Synonyms

Coronary angioplasty; Percutaneous coronary intervention (PCI); Percutaneous transluminal angioplasty (PTA); Percutaneous transluminal coronary angioplasty (PTCA)

Definition

Angioplasty is a minimally invasive (nonsurgical) percutaneously performed clinical procedure used to dilate blood vessels narrowed or blocked by atherosclerosis. Historically, angioplasty was performed most commonly on the coronary arteries that supply blood to the heart muscle. However, recent evidence indicates its effectiveness in improving cerebral circulation in patients with acute stroke. Angioplasty may be used to treat coronary artery disease, which often presents with persistent angina (chest pain) or a myocardial infarction (heart attack), cerebrovascular disease causing stroke or transient ischemic attacks, renal artery stenosis causing kidney dysfunction, and peripheral artery disease, usually in the blood vessel of the leg. During angioplasty, a stent is placed in the vessel to keep the vessel patent.

Current Knowledge

In this procedure, a small incision is made over the skin of a peripheral artery (usually the femoral artery in the thigh), and the artery is punctured to gain access into the blood vessel. A thin catheter is then inserted into the blood vessel, and both blood vessels and catheter are visualized by radiographic fluoroscopy. The catheter is then pushed further into the vessel (guided by fluoroscopic images). When the tip of the catheter reaches the target blood vessel, a previously folded balloon at the end of the catheter is inflated to flatten the plaque in the vessel wall, thereby reducing the blockage and expanding the diameter of the artery. Usually, a stent, a metal mesh tube of small diameter which also was on the end of the catheter, is then placed inside the vessel and expanded by manipulating the catheter tip. Many of these stents, called “drug-eluting stents,” contain and secrete antiplatelet medications that assist in preventing arterial stenosis in the future. The result of the angioplasty is a dilated artery and improved blood flow through the vessel.

This procedure is done to prevent the vessel from developing narrowing or becoming blocked again. It is a relatively safe procedure, and complications are rare, but they include allergy, bleeding, clotting, stroke, kidney failure, and re-blockage of the newly opened artery. After the procedure, patients usually remain on bedrest for a short time and are instructed to use antiplatelet medications.

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