Angioplasty
Overview
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...

, the latter typically being a result of atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...

. An empty and collapsed balloon on a guide wire, known as a balloon catheter
Balloon catheter
A balloon catheter is a type of "soft" catheter with an inflatable "balloon" at its tip which is used during a catheterization procedure to enlarge a narrow opening or passage within the body...

, is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...

 (6 to 20 atmospheres). The balloon crushes the fatty deposits, opening up the blood vessel for improved flow, and the balloon is then deflated and withdrawn.

The word is composed of the medical combining forms of the Greek
Koine Greek
Koine Greek is the universal dialect of the Greek language spoken throughout post-Classical antiquity , developing from the Attic dialect, with admixture of elements especially from Ionic....

 words ανγειος angeus meaning "vessel" and πλαστός plastus meaning "formed" or "moulded." Angioplasty has come to include all manner of vascular
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...

 interventions that are typically performed in a minimally invasive or percutaneous
Percutaneous
In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed .The percutaneous approach is commonly used in vascular procedures...

method.
Angioplasty was initially described by the US interventional radiologist Charles Dotter in 1964.
Encyclopedia
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...

, the latter typically being a result of atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...

. An empty and collapsed balloon on a guide wire, known as a balloon catheter
Balloon catheter
A balloon catheter is a type of "soft" catheter with an inflatable "balloon" at its tip which is used during a catheterization procedure to enlarge a narrow opening or passage within the body...

, is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...

 (6 to 20 atmospheres). The balloon crushes the fatty deposits, opening up the blood vessel for improved flow, and the balloon is then deflated and withdrawn.

The word is composed of the medical combining forms of the Greek
Koine Greek
Koine Greek is the universal dialect of the Greek language spoken throughout post-Classical antiquity , developing from the Attic dialect, with admixture of elements especially from Ionic....

 words ανγειος angeus meaning "vessel" and πλαστός plastus meaning "formed" or "moulded." Angioplasty has come to include all manner of vascular
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...

 interventions that are typically performed in a minimally invasive or percutaneous
Percutaneous
In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed .The percutaneous approach is commonly used in vascular procedures...

method.

History

Angioplasty was initially described by the US interventional radiologist Charles Dotter in 1964. 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. Charles Dotter is commonly known as the "Father of Interventional Radiology" and was nominated for the Nobel Prize
Nobel Prize
The Nobel Prizes are annual international awards bestowed by Scandinavian committees in recognition of cultural and scientific advances. The will of the Swedish chemist Alfred Nobel, the inventor of dynamite, established the prizes in 1895...

 in medicine in 1978.

The first coronary angioplasty on a waking patient was performed by Swiss cardiologist Andreas Gruentzig
Andreas Gruentzig
Andreas Roland Grüntzig was a German cardiologist who first developed successful balloon angioplasty for expanding lumens of narrowed arteries.-Angioplasties:...

 in September 1977.

Causes of Coronary Artery Disease

Blockages in the arteries may be caused by hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...

, sedentary lifestyle
Sedentary lifestyle
Sedentary lifestyle is a medical term used to denote a type of lifestyle with no or irregular physical activity. A person who lives a sedentary lifestyle may colloquially be known as a couch potato. It is commonly found in both the developed and developing world...

, smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...

, high cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...

 levels, and cardiovascular disease. Removing blockages is done with angioplasty.

Angioplasties are safer than bypass surgery
Bypass surgery
Bypass surgery refers to a class of surgeries involving rerouting a tubular body part.Types include:*Cardiopulmonary bypass*Partial ileal bypass surgery*Roux-en-Y gastric bypass surgery*Vascular bypass, e.g. Coronary artery bypass surgery...

; less than 1% of people die from complications after this procedure.
Complications that may occur after or during an angioplasty:
  • Tearing of the artery, resulting in total blockage and possible myocardial infarction; this can usually be repaired with a stent
    Stent
    In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...

  • dislodging of a clot, which may cause a stroke
    Stroke
    A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

     in some circumstances (in less than 1% of patients who undergo angioplasties)
  • Bleeding or bruising where the catheter
    Catheter
    In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...

    s were inserted
  • Kidney problems, especially in people with underlying kidney disease and diabetes. This is caused by the iodine contrast dye
    Iodinated contrast
    Iodinated contrast is a form of intravenous radiocontrast containing iodine, which enhances the visibility of vascular structures and organs during radiographic procedures...

     used for the X-ray; intravenous fluids and medications can be given before and after the procedure to reduce this risk.
  • Arrhythmia (irregular heartbeat);
  • Allergic reaction to the dye given during the angioplasty
  • Myocardial infarction
    Myocardial infarction
    Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

    , which occurs in 3% to 5% of cases
  • The artery closing down instead of opening up. This may necessitate emergency coronary artery bypass grafting during the procedure (2-4% of patients).
  • Restenosis
    Restenosis
    Restenosis literally means the reoccurrence of stenosis, a narrowing of a blood vessel, leading to restricted blood flow. Restenosis usually pertains to an artery or other large blood vessel that has become narrowed, received treatment to clear the blockage and subsequently become renarrowed...

