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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{{Interventions infobox |
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Name    = Angioplasty |
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Image    = Angioplasty - Balloon Inflated with Stent.png|
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Caption  = Balloon Inflated with Stent|
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ICD10    = |
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ICD9    = 00.6 |
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ICD9_mult  = {{ICD9proc|36.0}} {{ICD9proc|39.50}} |
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MeshID  = D017130 |
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OtherCodes = |
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}}
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'''Angioplasty''' is the mechanical widening of [[blood]] vessel that is abnormally narrowed (stenosis) or totally obstructed (occlusion). Angioplasty has come to include all manner of [[Blood vessel|vascular]] interventions typically performed in a minimally invasive or ''[[percutaneous]]'' (access via needle-puncture of the skin) method. Typically, it involves inflating balloons in the blood vessel to widen the vessel and using stents to provide structural support.
  
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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 [http://www.angioplasty.org/angio101/popups/stent_anim.html], but note the illustration error: the [[atheroma]] does not compress, instead it is pushed outward expanding the outer artery size.
+
Angioplasty reflects on the uniqueness of [[human being]]s, whose higher intelligence and creativity allows the development of this remarkable [[technology]], allowing the extension of human life. However, while there are many causal factors for vessel narrowing and obstruction, including ones that cannot be controlled (genetic, age), in some cases the need for angioplasty represents a failure of individuals to address controllable risk factors, such as [[tobacco]] smoking, high blood pressure, obesity, and a sedentary lifestyle.  
 +
{{toc}}
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The term ''angioplasty'' is a fusion of the words ''angio'' (from the [[Latin]]/[[Greek language|Greek]] word meaning "vessel") and ''plasticos'' (Greek: "fit for molding").  
  
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==Coronary angioplasty==
+
==Overview and basic procedure==
−
[[image:Ha1.jpg|thumb|300pc|X-ray image during Angioplasty]]
+
[[Blood vessel]]s are part of the [[cardiovascular system]] and function to transport [[blood]] throughout the body. The [[capillary|capillaries]] are the microscopic vessels that enable the actual exchange of [[water]] and chemicals between the blood and the tissues, while the conduit vessels, [[artery|arteries]] and [[vein]]s, carry blood away from the heart and through the capillaries or back towards the [[heart]], respectively.
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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.
+
At times these blood vessels can be narrowed by stenoses or blocked by occlusions. A ''stenosis'' (plural stenoses) is an abnormal narrowing in a [[blood vessel]]. Stenosis are often associated with a noise ([[bruit]]) resulting from turbulent flow over the narrowed blood vessel. This bruit can be made audible by a [[stethoscope]]. Other, more reliable methods of diagnosing a stenosis are imaging methods including [[ultrasound]], [[Magnetic Resonance Imaging]]/[[Magnetic Resonance Angiography]], [[Computed Tomography]]/CT-[[Angiography]], which display anatomic imaging (i.e. the visible narrowing of a vessel), and/or flow phenomena (signs of the movement of the bodily fluid through the bodily structure). ''Occlusion'' is a term often used in medicine to refer to blood vessels, arteries or veins, which have become totally blocked to any [[blood flow]].
  
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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.
+
Often such obstructions are often caused by [[atherosclerosis]]. ''Atherosclerosis'' is a [[disease]] affecting [[artery|arterial]] blood vessels. It is a chronic inflammatory response in the walls of arteries, in large part due to the deposition of [[lipoproteins]] (plasma proteins that carry cholesterol and [[triglycerides]]). It is commonly referred to as a "hardening" or "furring" of the arteries. It is caused by the formation of multiple [[atheroma|plaques]] within the arteries.
  
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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.  
+
Angioplasty is a procedure to widen these narrowed or occluded arteries. Originally, the procedure was performed by inserting a stiff catheter through the narrow space, followed by larger and larger catheters (Proseus 2006). Today, minimally sized devices are used, where catheters contain balloons that are inflated to widen the vessel and stents (mesh of wire) are used in the vessel for structural support (Proseus 2006). Lasers may also be used to help break up the plaque and catheters may have spinning wires or drill trips to clean out the plaque (Preseus 2006).  
  
−
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.  
+
Essentially, the technique involves preparing a site of entry into the vessel, introduction of a guidewire and movement of the guidewire to the destination, inflating a balloon on the catheter that has been passed along the guidewire, and use of a stent for structural support. Most commonly, the [[Seldinger technique]] is used to [[cannula]]te a blood vessel for access. 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.
  
