Angioplasty

The word angioplasty comes from the Greek roots angio, which means vessel, and plasticos, which means molding. It is sometimes referred to as Dottering, after Dr. C.T. Dottering, who with Dr. M.P. Judkins was the first to describe angioplasty without a balloon in 1964. In medical practice, angioplasty is the invasive widening of vessels that often are closed [Page 141]off or narrowed. The most common reason for the narrowing of vessels is atherosclerosis. This decrease in the cross-sectional area of the lumen of the artery decreases blood flow to vital organs and can cause ischemic damage.

An angiogram—a form of x-ray—is performed to diagnose blockages (occlusions) or narrowings (stenosis) in arteries.

Typically, angioplasty is performed under local anesthesia by inserting a wire through the skin and into the lumen of an artery beyond the blockage. Over the wire, a balloon catheter is passed to the area of the vessel that is occluded, then hydraulically inflated. This compresses the atheromatous plaque in the wall of the artery and dilates the vessel, thus restoring blood flow to the distal segment. In some cases, a stent (mesh tube) is left behind to support the walls of the vessel and prevent reclosure.

Angioplasty with stent placement has been shown to be superior to angioplasty alone in keeping arteries open. When a stent is used, in two out of 10 people the artery will close again within the first six months. When a stent is not used, in four out of 10 people the artery will close again within the first six months. Some newer stents are coated with drugs that prevent restenosis of the artery. These drugs include sirolimus, everolimus, and paclitaxel. Most patients receiving angioplasty will need to take medication for the rest of their lives to prevent platelets in the blood from forming clots due to stent placement. These drugs include clopidogrel and/or aspirin. Also, patients will need to carry a stent placement card to alert healthcare workers to the presence of the device. The most common arteries that receive angioplasty are the coronary, renal, and carotid arteries. Less commonly, angioplasty is done on peripheral arteries and narrowed veins.

Percutaneous transluminal coronary angioplasty (PTCA) was first performed by Dr. Andreas Gruentzig in 1977. In recent years, PTCA has become favored over coronary artery bypass grafting (CABG) in treating myocardial ischemia due to coronary artery stenosis. This is typically done by threading a catheter through the groin into the femoral artery, thus allowing access to the coronary arteries. Although PTCA has been associated with increased likelihood of recurrent angina and the need for repeated procedures, it is still the treatment of choice for revascularization, as it makes surgery unnecessary. Similarly, angioplasty has replaced carotid endartectomies and renal endartectomies making surgery unnecessary in the setting of carotid stenosis and renal artery stenosis, respectively.

Angioplasty is a relatively safe procedure that has become more common in recent years. Risks include restenosis of the occluded artery, bleeding from the catheter insertion site, hematoma formation (pseudoaneurysm), dissection of the artery, allergic reaction to the imaging dye, kidney damage from the dye, heart attack, or stroke. The overall mortality from an angioplasty procedure is approximately 1 percent. The risk for mortality is directly related to the overall health of the patient.

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