Coronary Angiography & Angioplasty in Turkey

When angiography identifies a significant coronary stenosis, the interventional cardiologist can proceed to PTCA (percutaneous transluminal coronary angioplasty) and stent implantation — either during the same procedure (ad hoc) if planned, or as an elective staged procedure.

The stenting procedure:

1. A guidewire is advanced through the catheter across the coronary stenosis
2. A balloon catheter is inflated at the stenosis — compressing the plaque and widening the vessel lumen
3. A drug-eluting stent (DES) is deployed over the balloon — a metal mesh scaffold that stays permanently, maintaining the open lumen
4. The drug coating on the stent (everolimus, sirolimus, or paclitaxel) prevents neo-intimal hyperplasia (re-narrowing)
5. Dual antiplatelet therapy (aspirin + P2Y12 inhibitor — ticagrelor or clopidogrel) is required for 6–12 months

Modern DES (Drug-Eluting Stents):

• Current-generation DES have restenosis rates below 5% at 1 year
• Bioresorbable scaffolds (BRS) available in select cases — the scaffold is absorbed over 2–3 years
• Calcified lesions may require rotational atherectomy (Rotablator) or intravascular lithotripsy (IVL) before stenting

Complex interventions: bifurcation, left main, CTO:

• Bifurcation stenting: two-stent techniques (Culotte, Crush) for bifurcation disease
• Left main coronary disease: historically treated with CABG; ad-hoc left main stenting now validated by EXCEL and NOBLE trials for suitable anatomy
• Chronic Total Occlusion (CTO): complex retrograde wire techniques to recanalise 100% blocked vessels — requires a specialist CTO operator

Primary PCI for heart attack (STEMI): Emergency same-day cardiac catheterisation and stenting for acute STEMI — door-to-balloon time under 90 minutes is the target. Available 24/7 at partner hospitals.

Radial vs. femoral access: The trans-radial (wrist) approach is standard at partner hospitals — lower bleeding complications, faster ambulation, earlier discharge, and better patient comfort than femoral (groin) access. A TR band (radial compression device) applied after the procedure allows immediate mobilisation.

Hospital stay:

• Diagnostic angiography only: day case or 1 overnight stay; discharged after 4–6 hours of radial compression
• Diagnostic + stent (elective): 1–2 overnight stays; cardiac monitoring post-procedure
• Primary PCI (STEMI): 3–5 days intensive monitoring

Antiplatelet therapy after stenting:

• Aspirin 75–100 mg lifelong
• Ticagrelor 90 mg twice daily (or clopidogrel 75 mg) for 12 months (6 months in bleeding-risk patients)
• Medication documentation provided for home cardiologist; antiplatelet regimen and any drug interactions highlighted

Post-stent lifestyle and secondary prevention:

• Statin therapy with high-intensity statin to achieve LDL <1.4 mmol/L
• ACE inhibitor/ARB for LV impairment
• Cardiac rehabilitation programme (exercise-based); coordinated with home centre
• BB Global Health provides secondary prevention medication plan, cardiac rehabilitation referral documentation, and remote follow-up WhatsApp access

Cost comparison: Diagnostic-only coronary angiography Turkey: €2,500–4,000 all-inclusive; UK private: £5,000–9,000. Elective stent (single vessel): Turkey €5,000–9,000; UK private £12,000–20,000.