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Q&A: Coronary stenting Q&A: Coronary stenting
(about 4 hours later)
The Duke of Edinburgh has undergone treatment for a blocked coronary artery at Papworth Hospital, Cambridge, after complaining of chest pains.The Duke of Edinburgh has undergone treatment for a blocked coronary artery at Papworth Hospital, Cambridge, after complaining of chest pains.
Buckingham Palace has confirmed that Prince Philip, 90, underwent an "invasive procedure of coronary stenting", a type of angioplasty. So what exactly is that and why would it be done?Buckingham Palace has confirmed that Prince Philip, 90, underwent an "invasive procedure of coronary stenting", a type of angioplasty. So what exactly is that and why would it be done?
What is an angioplasty?What is an angioplasty?
It is a procedure to unblock a coronary artery. These arteries supply the heart muscles with blood, which they need to stay healthy and functional like any other organ. If the heart muscle is damaged, it impairs the ability of the heart to pump blood around the body.It is a procedure to unblock a coronary artery. These arteries supply the heart muscles with blood, which they need to stay healthy and functional like any other organ. If the heart muscle is damaged, it impairs the ability of the heart to pump blood around the body.
Under local anaesthetic, a small balloon is inserted with a 2mm-diameter tube via an artery in the groin or arm and guided to the blockage.Under local anaesthetic, a small balloon is inserted with a 2mm-diameter tube via an artery in the groin or arm and guided to the blockage.
Once in place, the balloon is inflated. Dr Simon Davies, consultant interventional cardiologist at the Royal Brompton Hospital in London, said: "That forces the material that is blocking the artery outwards and then gets the blood flowing down the artery again.Once in place, the balloon is inflated. Dr Simon Davies, consultant interventional cardiologist at the Royal Brompton Hospital in London, said: "That forces the material that is blocking the artery outwards and then gets the blood flowing down the artery again.
"The stent is like a little metal sleeve fitted over the balloon when it is blown up. This metallic sleeve is opened up and then when the balloon is deflated and withdrawn the stent stays behind.""The stent is like a little metal sleeve fitted over the balloon when it is blown up. This metallic sleeve is opened up and then when the balloon is deflated and withdrawn the stent stays behind."
Why would someone be given a stent?Why would someone be given a stent?
The British Heart Foundation says coronary angioplasty and stents are used to treat coronary heart disease and severe chest pain, known as angina.The British Heart Foundation says coronary angioplasty and stents are used to treat coronary heart disease and severe chest pain, known as angina.
The procedure can help relieve angina symptoms and is sometimes used as an emergency treatment for people who have had a heart attack or unstable angina - that which comes on with less physical activity or even while you are resting.The procedure can help relieve angina symptoms and is sometimes used as an emergency treatment for people who have had a heart attack or unstable angina - that which comes on with less physical activity or even while you are resting.
Dr Davies said that when a person suffers chest pains it can - but does not necessarily - mean that "one or more of the coronary arteries is badly narrowed or perhaps blocked".Dr Davies said that when a person suffers chest pains it can - but does not necessarily - mean that "one or more of the coronary arteries is badly narrowed or perhaps blocked".
In serious cases, it can mean that blood is not passing through that artery. This means the muscle is starved of oxygen and may be in danger of dying - in other words the person could be on the verge of, or having, heart attack, Dr Davies said.In serious cases, it can mean that blood is not passing through that artery. This means the muscle is starved of oxygen and may be in danger of dying - in other words the person could be on the verge of, or having, heart attack, Dr Davies said.
What are the risks of an angioplasty?What are the risks of an angioplasty?
It is a commonly used procedure and the chances of recovery are generally good. However, consultant surgeon Shyam Kolvekar said the risks of the procedure increase with age.It is a commonly used procedure and the chances of recovery are generally good. However, consultant surgeon Shyam Kolvekar said the risks of the procedure increase with age.
With regards to a 90-year-old, he said: "At this age the arteries are quite thick and you may not even be able to pass a needle or plastic tube through it and that becomes quite difficult.With regards to a 90-year-old, he said: "At this age the arteries are quite thick and you may not even be able to pass a needle or plastic tube through it and that becomes quite difficult.
"The balloon may not even work to open this artery and the stent may not be able to deploy. So those are the risks at that age but it is one of the best treatments at that age too.""The balloon may not even work to open this artery and the stent may not be able to deploy. So those are the risks at that age but it is one of the best treatments at that age too."
When is primary angioplasty used to treat a heart attack?
There are two basic types of heart attack.
Patients with the most severe kind, known as a ST elevation myocardial infarction or STEMI, have a complete blockage which can be detected by an electrocardiogram.
It is this group - accounting for around 25,000 heart attacks in England every year - who should be treated with primary angioplasty if it can be done quickly enough.
Patients with milder, or non-STEMI, heart attack have partially blocked arteries and can be treated with drugs initially with surgery done if necessary later on.
What other treatment is there?
Use of clot-busting drugs, or thrombolysis, has been the mainstay of heart attack treatment for many years and has led to big reductions in deaths.
These drugs, which are usually given by intravenous drip, activate an enzyme which breaks down blood clots restoring blood-flow.
A national service framework for coronary heart disease launched in 2000 set a target that all eligible patients should receive thrombolysis within an hour of calling the health service.
By 2007/8, about 68% of people treated with thrombolysis received their treatment within 60 minutes.
Patients who have thrombolysis may in any case end up having an angioplasty a few days later.