Coronary Angioplasty
in Hyderabad

When is coronary angioplasty recommended?

Dr. Bhishma Chowdary recommends angioplasty based on your angiogram findings, symptoms, and overall heart function. The typical indications are:

• Stable angina — chest pain on exertion that is not adequately controlled with medications
• Unstable angina — chest pain occurring at rest or with increasing frequency and severity
• NSTEMI (non-ST elevation myocardial infarction) — a type of heart attack with partial blockage
• STEMI (ST elevation myocardial infarction) — a major heart attack requiring emergency primary angioplasty
• Significant blockage found on angiogram, confirmed by FFR/RFR physiology assessment to be causing reduced blood flow
• In-stent restenosis — re-narrowing inside a previously placed stent
• Graft disease — narrowing in a bypass graft performed years earlier

How is coronary angioplasty performed? Step by step

Before the procedure

• You will fast for 4 to 6 hours before a planned (elective) angioplasty.
• Blood tests, ECG, and a review of current medications are completed on admission.
• An IV line is placed in your arm for fluids, medications, and contrast dye.
• You will be given antiplatelet medications (aspirin + a loading dose of clopidogrel or ticagrelor) before the procedure to reduce clotting risk.
• The entry site — usually the right wrist — is shaved, cleaned, and prepared.

During the procedure

1. You lie on the cath lab table. A mild sedative is given — you remain awake and can communicate with the team throughout.
2. Local anaesthesia is injected at the wrist (or groin). A small sheath is placed in the artery to allow catheter access.
3. A thin guide catheter is advanced under live X-ray (fluoroscopy) through the aorta to the opening of the blocked coronary artery.
4. Contrast dye is injected to confirm the location and degree of the blockage. Dr. Bhishma Chowdary reviews the live images to plan the approach.
5. A fine guidewire — thinner than a human hair — is carefully threaded past the blockage into the coronary artery beyond it.
6. A balloon catheter is advanced over the wire to the blockage site. The balloon is inflated for 20 to 30 seconds to compress the plaque and expand the artery. You may feel mild pressure at this point.
7. If IVUS or OCT imaging is used, a tiny imaging probe is advanced through the artery to confirm blockage severity and vessel size before and after stenting.
8. The stent — crimped tightly around a second balloon — is advanced to the blockage site and deployed by inflating the balloon. The balloon is deflated and removed; the stent remains expanded inside the artery, holding it open.
9. Final imaging confirms the stent is fully expanded and well-positioned, with good blood flow beyond it.
10. The catheter and sheath are removed. The wrist is compressed with a band for 2 to 4 hours to seal the artery.

After the procedure

• You are monitored in a recovery area for 4 to 6 hours, then moved to a ward bed.
• The compression band on the wrist is gradually deflated over 2 hours and removed.
• Most patients sit up and eat within a few hours of the procedure.
• Dr. Bhishma Chowdary reviews the results with you and your family the same day.
• Discharge is typically the following morning after a planned angioplasty.

IVUS and OCT guided angioplasty — the AIG Hospitals difference

Standard angioplasty uses X-ray angiography to guide stent placement. However, an angiogram shows only the silhouette of the artery — not the plaque composition, calcium content, or exact vessel dimensions. Dr. Bhishma Chowdary routinely uses intravascular imaging for complex cases to optimise results:

IVUS (Intravascular Ultrasound)	An ultrasound probe inside the artery provides real-time cross-sectional images of the vessel wall. Used to accurately measure vessel diameter for stent sizing, assess plaque burden and calcification, confirm stent is fully expanded and well-apposed to the vessel wall, and diagnose stent complications early.
OCT (Optical Coherence Tomography)	Light-based imaging with 10x higher resolution than IVUS. Provides the most detailed view currently available of the artery wall and stent. Used for complex bifurcation lesions, heavily calcified arteries, left main stenting, and in-stent restenosis assessment.
FFR / RFR / IFR (Coronary Physiology)	A pressure wire passed beyond a borderline blockage measures whether the narrowing is actually reducing blood flow. Only physiologically significant lesions are stented — avoiding unnecessary procedures and their associated risks.
Rotational Atherectomy (for calcified arteries)	When plaque is heavily calcified and cannot be compressed by a balloon alone, a tiny rotating diamond-tipped burr drills through the calcium before stent deployment. Dr. Bhishma Chowdary is experienced in this advanced technique for complex calcific PCI.