−
Angioplasty is sometimes [[Eponym|referred]] to as ''Dottering'', after Dr C.T. Dotter, who, together with Dr M.P. Judkins, first [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14226164&dopt=Abstract described] 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).
+
==Types of angioplasty==
  
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===Risks of angioplasty===
+
There are various types of angioplasty and the names of the procedures are related to the type of vessel entry and equipment used (Proseus 2006). Percutaneous transluminal angioplasty (PTA), for example, involves entry through the skin (percutaneous) and transluminal refers to the movement through the vessel of interest or one that communicates with it (Preseus 2006).
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Angioplasty has become considerably safer over the years and is now commonly performed. Although it is associated with some risks<ref>[[United Kingdom|UK]]'s [[NHS]] endorsed 'Best Treatments' advice on '[[Evidence-based medicine|clinical evidence]] for patients from the [[BMJ]]' on [http://www.besttreatments.co.uk/btuk/electsurgery/18627.html Coronary angioplasty] and its [http://www.besttreatments.co.uk/btuk/electsurgery/18627.html#What%20are%20the%20risks%20of%20coronary%20angioplasty? risks]</ref> 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.
+
===Coronary angioplasty===
 +
[[Image:Ha1.jpg|right|thumb|250px|Coronary angiogram, showing the circulation in the left main coronary artery and its branches]]
  
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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.  
+
''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 [[cardiologist|invasive cardiologist]]. Percutaneous coronary intervention can be performed to reduce or eliminate the symptoms of coronary artery disease, including [[angina pectoris|angina]] (chest pain), dyspnea (shortness of breath) on exertion, and [[congestive heart failure]]. PCI is also used to abort an acute [[myocardial infarction]], and in some specific cases it may reduce [[death|mortality]].
  
−
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.
+
Coronary angioplasty, also known as ''percutaneous transluminal coronary angioplasty'' (PTCA), was first developed in 1977 by [[Andreas Gruentzig]]. The procedure was quickly adopted by numerous [[cardiologist]]s, and by the mid-1980s, many leading medical centers throughout the world were adopting the procedure as a treatment for [[coronary heart disease|coronary artery disease]] (CAD).  
  
−
When failures of PTCA occur, they are often treated using coronary artery bypass grafting ([[CABG]]).
+
Angioplasty is sometimes [[eponym]]ously referred to as ''Dottering'', after Dr. Charles Theodore Dotter, who, together with Dr. Melvin P. Judkins, first described angioplasty in 1964 (Dotter and Judkins 1964). 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).
  
−
==Peripheral angioplasty==
+
Basically, in this technique, 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.
−
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. 
 
−
<!-- Unsourced image removed: [[Image:Common iliac PTA 7mm.jpg|750px]] —>
 
  
−
==Renal artery angioplasty==
+
In coronary angioplasty, the angioplasty and stenting typically 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 (i.e., reduction) with this form of treatment compared with medical therapy, usually consisting of [[thrombolysis|thrombolytic]] ("clot busting") medication.
−
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 failure|renal function]].
 
  
−
==Carotid angioplasty==
+
===Peripheral angioplasty===
−
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 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>.
+
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 failure|renal function]].
  
 +
===Carotid angioplasty===
 +
Generally, [[carotid artery]] stenosis is treated with angioplasty and stenting for high-risk patients in many hospitals. It has changed in the [[United States]] since the [[Food and Drug Administration]] 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 (Yadav et al. 2004).
  
 
==References==
 
==References==
−
<references />
+
 
 +
* Dotter, C. T., and 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 May 30, 2019.
 +
* Proseus, E. R. 2006. Angioplasty. In J. L. Longe, ''The Gale Encyclopedia of Medicine.'' Detroit: Thomson Gale. ISBN 1414403682.
 +
* 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, and K. Ouriel. 2004. Protected carotid-artery stenting versus endarterectomy in high-risk patients. ''N Engl J Med'' 351: 1493-501. PMID 15470212
  
 
==External links==
 
==External links==
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* [http://www.angioplasty.org Angioplasty.Org]
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All links retrieved July 27, 2023.
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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]
+
*[https://www.nhlbi.nih.gov/health-topics/percutaneous-coronary-intervention Percutaneous Coronary Intervention: Also known as Coronary Angioplasty] National Heart Lung and Blood Institute.
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* [http://www.cardiovillage.com Cardiovillage], cardiovascular education online
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* [http://www.angioplasty.org Angioplasty.Org] celebrating a decade of independent cardiology news and education.
  
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[[Category:Life sciences]]
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[[Category:Life sciences]][[Category:Health and disease]][[Category:Medicine]]
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[[Category:Radiology]]
 
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[[Category:Surgery]]
 
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[[Category:Surgical procedures]]
 
  
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{{credit|84790541}}
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{{credit|Angioplasty|176879328|Blood_vessel|178618302|Stenosis|177143221|Occlusion|166038879|Atherosclerosis|178758456|Percutaneous_coronary_intervention|170182129}}

Latest revision as of 18:06, 27 July 2023

Intervention:
Angioplasty
Angioplasty - Balloon Inflated with Stent.png
Balloon Inflated with Stent
ICD-10 code:
ICD-9 code: 00.6 36.0 39.50
MeSH D017130
Other codes:

Angioplasty is the mechanical widening of blood vessel that is abnormally narrowed (stenosis) or totally obstructed (occlusion). Angioplasty has come to include all manner of vascular interventions typically performed in a minimally invasive or percutaneous (access via needle-puncture of the skin) method. Typically, it involves inflating balloons in the blood vessel to widen the vessel and using stents to provide structural support.

