Difference between revisions of "Angioplasty" - New World Encyclopedia

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'''Angioplasty''' is the mechanical widening of a narrowed or totally obstructed [[blood vessel]]. These obstructions are often caused by [[atherosclerosis]]. The term derives from the roots "angio" or vessel and "plasticos" fit for molding. The term has come to include all manner of vascular interventions typically performed in a minimally invasive or [[percutaneous]] method.
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Most commonly, the [[Seldinger technique]] is used to [[cannula]]te a blood vessel for access. A guiding [[catheter]] is then introduced into the [[artery|arterial]] (or [[vein|venous]]) system and advanced through the system to the location of an obstruction. This in turn is followed by introduction of a guidewire which is advanced though the guide catheter, through the obstruction and extended into the blood vessel [[lumen (anatomy)|lumen]] beyond the obstruction. Over the guidewire, a balloon catheter is advanced through both the guide catheter and the obstruction. Once in position, the balloon is inflated using high [[hydraulic]] pressure so as to force the narrowed vessel lumen to expand, pushing the lesion producing the narrowing outwards. The balloon may also include a [[stent]] (compressed over the balloon before expansion) or be followed by a stent/balloon combination so that the expanded stent is left within the previously narrowed lumen to mechanically support patency of the vessel lumen. See the PTCA stent animation <ref>[http://www.angioplasty.org/angio101/popups/stent_anim.html Angiolplasty Illustration.] angioplasty.org. Retrieved December 13, 2007.</ref>, but note the illustration error: the [[atheroma]] does not compress, instead it is pushed outward expanding the outer artery size.
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'''Angioplasty''' is the mechanical widening of a narrowed or totally obstructed [[blood vessel]]. These obstructions are often caused by [[atherosclerosis]]. The term ''angioplasty'' is a [[portmanteau]] of the words ''angio'' (from the [[Latin language|Latin]]/[[Greek language|Greek]] word meaning "vessel") and ''plasticos'' (Greek: "fit for moulding"). Angioplasty has come to include all manner of [[Blood vessel|vascular]] interventions typically performed in a minimally invasive or ''[[percutaneous]]'' method.
  
 
==Coronary angioplasty==
 
==Coronary angioplasty==
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[[image:Ha1.jpg|thumb|300pc|X-ray image during Angioplasty]]
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[[Image:Ha1.jpg|thumb|300px|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 of 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.]]
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One way to unblock a [[coronary artery]] is '''percutaneous transluminal coronary angioplasty''' (PTCA), which was first performed in 1977 by Andreas Gruentzig. A wire is passed from the [[femoral artery]] in the leg (or, less commonly, from the [[radial artery]] or [[brachial artery]] in the arm) to beyond the area of the coronary artery that is being worked upon. Over this wire, a [[balloon catheter]] is passed into the segment that is to be opened up. The end of the catheter contains a small folded balloon. When the balloon is hydraulically inflated, it compresses the [[atheroma]]tous [[plaque]] and stretches the artery wall to expand. At the same time, if an expandable wire mesh tube ([[stent]]) was on the balloon, then the stent will be implanted (left behind) to support the new stretched open position of the [[artery]] from the inside.
 
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Angioplasty and stenting is performed through a thin flexible [[catheter]] during [[Cardiac]] [[Catheterization]] with just a [[local anaesthetic]] to the groin (or wrist) where the catheter was inserted, often making [[coronary artery bypass surgery|heart surgery]] unnecessary. While coronary angioplasty has consistently been shown to reduce symptoms due to coronary artery disease and to reduce cardiac [[ischemia]], it has not been shown in large trials to reduce mortality due to coronary artery disease, except in patients being treated for a heart attack acutely (also called primary angioplasty). There is a small but definite [[mortality]] benefit (ie., reduction) with this form of treatment compared with medical therapy, usually consisting of thrombolysis|thrombolytic ("clot busting") medication.
 
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Traditional ("bare metal") coronary [[stent]]s provide a mechanical framework that holds the artery wall open, preventing stenosis, or narrowing, of arteries feeding critical structures like the [[myocardium]].  Traditional stenting is superior to angioplasty alone in keeping arteries open.
 
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Newer drug-eluting stents (DES) are coated with drugs that prevent re-stenosis of the artery. Three drugs, sirolimus, everolimus and paclitaxel, have been demonstrated effective and safe in this application by stent device manufacturers and are being used.
 
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Risks of angioplasty are uncommon, and the procedure is widely practiced. Coronary angioplasty is usually performed by an interventional [[cardiologist]], a medical doctor with special training in the treatment of the heart using invasive [[catheter]]-based procedures.  
 
