Coronary angioplasty and cardiac stenting in Turkey: procedure and prices

What is coronary angioplasty?

Also known as percutaneous coronary intervention (PCI),coronary angioplasty is a minimally invasive cardiac procedure that restores 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 compress the plaque and restore blood flow. In most cases, a stent (a small, expandable metal mesh tube) is placed to keep the artery open long term. Many current stents release a drug that lowers the risk of restenosis, the renarrowing of the artery.

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

When is coronary angioplasty required?

Coronary arteries carry oxygen-rich blood to the heart muscle (myocardium). When they become narrowed or blocked by atherosclerotic plaques, the heart receives too little oxygen. This causes angina (chest pain or pressure),shortness of breath or unusual fatigue on exertion. Without treatment, it can damage part of the heart muscle and lead to a myocardial infarction.

Coronary angioplasty is indicated in the following situations:

• Stable angina that persists despite medical treatment, or unstable angina.
• Acute myocardial infarction: emergency intervention within the first hours.
• Myocardial ischemia shown by functional tests.
• Significant stenosis (above 70%) seen on coronary angiography.

It is also used to treat restenosis (renarrowing of a lesion that was already treated) and some cases of multi-vessel disease. The decision depends on the severity of the symptoms, the extent of the disease, ventricular function and the risk-benefit assessment made by the interventional cardiologist.

See a cardiologist promptly if you have:

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

If chest pain is prolonged or getting worse, call emergency services immediately.

Stages of coronary angioplasty in Turkey

Step 1: preoperative preparation. The patient has blood tests, an electrocardiogram and an echocardiogram, and fasts for about 8 hours. The cardiologist says which medications are continued or adjusted; never stop an anticoagulant on your own. In the catheterization room, continuous monitoring is set up (ECG, blood pressure, oximetry).

Step 2: vascular access and diagnostic catheterization. Under local anesthesia, an artery (radial or femoral) is punctured and an introducer sheath is placed. A diagnostic catheter is advanced to the coronary arteries, then iodinated contrast is injected to show the lesions in real time (coronary angiography).

Step 3: angioplasty and stent placement. A guide catheter with a deflated balloon is positioned at the lesion. The balloon is inflated at controlled pressure for a few seconds, then removed. The stent is then placed if needed using a dedicated catheter. A final angiogram checks the position and expansion of the stent. Intracoronary imaging (OCT or IVUS) may be used to refine the placement.

Step 4: closure and immediate monitoring. The catheters are removed and the puncture site is closed by manual compression or a closure device. The patient stays in a monitoring room for several hours. Discharge usually takes place within 24 to 48 hours if there are no complications.

Risks of percutaneous transluminal dilatation

As with any invasive procedure, coronary angioplasty carries risks that vary with the complexity of the lesion, the patient's profile and the experience of the team. The most common are local: hematoma or bleeding at the puncture site, superficial infection and pseudoaneurysm. Less often, dissection or perforation of the coronary artery, acute stent thrombosis, embolization, a heart attack during the procedure, stroke, temporary arrhythmias, an allergic reaction to the iodinated contrast and kidney injury from the contrast in people with existing kidney failure can occur.

In the longer term, restenosis inside the stent can appear, more often with bare-metal stents than with drug-eluting stents, and, rarely, late stent thrombosis. The risk is higher in urgent procedures and in patients with severe ventricular dysfunction. If restenosis occurs, a new angioplasty or coronary artery bypass grafting may be required. A complete cardiology assessment before the procedure helps estimate the risk in your case.

Follow-up and convalescence after coronary angioplasty in Turkey

Our partner clinics have digital angiography and, depending on the center, intravascular ultrasound (IVUS) or optical coherence tomography (OCT) to optimize stent placement.

Immediate follow-up (first 24 to 48 hours)

Continuous monitoring takes place in the coronary unit: repeated electrocardiograms, troponin tests to rule out a heart attack related to the procedure, and checks of blood pressure and heart rate. The team explains how to take your antiplatelet medication.

Treatment after stent placement

Dual antiplatelet treatment, usually aspirin and clopidogrel, is prescribed to prevent clots from forming on the stent. It usually lasts 6 to 12 months depending on the type of stent and the clinical situation, after which aspirin is often continued. Never stop this treatment on your own: the decision belongs to your cardiologist.

Medium- and long-term follow-up

Once back in your country, your regular cardiologist resumes check-ups, usually every 3 to 6 months during the first year, with functional tests if symptoms return. Control of blood pressure, cholesterol and blood sugar is essential, and supervised cardiac rehabilitation is often recommended.

Recovery

• Within 24 to 48 hours: monitoring in hospital, gradual return to mobility.
• Within 5 to 7 days: return to daily activities.
• About one week: sedentary work can usually resume, as advised by the cardiologist.
• Around 2 weeks: moderate physical activity such as walking.
• 4 to 6 weeks: intense exercise or competitive sports, with the cardiologist's approval.

The puncture scar is minimal. Your doctor assesses your recovery and tells you when to resume your activities.

Alternatives to coronary angioplasty in Turkey

Coronary angioplasty is not the only option for coronary artery disease. The choice depends on coronary anatomy, the severity of the disease, ventricular function, age and associated conditions.

Optimal medical treatment

Indicated in mild stable angina, non-significant coronary lesions or when the patient declines intervention. It includes antiplatelet agents, statins, beta-blockers and nitrates. It controls symptoms but does not open the narrowed artery.

Coronary artery bypass grafting (CABG)

This open-heart surgery creates a bypass around the blocked artery using grafts taken from the patient's other vessels. CABG is the usual option when several arteries are affected, when lesions cannot be treated by catheter, in severe ventricular dysfunction, or in diabetes combined with multi-vessel disease.

Hybrid procedure

It combines a bypass of the left anterior descending artery (surgery) with angioplasty of the other arteries (catheterization),in selected cases of complex multi-vessel disease.

Lifestyle and cardiac rehabilitation

Whatever the option, management includes an appropriate diet, supervised physical activity, quitting smoking and a cardiac rehabilitation program to reduce future risks.

The final decision is made jointly (Heart Team) by the interventional cardiologist, the cardiac surgeon, the clinical cardiologist and you, after the risks and benefits of each option have been explained.