Angioplasty versus bypass surgery — how is the decision made?

Both coronary angioplasty and coronary artery bypass grafting (CABG) are effective treatments for coronary artery disease. The choice depends on several factors:

Number of blocked arteries	Single or double vessel disease — angioplasty is usually preferred. Triple vessel or left main disease — bypass surgery may be recommended.
Complexity of blockages	Simple, focal blockages — well suited to angioplasty. Diffuse, calcified, or bifurcating blockages — may favour surgery or require advanced angioplasty techniques.
Heart muscle function	Severely reduced heart function may favour surgery in some cases.
Diabetes	Diabetic patients with triple vessel disease often have better long-term outcomes with bypass surgery. Each case is assessed individually.
SYNTAX score	An internationally validated scoring system for coronary anatomy complexity — used by Dr. Bhishma Chowdary to guide the angioplasty vs. surgery discussion.
Patient preference and fitness	Angioplasty avoids a major operation, has faster recovery, and is preferred by many patients. Surgical fitness and patient preference are always part of the decision.

Multidisciplinary decision

For complex cases, the choice between angioplasty and bypass surgery is made jointly by the interventional cardiologist and cardiac surgeon — a process called the Heart Team discussion. At AIG Hospitals, this collaborative approach ensures you receive the most appropriate treatment for your specific anatomy.

Medications after coronary angioplasty

Medication compliance after angioplasty is as important as the procedure itself. Stopping medications early is the most common cause of stent thrombosis — a rare but serious complication.

Dual antiplatelet therapy (DAPT)	Aspirin + clopidogrel (or ticagrelor or prasugrel) for 6 to 12 months after drug-eluting stent placement. Prevents clot formation inside the stent while it heals. NEVER stop either medication without first consulting Dr. Bhishma Chowdary.
Aspirin (lifelong)	Continued indefinitely after the DAPT period ends.
Statin (cholesterol medication)	High-intensity statin therapy (e.g. rosuvastatin or atorvastatin) to stabilise plaques and prevent new blockages. Taken lifelong in most cases.
Beta-blocker	Reduces heart rate and workload. Particularly important after a heart attack.
ACE inhibitor / ARB	Protects heart muscle function and reduces blood pressure. Recommended especially after a heart attack or in patients with reduced heart function.
Blood pressure medication	Continued as prescribed to keep blood pressure below 130/80 mmHg.

Recovery and lifestyle after angioplasty

First week

• Rest at home for the first 2 to 3 days. Light walking is encouraged — it is good for recovery.
• Keep the wrist entry site clean and dry. A waterproof dressing is provided.
• Avoid lifting anything heavier than 2 kg for 1 week.
• You may drive after 1 week (wrist access) — confirm with Dr. Bhishma Chowdary based on your specific situation.
• Desk work can usually resume within 5 to 7 days.

First month

• Gradually increase walking — aim for 30 minutes of brisk walking most days by the end of the month.
• Avoid strenuous exercise, heavy lifting, and contact sports for 4 weeks.
• Attend your 4-week follow-up appointment. An ECG and clinical review will be done.
• Report immediately to the hospital if you develop chest pain, breathlessness, or pain at the wrist site.

Long-term lifestyle changes

• Diet: Adopt a heart-healthy diet — rich in vegetables, fruits, whole grains, legumes, and fish. Reduce saturated fats, processed foods, refined sugars, and excess salt.
• Exercise: Regular aerobic activity (brisk walking, swimming, cycling) for at least 150 minutes per week after clearance from your cardiologist.
• Smoking: Complete cessation is mandatory. Smoking after a stent dramatically increases the risk of stent thrombosis and new blockages.
• Weight: Achieve and maintain a healthy body weight. Even a 5 to 10% reduction in weight in overweight patients significantly reduces cardiovascular risk.
• Blood pressure: Target below 130/80 mmHg with medications and lifestyle.
• Diabetes: Tight blood sugar control is essential — HbA1c below 7% in most cases.
• Stress management: Chronic stress is an independent cardiac risk factor. Yoga, meditation, and adequate sleep are beneficial.