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Angioplasty is sometimes [[Eponym|referred]] to as ''Dottering'', after Dr C.T. Dotter, who, together with Dr M.P. Judkins, first described <ref>Dotter, C.T., M.P. Judkins. 1964. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14226164&dopt=Abstract Transluminal Treatment of Arteriosclerotic Obstruction. Description of a New Technic and a Preliminary Report of its Application.] ''Circulation''. 30:654-70. Retrieved December 13, 2007.</ref> angioplasty (without the balloon) in 1964 (Circulation 1964;30:654-70). As the range of procedures performed upon lumens of coronary arteries has widened, the name of the procedure has changed to percutaneous coronary intervention (PCI).
 
  
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===Risks of angioplasty===
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{{main|Percutaneous coronary intervention}}
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Angioplasty has become considerably safer over the years and is now commonly performed. Although it is associated with some risks and its risks these are considerably less than for open-heart [[bypass surgery]] with its resulting post-operative pain. However the likelihood of recurrence of angina, and requirement for repeated procedures has been higher with angioplasty. The latest trial (ARTS II) has suggested that PCI with DES may be superior, at least in the short term.
 
  
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Some chest discomfort occasionally may be experienced and it is for this reason that the patient is awake during minimally invasive angioplasty; the reporting of any symptom allows the cardiologist to take necessary immediate action. Bleeding from the insertion point in the groin is common, in part due to the use of anti-[[platelet]] clotting drugs. Some [[bruising]] is therefore to be expected, but occasionally a [[haematoma]] may form. This may delay hospital discharge as flow from the artery into the haematoma may continue (pseudoaneurysm) which requires repair. Infection at the skin puncture site is rare and dissection (tearing) of the access blood vessel is uncommon. [[Allergic reaction]] to the contrast dye used is possible, but has been reduced with the newer agents. Deterioration of kidney function can occur in patients with pre-existing kidney disease, but kidney failure requiring dialysis is rare. Vascular access complications are less common and less serious when the procedure is performed via the radial artery.
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'''Percutaneous coronary intervention''' ('''PCI'''), commonly known as '''coronary angioplasty''' is a therapeutic procedure to treat the [[stenosis|stenotic]] (narrowed) [[coronary artery|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 cardiology|interventional cardiologist]].
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In the long term, the most common risk is of the stent restenosis, as discussed above. This has been reduced considerably with the use of newer stents coated with certain medicines (drug-eluting stents). The most serious risk is the rare provocation (3%) of a heart attack during or shortly after the procedure; this may require emergency open cardiac surgery. Angioplasty carried out shortly after a [[myocardial infarction]] has a risk of causing a [[stroke]] of 1 in 1000, which is less than the 1 in 100 risk encountered by those receiving thrombolytic drug therapy.
 
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The overall risks of death with angioplasty is approximately 1%, but the underlying severity of the heart disease, fitness of the patient and presence of other illness affect each individual’s risk. Hence for those with relatively minor heart disease, preserved good cardiac function, reasonable level of fitness and absence of other illnesses, the risk will be considerably less than this.
 
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When failures of PTCA occur, they are often treated using coronary artery bypass grafting ([[CABG]]).
 
  
 
==Peripheral angioplasty==
 
==Peripheral angioplasty==
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Peripheral angioplasty refers to the use of similar techniques in opening blood vessels other than the coronary arteries.  It is often called '''percutaneous transluminal angioplasty''' or '''PTA''' for short. PTA is most commonly done to treat narrowings in the leg arteries, especially the common iliac, external iliac, superficial femoral and popliteal arteries. PTA can also be done to treat narrowings in veins.
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Peripheral angioplasty refers to the use of mechanical widening in opening blood vessels other than the coronary arteries.  It is often called '''percutaneous transluminal angioplasty''' or '''PTA''' for short. PTA is most commonly done to treat narrowings in the leg arteries, especially the common iliac, external iliac, superficial femoral and popliteal arteries. PTA can also be done to treat narrowings in veins.
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<!-- Unsourced image removed: [[Image:Common iliac PTA 7mm.jpg|750px]] —>
 
  
 
==Renal artery angioplasty==
 
==Renal artery angioplasty==
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==Carotid angioplasty==
 
