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Angioplasty

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Balloon angioplasty.
ICD-9-CM00.6, 36.0 39.50
MeSHD017130

Angioplasty is the technique of mechanically widening narrowed or obstructed arteries, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres). The balloon forces expansion of the inner white blood cell/clot plaque deposits and the surrounding muscular wall, opening up the blood vessel for improved flow, and the balloon is then deflated and withdrawn. A stent may or may not be inserted at the time of ballooning to ensure the vessel remains open.

The word is composed of the combining forms of the Greek words ἀγγεῖον angīon ‘vessel’/‘cavity’ (of the human body) and πλάσσω plasso ‘form’/‘mould’. Angioplasty has come to include all manner of vascular interventions that are typically performed in a minimally invasive or percutaneous method.

Medical uses

3D view of balloon inflating in artery and flattening plaque.

Metal stents and drug eluting stents result in an equivalent chance of death when used for primary angioplasty of ST elevation myocardial infarction.[1]

After the procedure

After angioplasty, most of the patients are monitored overnight in the hospital but if there are no complications, the next day, patients are sent home.

The catheter site is checked for bleeding and swelling and the heart rate and blood pressure is monitored. Usually, patients receive medication that will relax them to protect the arteries against spasms. Patients are typically able to walk within two to six hours following the procedure and return to their normal routine by the following week.[2]

Angioplasty recovery consists of avoiding physical activity for several days after the procedure. Patients are advised to avoid any type of lifting, or other strenuous physical activity for a week.[3] Patients will need to avoid physical stress or prolonged sport activities for a maximum of two weeks after a delicate balloon angioplasty.[4]

Patients with stents are usually prescribed an anticoagulant, clopidogrel, which is taken at the same time as acetylsalicylic acid (aspirin). These medicines are intended to prevent blood clots and they are usually taken for at least the first months after the procedure is performed. In most cases, patients are given these medicines for 1 year.

Patients who experience swelling, bleeding or pain at the insertion site, develop fever, feel faint or weak, notice a change in temperature or color in the arm or leg that was used or have shortness of breath or chest pain should immediately seek medical advice.

Peripheral angioplasty

Peripheral angioplasty (PA) refers to the use of a balloon to open a blood vessel outside the coronary arteries. It is commonly done to treat atherosclerotic narrowings of the abdomen, leg and renal arteries. PA can also be done to treat narrowings in veins, etc. Often, peripheral angioplasty is used in conjunction with peripheral stenting and atherectomy. Technically, angioplasty can be used to describe any dimensional treatment of blood vessels, whether enlarging, or reducing diameter, depending on requirements to treat the pathology.

Coronary angioplasty

A coronary angiogram (an X-ray with radio-opaque contrast in the coronary arteries) that shows the left coronary circulation. The distal left main coronary artery (LMCA) is in the left upper quadrant of the image. Its main branches (also visible) are the left circumflex artery (LCX), which courses top-to-bottom initially and then toward the centre-bottom, and the left anterior descending (LAD) artery, which courses from left-to-right on the image and then courses down the middle of the image to project underneath the distal LCX. The LAD, as is usual, has two large diagonal branches, which arise at the centre-top of the image and course toward the centre-right of the image.
Main article: Percutaneous coronary intervention

Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty is a therapeutic procedure to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build up of cholesterol-laden plaques that form due to atherosclerosis. PCI is usually performed by an interventional cardiologist.

Treatment with PCI for patients with stable coronary artery disease reduces chest pain, but does not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy.[5]

Renal artery angioplasty

Atherosclerotic obstruction of the renal artery can be treated with angioplasty of the renal artery (percutaneous transluminal renal angioplasty, PTRA). Renal artery stenosis can lead to hypertension and loss of renal function.

Carotid angioplasty

Carotid artery stenosis is treated with angioplasty and stenting for high-risk patients in many hospitals.

Cerebral arteries angioplasty

In 1983, the Russian neurosurgeon Zubkov and colleagues reported the first use of transluminal balloon angioplasty for vasospasm after aneurysmal SAH.[6][7]

History

Diagram of a balloon catheter.

Angioplasty was initially described by the US interventional radiologist Charles Dotter in 1964.[8] Dr. Dotter pioneered modern medicine with the invention of angioplasty and the catheter-delivered stent, which were first used to treat peripheral arterial disease. On January 16, 1964, Dotter percutaneously dilated a tight, localized stenosis of the superficial femoral artery (SFA) in an 82-year-old woman with painful leg ischemia and gangrene who refused leg amputation. After successful dilation of the stenosis with a guide wire and coaxial Teflon catheters, the circulation returned to her leg. The dilated artery stayed open until her death from pneumonia two and a half years later.[9]Charles Dotter is commonly known as the "Father of Interventional Radiology" and was nominated for the Nobel Prize in medicine in 1978.

The first coronary angioplasty on a waking patient was performed by the German cardiologist Andreas Gruentzig in September 1977.[10]

Ingemar Henry Lundquist invented the over the wire balloon catheter that is used in the majority of angioplasty procedures in the world.[11]

See also

References

  1. ^ De Luca G, Dirksen MT, Spaulding C; et al. (2012). "Drug-eluting vs bare-metal stents in primary angioplasty: a pooled patient-level meta-analysis of randomized trials". Arch. Intern. Med. 172 (8): 611–21, discussion 621–2. doi:10.1001/archinternmed.2012.758. PMID 22529227. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  2. ^ "What should I expect after my procedure?". Archived from the original on 9 April 2010. Retrieved 2010-04-06. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  3. ^ "After the operation". Retrieved 2010-04-06.
  4. ^ "Angioplasty Recovery". Archived from the original on 9 April 2010. Retrieved 2010-04-06. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  5. ^ Boden W. E., O'Rourke R. A.; et al. (2007). "Optimal medical therapy with or without PCI for stable coronary disease". N Engl J Med. 356 (15): 1503–16. doi:10.1056/NEJMoa070829. PMID 17387127. {{cite journal}}: Explicit use of et al. in: |author= (help)
  6. ^ Zubkov IuN, Nikiforov BM, Shustin VA (1983). "1st attempt at dilating spastic cerebral arteries in the acute stage of rupture of arterial aneurysms". Zh Vopr Neirokhir Im N N Burdenko. 5 (5): 17–23. PMID 6228084. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  7. ^ Zubkov YN, Nikiforov BM, Shustin VA (1984). "Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH". Acta Neurochir (Wien). 70 (1–2): 65–79. doi:10.1007/BF01406044. PMID 6234754. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ Dotter CT, Judkins MP (1964). "Transluminal treatment of arteriosclerotic obstruction". Circulation. 30: 654–70. PMID 14226164. {{cite journal}}: Unknown parameter |month= ignored (help)
  9. ^ Rosch Josef; et al. (2003). "The birth, early years, and future of interventional radiology". J Vasc Interv Radiol. 14 (7): 841–853. PMID 12847192. {{cite journal}}: Explicit use of et al. in: |author= (help)
  10. ^ Biographic sketch of Andreas Gruentzig
  11. ^ "System for filling and inflating and deflating a vascular dilating cathether assembly". patents.com. patents.com. Retrieved 2013-07-08.
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