Angioplasty

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

Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel; typically as 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 crushes the fatty deposits, so opening up the blood vessel to improved flow, and the balloon is then collapsed and withdrawn.

The word is composed of the medical combining forms of the Greek words αγγειος aggeîos meaning "vessel" and πλαστός plastós meaning "formed" or "moulded". Angioplasty has come to include all manner of vascular interventions typically performed in a minimally invasive or percutaneous method.

Causes of Coronary Artery Disease

Blockages in the arteries may be caused by hypertension, diabetes, sedentary lifestyle, smoking, high cholesterol levels, diets high in saturated fats, and cardiovascular disease. Removing blockages is done with angioplasty.

Angioplasty risks

Angioplasties are safer than bypass surgeries and according to statistics less than 1% of people die from complications after this procedure. Complications that may occur after or during an angioplasty are the following:

• Tearing of the artery resulting in total blockage and possible myocardial infarction - this can usually be repaired with a stent
• A dislodged clot may cause a stroke in some circumstances (in less than 1% of patients who undergo angioplasties);
• Bleeding or bruising where the catheters were inserted;
• Kidney problems, especially in people with underlying kidney disease and diabetes - this is caused by the iodine contrast dye used for the X-ray; intravenous fluids and medications can be given before and after the procedure to try to reduce this risk.
• Arrhythmia (irregular heartbeat);
• Allergic reaction to the dye given during the angioplasty;
• Myocardial infarction happens in 3 to 5% of the cases;
• The need for emergency coronary artery bypass grafting during the procedure (2-4 percent of people). This may occur if an artery closes down instead of opening up;
• Restenosis is one of the most common complications of angioplasties and it consists in the gradual re-narrowing of the blood vessels within the next several weeks to months after the procedure. There are certain conditions that increase the risk of developing this complication and these are hypertension, diabetes, angina or kidney disease.
• Blood clots (in-stent thrombosis) can form within stents hours or months after angioplasty and they may cause myocardial infarction.

The risks carried by angioplasty are greater in patients older than 75 years, patients who suffer from diabetes or kidney disease or who have extensive heart disease or blot clots in the heart arteries. Also, patients with poor pumping function in their hearts and women are considered to have an increased risk for complications.

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).

All in all, the risks are relatively low and acceptable in most cases when one balances the potential benefit against the expected risk (risk-benefit ratio).

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 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.

Angioplasty recovery consists in 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. 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 a blood thinner medication, clopidogrel which is taken at the same time with acetylsalicylic acid. These medications 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 administrated this type of medication for 1 year. Also, patients who are doing dental work are advised to cancel it because there is a risk of endocarditis, an infection of the heart.

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 contact their doctors.

History

File:Balloon-catherter.png

Diagram of a balloon catheter.

The first balloon angioplasty was performed interoperatively during bypass surgery in May, 1977 in St. Mary's Hospital in San Francisco, California. On September 16, 1977 German cardiologist Andreas Gruentzig (1939–85) performed the operation on an awake 37-year-old insurance salesman in Zurich, Switzerland.

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 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.

Coronary angioplasty

File:Ha1.jpg

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.

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

The SAPPHIRE trial also discloses that Jay Yadav was the inventor of the Angioguard embolic protection device used in the trial and held Angioguard stock at the time of purchase by Cordis, a sub-unit of Johnson and Johnson.

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
• Charles Dotter
• Vascular surgery
• Atherectomy
• Stent

External links

• A BBC film showing angioplasty being used for primary percutaneous intervention.
• Angioplasty.Org, celebrating a decade of independent cardiology news and education.
• Cardiovascular and Interventional Radiological Society of Europe
• Angioplasty
• Cardiovillage, cardiovascular education online
• National Heart Lung and Blood Institute, Diseases and Conditions Index
• Overview Coronary Artery Disease Treatment - Coronary Interventions ANGIOPLASTY, STENTS AND ATHERECTOMY (Cleveland Clinic)
• NYU Interventional Radiology Pictorial explanation of angioplasty and stenting

de:Angioplastie zh:血管再成形術