    —one of the most common complications of angioplasties, which consists in the gradual re-narrowing of the blood vessels within several weeks or months of the procedure. Some conditions increase the risk of developing this complication, e.g., hypertension, diabetes, angina
    Angina
    Angina pectoris, commonly known as angina, is chest pain due to ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries . Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries...

     or kidney disease.
  • Blood clots (in-stent thrombosis
    Thrombosis
    Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss...

    ) forming within stents hours or months after the procedure. These may cause myocardial infarction.


The risks associated with angioplasty are greater in
  • patients older than 75 years,
  • patients who suffer from diabetes or kidney disease,
  • those who have extensive heart disease or blood clots in the heart arteries
  • people with poor pumping function in their hearts
  • women


Complications such as myocardial infarction, stroke or kidney problems are, however, among the rarest. The death rate among patients who have angioplasty is very small, about 0.1% (compared to 1% to 2% for routine bypass surgery).

In most cases, when the potential benefits and the expected risks are taken into account the choice to perform angioplasty is the right one. (risk-benefit ratio).

Limited value in stable patients

The value of angioplasty in rescuing someone having a heart attack (by immediately alleviating an obstruction) is clearly defined in multiple studies, but studies have failed to find reduction in hard endpoints for angioplasty vs. medical therapy in stable angina patients. The artery-opening procedure can temporarily alleviate chest pain, but does not contribute to longevity. The "vast majority of heart attacks do not originate with obstructions that narrow arteries".

A more permanent and successful way to prevent heart attacks in patients at high risk is to give up smoking, increase exercise/yoga and take "drugs to get blood pressure under control, drive cholesterol levels down and prevent blood clotting".

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 are monitored. Usually, patients receive medication that will relax them to protect the arteries against spasm
Spasm
In medicine a spasm is a sudden, involuntary contraction of a muscle, a group of muscles, or a hollow organ, or a similarly sudden contraction of an orifice. It is sometimes accompanied by a sudden burst of pain, but is usually harmless and ceases after a few minutes...

s. Patients are typically able to walk within two to six hours following the procedure and return to their normal routine by the following week.

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

Patients with stents are usually prescribed an anticoagulant, clopidogrel
Clopidogrel
Clopidogrel is an oral, thienopyridine class antiplatelet agent used to inhibit blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease. It is marketed by Bristol-Myers Squibb and Sanofi-Aventis under the trade name Plavix. The drug works by irreversibly...

, 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
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

, 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 refers to the use of a balloon to open a blood vessels outside the coronary arteries. It is commonly done to treat atherosclerotic
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...

 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
Atherectomy
Atherectomy is a minimally invasive surgical method of removing, mainly, atherosclerosis from a large blood vessel within the body. Today, it is generally used to effectively treat peripheral arterial disease of the lower extremities...

.

Coronary angioplasty


Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty is a therapeutic procedure to treat the stenotic
Stenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....

 (narrowed) coronary arteries of the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...

 found in coronary heart disease
Coronary heart disease
Coronary artery disease is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium with oxygen and nutrients. It is sometimes also called coronary heart disease...

. These stenotic segments are due to the build up of cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...

-laden plaques that form due to atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...

. PCI is usually performed by an interventional cardiologist
Interventional cardiology
Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist, Dr. Charles...

.

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.

Renal artery angioplasty

Atherosclerotic obstruction of the renal artery
Renal artery
The renal arteries normally arise off the side of the abdominal aorta, immediately below the superior mesenteric artery, and supply the kidneys with blood. Each is directed across the crus of the diaphragm, so as to form nearly a right angle with the aorta....

 can be treated with angioplasty of the renal artery (percutaneous transluminal renal angioplasty, PTRA). Renal artery stenosis
Renal artery stenosis
Renal artery stenosis is the narrowing of the renal artery, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of the renal artery can impede blood flow to the target kidney...

 can lead to hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...

 and loss of renal function
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...

.

Carotid angioplasty

Carotid artery stenosis
Carotid artery stenosis
Carotid stenosis is a narrowing or constriction of the inner surface of the carotid artery, usually caused by atherosclerosis .-Signs and symptoms:...

 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.

See also

  • Angiogram
    Angiogram
    Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers...

  • Atherectomy
    Atherectomy
    Atherectomy is a minimally invasive surgical method of removing, mainly, atherosclerosis from a large blood vessel within the body. Today, it is generally used to effectively treat peripheral arterial disease of the lower extremities...

  • Charles Dotter
  • Interventional Radiology
    Interventional radiology
    Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...

  • Vascular surgery
    Vascular surgery
    Vascular surgery is a specialty of surgery in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The specialty evolved from general and cardiac surgery...

  • Stent
    Stent
    In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...


External links

Angioplasty Procedure
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