Angioplasty: 4 Different Official Techniques

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Angioplasty

Angioplasty

DEFINITION

Angioplasty is a method used to widen arteries that have been narrowed by the buildup of plaque, a condition called atherosclerosis.

Plaque blockage can occur in any artery, but angioplasty is most often performed to open the coronary arteries supplying blood to the heart.

For some people, angioplasty may be an alternative to coronary bypass surgery.

PURPOSE

In individuals with an occlusive vascular disease such as atherosclerosis, blood flow to an organ or a distant body part such as the lower leg is reduced because of the buildup of fatty deposits and/or calcium accumulation walls the artery.

This narrowing may occur in any blood vessel. Once the blood vessel is widened, adequate blood flow can be restored.

The vessel can narrow again over time (restenosis), and the procedure may be repeated.

PRECAUTIONS

Angioplasty procedures are performed in a cardiac catheterization laboratory in a hospital with equipment for correct monitoring and recuperation.

If the operation is to be performed in a coronary artery, the patient’s care is likely to be provided by a specially trained cardiologist, radiologist, nurses, and vascular specialists.

The patient may be given anticoagulants before the procedure to help prevent the development of blood clots (thromboses).

Implementation of anti-coagulants, nonetheless, can block the closing of the vascular entry point.

The action is performed using fluoroscopic guidance and contrast media so that the physician can track the position of the catheter and the blockage.

As the decision to execute angioplasty could have been made after a diagnostic angiogram, the subject’s sensitiveness to iodinated contrast media is likely to be known.

If patient sensitivity is unknown or if the patient’s renal function is severely compromised, the procedure may require an alternate contrast agent.

DESCRIPTION

Angioplasties can be performed to treat coronary artery disease (narrowing of the arteries that carry blood to the heart), carotid artery disease (narrowing of arteries in the neck that carry blood to the brain), to treat peripheral artery disease (blockage of arteries in the arms and legs), and renal (kidney) vascular hypertension.

There are various types of angioplasties. Their names are correlated with the sort of vessel entry point and equipment being used.

For instance, percutaneous transluminal angioplasty (PTA) describes entry through the skin (percutaneous) and navigates to the area of the blockage thru the same vessel or one that is communicating with it (transluminal).

If the procedure involving the coronary arteries, the point of entry could be the femoral artery in the groin. The catheter/guidewire system is passed through the aorta to coronary arteries at the source of the aorta just outside the aortic valve.

Angioplasties can be performed using several different techniques.

  • Balloon angioplasty. A catheter with a deflated balloon in its tip is inserted into an artery. When the balloon reaches the blockage, it is inflated, stretching the artery walls and widening the vessel.
  • Cutting balloon. A balloon catheter with a window on one side of the catheter and small cutting blades is inserted. At the blockage, the window is positioned against the plaque, and the balloon is inflated. The window presses against the blockage and the blades are used to cut the blockage away.
  • A hollow catheter with a window and a rotating blade is inserted. The balloon is inflated at the site of the blockage, pressing the window against the blockage. The rotating cutter is activated, and the tiny pieces of plaque are captured in the hollow catheter.
  • This procedure is not done as often as it was in the past because of the effectiveness of balloon angioplasty. A catheter with a special grinding tip is inserted, and the plaque is ground away. The small pieces of plaque enter the bloodstream and are destroyed by the liver.

Angioplasty can be executed while the subject is anesthetized or sedated build upon on the vessels affected.

If a percutaneous transluminal coronary angioplasty (PTCA) needs to be performed, the patient will be kept awake to report uneasiness and cough if needed.

PTCA actions are done in cardiac catheterization laboratories with delicate monitoring equipment. 

If angioplasty is done in the radiology department’s angiographic suite, the subject may be put under sedation for the procedure, and a medic will monitor the subject’s vital signs along the procedure being done. 

If a vascular surgeon performs the procedure, the angioplasty will occur in a surgical room or specially designed vascular procedure suite.