Angioplasty reflects on the uniqueness of human beings, whose higher intelligence and creativity allows the development of this remarkable technology, allowing the extension of human life. However, while there are many causal factors for vessel narrowing and obstruction, including ones that cannot be controlled (genetic, age), in some cases the need for angioplasty represents a failure of individuals to address controllable risk factors, such as tobacco smoking, high blood pressure, obesity, and a sedentary lifestyle.

The term angioplasty is a fusion of the words angio (from the Latin/Greek word meaning "vessel") and plasticos (Greek: "fit for molding").

Overview and basic procedure

Blood vessels are part of the cardiovascular system and function to transport blood throughout the body. The capillaries are the microscopic vessels that enable the actual exchange of water and chemicals between the blood and the tissues, while the conduit vessels, arteries and veins, carry blood away from the heart and through the capillaries or back towards the heart, respectively.

At times these blood vessels can be narrowed by stenoses or blocked by occlusions. A stenosis (plural stenoses) is an abnormal narrowing in a blood vessel. Stenosis are often associated with a noise (bruit) resulting from turbulent flow over the narrowed blood vessel. This bruit can be made audible by a stethoscope. Other, more reliable methods of diagnosing a stenosis are imaging methods including ultrasound, Magnetic Resonance Imaging/Magnetic Resonance Angiography, Computed Tomography/CT-Angiography, which display anatomic imaging (i.e. the visible narrowing of a vessel), and/or flow phenomena (signs of the movement of the bodily fluid through the bodily structure). Occlusion is a term often used in medicine to refer to blood vessels, arteries or veins, which have become totally blocked to any blood flow.

Often such obstructions are often caused by atherosclerosis. Atherosclerosis is a disease affecting arterial blood vessels. It is a chronic inflammatory response in the walls of arteries, in large part due to the deposition of lipoproteins (plasma proteins that carry cholesterol and triglycerides). It is commonly referred to as a "hardening" or "furring" of the arteries. It is caused by the formation of multiple plaques within the arteries.

Angioplasty is a procedure to widen these narrowed or occluded arteries. Originally, the procedure was performed by inserting a stiff catheter through the narrow space, followed by larger and larger catheters (Proseus 2006). Today, minimally sized devices are used, where catheters contain balloons that are inflated to widen the vessel and stents (mesh of wire) are used in the vessel for structural support (Proseus 2006). Lasers may also be used to help break up the plaque and catheters may have spinning wires or drill trips to clean out the plaque (Preseus 2006).

Essentially, the technique involves preparing a site of entry into the vessel, introduction of a guidewire and movement of the guidewire to the destination, inflating a balloon on the catheter that has been passed along the guidewire, and use of a stent for structural support. Most commonly, the Seldinger technique is used to cannulate a blood vessel for access. 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.

Types of angioplasty

There are various types of angioplasty and the names of the procedures are related to the type of vessel entry and equipment used (Proseus 2006). Percutaneous transluminal angioplasty (PTA), for example, involves entry through the skin (percutaneous) and transluminal refers to the movement through the vessel of interest or one that communicates with it (Preseus 2006).

Coronary angioplasty

Coronary angiogram, showing the circulation in the left main coronary artery and its branches

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 invasive cardiologist. Percutaneous coronary intervention can be performed to reduce or eliminate the symptoms of coronary artery disease, including angina (chest pain), dyspnea (shortness of breath) on exertion, and congestive heart failure. PCI is also used to abort an acute myocardial infarction, and in some specific cases it may reduce mortality.

Coronary angioplasty, also known as percutaneous transluminal coronary angioplasty (PTCA), was first developed in 1977 by Andreas Gruentzig. The procedure was quickly adopted by numerous cardiologists, and by the mid-1980s, many leading medical centers throughout the world were adopting the procedure as a treatment for coronary artery disease (CAD).

Angioplasty is sometimes eponymously referred to as Dottering, after Dr. Charles Theodore Dotter, who, together with Dr. Melvin P. Judkins, first described angioplasty in 1964 (Dotter and Judkins 1964). 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).

Basically, in this technique, 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 atheromatous 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.

In coronary angioplasty, the angioplasty and stenting typically 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 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 (i.e., reduction) with this form of treatment compared with medical therapy, usually consisting of thrombolytic ("clot busting") medication.

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 in the United States since the Food and Drug Administration 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 (Yadav et al. 2004).

References
ISBN links support NWE through referral fees

External links

All links retrieved July 27, 2023.

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