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At a glance
- Angioplasty (PCI) opens narrowed or blocked coronary arteries, usually placing a stent to keep them open.
- It treats coronary artery disease and is used urgently during many heart attacks.
- It is a minimally invasive procedure done through a wrist or groin artery.
- Medication and lifestyle changes remain essential afterwards.
What it treats
Coronary arteries can narrow with fatty plaque, reducing blood flow to the heart and causing angina or, if a clot blocks the artery, a heart attack. Angioplasty restores blood flow — as an emergency during a heart attack, or as a planned procedure for angina not controlled by medication.
What angioplasty and a stent are
Coronary angioplasty, also called percutaneous coronary intervention (PCI), is a procedure to open a coronary artery that has become narrowed or blocked. A small balloon is guided to the narrowing and inflated to press the fatty plaque outward and widen the channel, restoring blood flow to the heart muscle. In almost all cases a stent — a small, expandable mesh tube — is then placed at the site and left permanently in place to scaffold the artery and stop it from springing back or collapsing. Most stents used today are drug-coated, releasing medicine slowly to reduce the chance of the artery re-narrowing as it heals.
Why and when it is done
Angioplasty is carried out in two main situations. The first is angina — chest tightness, pressure or breathlessness on exertion — that is limiting daily life despite medicines, where opening the narrowed artery can ease symptoms. The second is an emergency during a heart attack, when a blocked artery is starving part of the heart muscle of blood. Here, opening the artery quickly is the priority, because the longer the blockage lasts, the more heart muscle is lost — the reason cardiologists speak of “time is muscle”. A cardiologist decides whether the procedure is appropriate after reviewing your symptoms, tests and the pattern of narrowing seen on an angiogram.
Alternatives to consider
Angioplasty is one option among several, and it is not always the best fit. For milder or stable disease, medicines and lifestyle changes — controlling blood pressure, cholesterol and diabetes, stopping smoking and becoming more active — may manage symptoms and lower risk well without any procedure. For more extensive disease, disease affecting several arteries, or certain patterns of blockage (particularly in people with diabetes), coronary bypass surgery may give better long-term results. A heart team weighs these choices with you.
How it is done
Angioplasty is usually done while you are awake but relaxed with sedation, using local anaesthetic at the entry point. A thin, flexible tube (a catheter) is passed from an artery in the wrist or groin and threaded gently up to the heart arteries. Contrast dye is injected and X-ray images guide the cardiologist to the narrowing (a coronary angiogram maps the blockages). A balloon is inflated to widen the artery, and a stent is expanded into place to hold it open. You may feel brief pressure or a flutter, but the artery walls themselves have no pain sensation. The procedure often takes under an hour, though complex blockages take longer.
Preparing for the procedure
Your team will review your medicines and tell you which to continue and which to pause, and you may be asked not to eat for a few hours beforehand. Let them know about kidney problems, diabetes, bleeding tendencies, and any allergy to contrast dye or medicines, as these affect planning. Blood tests and a heart tracing are usually done first. Arrange for someone to take you home afterwards. In an emergency there is no time to prepare — the procedure goes ahead straight away to save heart muscle.
Recovery
Many people go home the same day or the next, especially with wrist access, and return to light activities within a week. The access site needs care: keep it clean and dry, avoid heavy lifting or straining for a short period, and watch for bleeding, a growing lump or bruising. Drinking enough fluids helps clear the contrast dye. You will be given clear advice on wound care, driving and returning to work, and a follow-up appointment. Cardiac rehabilitation is often recommended to rebuild fitness safely.
Risks and complications
Angioplasty is generally safe, but no procedure is risk-free. The commonest issues are minor — bruising or bleeding at the access site in the wrist or groin. Less commonly there can be damage to the artery used for access or to the heart artery being treated, an irregular heartbeat, or a reaction to the contrast dye. The dye can also strain the kidneys, especially if kidney function is already reduced. Serious complications, such as a heart attack, stroke or the need for emergency surgery, are rare. Over time the treated segment can re-narrow, or a clot can form on the stent — risks that medicines and good risk-factor control are designed to reduce. Your cardiologist will explain how these apply to you.
Very important: medicines after a stent
After a stent is placed you will be prescribed antiplatelet (blood-thinning) medicines, usually a combination for a set period followed by one long-term. Until the stent surface heals over, these medicines are what stop a clot forming on it — and a clot inside a stent can cause a sudden, dangerous heart attack. For this reason you must not stop these medicines, or miss doses, without your cardiologist’s advice, even if you feel well. If any other doctor or dentist suggests stopping them before a procedure, check with your cardiology team first. Tell your team promptly about unusual bleeding or bruising rather than stopping the medicine yourself.
Living with a stent
A stent treats the blockage but not the underlying disease, so protecting your heart for the long term matters most. Cardiac rehabilitation — supervised exercise and education — helps you recover confidence and fitness. Alongside it, controlling risk factors is the core of staying well: taking prescribed medicines (including those for cholesterol), keeping blood pressure, cholesterol and diabetes in target range, stopping smoking, eating a heart-healthy diet, staying active and maintaining a healthy weight. These steps lower the chance of new blockages and of trouble with the treated artery. Keep your follow-up appointments so your progress and medicines can be reviewed.
When to seek help after
Call 995 immediately for chest pain or pressure, breathlessness, cold sweating, or pain spreading to the arm, neck or jaw — these can signal a heart attack, which is an emergency, and prompt treatment saves heart muscle (“time is muscle”). Also seek urgent care at the nearest A&E for heavy bleeding, or a rapidly swelling lump or severe pain at the wrist or groin access site. Contact your care team sooner rather than later for redness, oozing, increasing bruising, fever, or if you have run out of your blood-thinning medicine. When in doubt, get checked.
Stent versus bypass
Angioplasty with stenting is less invasive with a quicker recovery, while coronary bypass surgery may be better for extensive disease or certain patterns of blockage, particularly with diabetes. A heart team advises which suits your arteries and overall health.
Afterwards
Angioplasty treats the blockage but not the underlying disease, so controlling risk factors is vital: taking prescribed medicines (including statins and blood thinners), stopping smoking, eating healthily, exercising and managing blood pressure, cholesterol and diabetes.
Common questions
How long does a stent last?
A stent is permanent; modern drug-coated stents have a low rate of re-narrowing, and ongoing medication and risk-factor control protect the artery.
Is angioplasty major surgery?
No. It is a minimally invasive procedure through an artery, usually with a short recovery, not open surgery.
Will I still need medication after a stent?
Yes. Blood thinners for a period and long-term medicines for cholesterol and other risk factors are important.
Related guides
Sources
- Singapore Heart Foundation — angioplasty.
- National Heart Centre Singapore — coronary interventions.
- HealthHub Singapore — heart procedures.
This article is for general information only and does not replace a consultation with a qualified doctor. If you have chest pain, breathlessness or fainting, seek urgent medical care.