First, you’ll have what’s called a cardiac catheterization. Medication will be given to relax you, then the doctor will numb where the catheter will go with anesthesia.

Next, a thin plastic tube called a sheath is inserted into an artery — sometimes in your groin, sometimes in your arm. A long, narrow, hollow tube called a catheter is passed through the sheath and guided up a bloodvessel to the arteries surrounding the heart.

A small amount of contrast liquid is put into your blood vessel through the catheter. It’s photographed with an X-ray as it moves through your heart’s chambers, valves, and major vessels. From those pictures, doctors can tell if your coronary arteries are narrowed and, in some cases, whether the heart valves are working correctly.

If the doctor decides to perform angioplasty, he will move the catheter into the artery that’s blocked. He’ll then do one of the procedures described below.

The whole thing lasts from 1 to 3 hours, but the preparation and recovery can add much more time. You may stay in the hospital overnight for observation.

What Types of Procedures Are Used in Angioplasty?

There are several your doctor will choose from. They include:

Balloon: A catheter with a small balloon tip is guided to the narrowing in your artery. Once in place, the balloon is inflated to push the plaque and stretch the artery open to boost blood flow to the heart.

Stent: This is a small tube that acts as a scaffold to support the inside your coronary artery. A balloon catheter, placed over a guide wire, puts the stent into your narrowed coronary artery. Once in place, the balloon is inflated, and the stent expands to the size of the artery and holds it open. The balloon is then deflated and removed while the stent stays in place. Over several weeks, your artery heals around the stent.

These are often placed during angioplasty to help keep the coronary artery open. The stent is usually made of metal and is permanent. It can also be made of a material that the body absorbs over time.

Some stents contain medicine and are designed to reduce the risk of the artery getting blocked again (your doctor may call that restenosis). The doctor will decide if this is the right stent for your blockage.

Rotablation: A special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of the narrowing in your coronary artery. The tip spins at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed away in your bloodstream. This process is repeated as needed to improve blood flow.

This is rarely used because balloon angioplasty and stenting have much better results. They’re also easier for the cardiologist to perform.

Atherectomy: The catheter used here has a hollow cylinder on the tip with an open window on one side and a balloon on the other. When the catheter is put into the narrowed artery, the balloon is inflated, pushing the window against the plaque. A blade in the cylinder rotates and shaves off any plaque that protrudes into the window. The shavings are caught in the catheter chamber and removed. This process is repeated as needed to allow for better blood flow.

Like rotablation, this procedure isn’t used much.

Cutting balloon: This catheter has a special balloon tip with small blades. When the balloon is inflated, the blades are activated. The small blades score the plaque, then the balloon presses the plaque against the artery wall.