==Carotid angioplasty==
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Generally, [[carotid artery]] stenosis is still not treated with angioplasty and stenting in most hospitals, due to the increased risk of embolic [[stroke]] with the procedure. But this is changing since the FDA has approved the first cartoid stent system (Guidant) in August 2004 and the second (Abbott) in September 2005. The system usually comprises a stent along with an anti-embolic device designed to reduce or trap [[atheroma]] and clot debris. Angioplasty and stenting is increasingly being used to also treat carotid stenosis, with success rates similar to [[carotid endarterectomy]] surgery. Simple angioplasty without stenting is falling out of favor in this vascular bed. A large trial comparing endarterectomy and stenting found stenting equally efficacious <ref>Yadav J.S., M.H. Wholey, R.E. Kuntz, P. Fayad, B.T. Katzen, G.J. Mishkel, T.K. Bajwa, P. Whitlow, N.E. Strickman, M.R. Jaff, J.J. Popma, D.B. Snead, D.E. Cutlip, B.G. Firth, K. Ouriel. 2004. Protected carotid-artery stenting versus endarterectomy in high-risk patients. ''N Engl J Med''. 351:1493-501. PMID 15470212. Retrieved December 13, 2007.</ref>.
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Generally, [[carotid artery]] stenosis is treated with angioplasty and stenting for high-risk patients in many hospitals. It has changed since the FDA has approved the first carotid stent system (Cordis) in July 2004 and the second (Guidant) in August 2004. The system comprises a stent along with an embolic capture device designed to reduce or trap [[emboli]] and clot debris. Angioplasty and stenting is increasingly being used to also treat carotid stenosis, with success rates similar to [[carotid endarterectomy]] surgery. Simple angioplasty without stenting is falling out of favor in this vascular bed. SAPPHIRE, a large trial comparing carotid endarterectomy and carotid stenting with the Cordis stent found stenting non-inferior to carotid endarterectomy.<ref>Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K. ''Protected carotid-artery stenting versus endarterectomy in high-risk patients.'' N Engl J Med 2004;351:1493-501. PMID 15470212.</ref>
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==See also==
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* [[Angiogram]]
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* [[Charles Dotter]]
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* [[Vascular surgery]]
  
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==Notes==
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==References==
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<references />
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<references/>
  
 
==External links==
 
==External links==
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* [http://www.angioplasty.org Angioplasty.Org]. Retrieved December 14, 2007.
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* [http://www.angioplasty.org Angioplasty.Org], celebrating a decade of independent cardiology news and education
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* [http://www.cirse.org/index.php?pid=85 Cardiovascular and Interventional Radiological Society of Europe]. Retrieved December 14, 2007.
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* [http://www.cirse.org/index.php?pid=85 Cardiovascular and Interventional Radiological Society of Europe]
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* [http://www.scai.org Society for Cardiovascular Angiography and Interventions]. Retrieved December 14, 2007.
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* [http://www.scai.org Society for Cardiovascular Angiography and Interventions]
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* [http://www.cardiovillage.com Cardiovillage], cardiovascular education online. Retrieved December 14, 2007.
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* [http://www.cardiovillage.com Cardiovillage], cardiovascular education online
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*[http://www.nhlbi.nih.gov/health/dci/Diseases/Angioplasty/Angioplasty_WhatIs.html National Heart Lung and Blood Institute, Diseases and Conditions Index]
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*[http://www.clevelandclinic.org/heartcenter/pub/guide/disease/cad/treatment_interventional.htm  Overview Coronary Artery Disease Treatment - Coronary Interventions ANGIOPLASTY, STENTS AND ATHERECTOMY (Cleveland Clinic)]
  
 
[[Category:Life sciences]]
 
[[Category:Life sciences]]
  
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{{credit|Angioplasty|176879328}}

Revision as of 15:15, 20 December 2007

Intervention:
Angioplasty
ICD-10 code:
ICD-9 code: 00.6 36.0 39.50
MeSH D017130
Other codes:

Angioplasty is the mechanical widening of a narrowed or totally obstructed blood vessel. These obstructions are often caused by atherosclerosis. The term angioplasty is a portmanteau of the words angio (from the Latin/Greek word meaning "vessel") and plasticos (Greek: "fit for moulding"). Angioplasty has come to include all manner of vascular interventions typically performed in a minimally invasive or percutaneous method.

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 of 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.


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.

Peripheral angioplasty

Peripheral angioplasty refers to the use of mechanical widening in opening blood vessels other than the coronary arteries. It is often called percutaneous transluminal angioplasty or PTA for short. PTA is most commonly done to treat narrowings in the leg arteries, especially the common iliac, external iliac, superficial femoral and popliteal arteries. PTA can also be done to treat narrowings in veins.

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

Generally, carotid artery stenosis is treated with angioplasty and stenting for high-risk patients in many hospitals. It has changed since the FDA has approved the first carotid stent system (Cordis) in July 2004 and the second (Guidant) in August 2004. The system comprises a stent along with an embolic capture device designed to reduce or trap emboli and clot debris. Angioplasty and stenting is increasingly being used to also treat carotid stenosis, with success rates similar to carotid endarterectomy surgery. Simple angioplasty without stenting is falling out of favor in this vascular bed. SAPPHIRE, a large trial comparing carotid endarterectomy and carotid stenting with the Cordis stent found stenting non-inferior to carotid endarterectomy.[1]

See also

  • Angiogram
  • Charles Dotter
  • Vascular surgery

References
ISBN links support NWE through referral fees

  1. ↑ Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004;351:1493-501. PMID 15470212.

External links

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