkey

Coronary angioplasty is not the best option for every patient with coronary artery disease. Several alternatives exist that are adapted to the severity of the disease and the medical profile of each patient.

Coronary artery bypass grafting (CABG)

This surgical procedure involves creating a bypass around blocked arteries using grafts taken from the patient's vessels. CABG is recommended for patients with extensive coronary disease and several blocked arteries, or when angioplasty is not possible or effective.

Optimal medical treatment

For certain patients with stable coronary disease, drug therapy may be preferred. This includes antiplatelet agents, statins to control cholesterol, beta-blockers, and other drugs to reduce cardiac workload and prevent complications.

Revascularization using advanced endovascular techniques

In addition to conventional angioplasty, innovative techniques such as atherectomy (the mechanical removal of plaque) and bioabsorbable stenting are available at certain specialized centers. The option chosen depends on the nature and location of the lesions.

Lifestyle modifications and cardiac rehabilitation

Comprehensive management includes cardiac rehabilitation programs, a healthy diet, and supervised physical activity to improve cardiovascular health and reduce future risks.