At the start of the procedure, introducing the angioplasty equipment is prepared as a sterile surgical site.

Once the guidewire is introduced, small injections of contrast media are used to visualize the path through the vessel using x-ray technology.

When the blockage is reached, the physician inflates the balloon or performs other angioplasty procedures.

A stent (a mesh of wire resembles a Chinese finger puzzle) may be inserted to keep the vessel open in some cases.

Some stents, called drug-eluting stents, contain a slowly released drug into the bloodstream to help prevent the artery from narrowing again (restenosis).

Widening of the artery and placement of a stent is verified using fluoroscopy and contrast media to produce an angiogram or by using intravascular ultrasound or both.

All equipment is withdrawn from the vessel, and the puncture site is repaired.

RISKS

During the procedure, there is a danger of puncturing the vessel with the guidewire.

This is a minimal risk. Patients must be monitored for bleeding at the puncture site.

There is also a small risk of heart attack, the formation of blood clots that block the artery (emboli), and, although unlikely, death.

Hospitalization will vary in length depending on the patient’s overall condition, any complications, and the availability of home care.

SPECIAL CONCERNS FOR SENIORS

Angioplasty is not appropriate for some individuals. Many seniors have additional health problems or are taking medications that increase the risk of complications.

Also, seniors are often slower to recover from the procedure than younger individuals.

KEY TERMS

Cardiac catheterization— A procedure to pass a catheter to the heart and its vessels to diagnose coronary artery disease, assess the aorta’s injury or disease, or evaluate cardiac function.
Plaque— In atherosclerosis, a swollen area in the lining of an artery is formed by fatty deposits.

QUESTIONS TO ASK YOUR DOCTOR

  • Where and how many blockages do I have?
  • How long does this procedure take?
  • How long can I expect to be hospitalized?
  • What are the most common complications of this procedure?
  • What kind of medical follow-up is required?

Resources

BOOKS

King, Martin W., et al. Coronary Artery Disease and the Evolution of Angioplasty Devices. Springer, 2020. Watson, Timothy J., Paul J.L. Ong, and James E. Tcheng, eds. Primary Angioplasty: A Practical Guide. Springer, 2018.

PERIODICALS

Bulsara, Shahzad, et al. “Ultrasound-assisted angioplasty for failing arteriovenous access.” Indian Journal of Vascular and Endovascular Surgery, vol. 6, no. 2, 2019, p. 82.

Liao, Min-Tsun, et al. “Drug-coated balloon versus conventional balloon angioplasty of hemodialysis arteriovenous fistula or graft: A systematic review and meta-analysis of randomized controlled trials.” PLoS ONE, vol. 15, no. 4, 2020, p. e0231463.

Meliota, Giovanni, et al. “Balloon angioplasty of aortic coarctation in critically ill newborns using axillary artery access.” Annals of Pediatric Cardiology, vol. 13, no. 1, 2020, p. 67.

WEBSITES

Angioplasty.” MedlinePlus. April 30, 2020. https://medlineplus.gov/angioplasty.html (accessed May 14, 2020).

“Coronary angioplasty and stents.” Mayo Clinic. November 15, 2019. https://www.mayoclinic.org/tests-procedures/coronary-angioplasty/about/pac-20384761 (accessed May 14, 2020).

“Coronary artery balloon angioplasty series—Normalanatomy.” MedlinePlus Medical Encyclopedia. April 9, 2020. https://medlineplus.gov/ency/presentations/100160_1.htm (accessed May 14, 2020).

ORGANIZATIONS

American Heart Association National Center, 7272 Greenville Avenue, Dallas, TX 75231, (800) 242-8721, http://www.heart.org

National Heart, Lung, and Blood Institute Health Information Center, PO Box 30105, Bethesda, MD 20824-0105, (301) 592-8573, Fax: (301) 592-8563, [email protected]http://www.nhlbi.nih.gov