Frequently asked questions

Is angioplasty a surgery?

No. Angioplasty is not surgery in the conventional sense — there is no incision into the chest, no general anaesthesia, and no heart-lung machine. It is a catheter-based procedure done through a small puncture in the wrist or groin, with the patient awake throughout. The recovery is measured in days, not weeks.

Will I feel pain during angioplasty?

Most patients experience little to no pain. You may feel mild pressure when the balloon is inflated — this lasts only 20 to 30 seconds — and a brief warm flush when contrast dye is injected. Local anaesthesia at the entry site ensures you feel no pain there. Dr. Bhishma Chowdary and the team communicate with you throughout the procedure.

How long will I stay in hospital after angioplasty?

For a planned (elective) angioplasty, most patients are discharged the morning after the procedure — approximately 24 hours. If angioplasty was performed during a heart attack (primary PCI), monitoring for 3 to 5 days is typical. Your discharge timing is based on your clinical condition, not a fixed rule.

How long will I be on blood thinners?

After a drug-eluting stent, dual antiplatelet therapy (aspirin plus a second agent such as clopidogrel or ticagrelor) is prescribed for 6 to 12 months depending on the clinical indication. After this period, aspirin alone is continued lifelong. Never stop either medication without consulting Dr. Bhishma Chowdary — stopping early is the most common cause of stent clotting.

Can the stent cause problems later?

Modern drug-eluting stents are extremely safe long-term. The two main complications are: (1) In-stent restenosis — re-narrowing of scar tissue inside the stent, occurring in less than 5% of cases with modern stents. Treatable with another angioplasty. (2) Stent thrombosis — clot formation in the stent, very rare (less than 1%) and almost always related to stopping antiplatelet medications early. Following your medication regimen and attending follow-up appointments essentially eliminates these risks.

Can I fly after angioplasty?

For planned elective angioplasty via the wrist, most patients can fly after 2 to 3 days if they feel well and the wrist site has healed. After a heart attack with primary angioplasty, most cardiologists recommend waiting 4 to 6 weeks before long-haul flights. Always inform your treating cardiologist before booking travel.

Will I need bypass surgery in the future if I have a stent?

Not necessarily. The vast majority of patients with a successful angioplasty do not require bypass surgery. However, coronary artery disease is a chronic condition — new blockages can develop in other arteries over time. This is why lifelong risk factor management (medications, lifestyle, regular follow-up) is equally important as the procedure itself.

Is angioplasty safe for elderly patients?

Yes. Angioplasty's minimally invasive nature makes it particularly well-suited to elderly patients who may not be fit for open-heart surgery. Age alone is not a contraindication. Dr. Bhishma Chowdary has extensive experience managing complex angioplasty in older patients, including with mechanical circulatory support (Impella) when heart function is reduced.

What is the difference between angioplasty and primary angioplasty?

Coronary angioplasty (elective PCI) is performed as a planned procedure to treat stable or unstable angina once the blockage has been identified on a prior angiogram. Primary angioplasty (primary PCI) is performed as an emergency during an acute heart attack to open the blocked artery as rapidly as possible — ideally within 90 minutes of arrival — to limit heart muscle damage. Both use the same catheter technique; the urgency and clinical context differ.

What if I need a dental procedure while on blood thinners?

Most routine dental work (fillings, scaling, simple extractions) can be performed safely while on dual antiplatelet therapy without stopping the medications. Stopping blood thinners for dental work is a leading cause of preventable stent thrombosis. Always inform your dentist about your stent and blood thinners, and have them coordinate with Dr. Bhishma Chowdary if they are concerned before any significant dental procedure.