Background

Angioplasty is invasive procedure used to open blocked coronary arteries without open heart surgery, which restores blood flow to the heart muscle. 

It was previously called percutaneous coronary intervention (PCI).
In 1977, Andreas Gruentzig performed first successful human coronary angioplasty with help of double-lumen balloon catheter.  

Improved catheter designs and imaging techniques enhanced angioplasty safety. Angioplasty is a non-surgical treatment for coronary artery disease symptoms. 

For e.g., chest pain and shortness of breath 

Indications

Angioplasty is preferred in patients with coronary artery disease, especially in cases of unstable angina and coronary perforation. 

Angioplasty is indicated to improves quality of life when medications and lifestyle changes are ineffective. Urgent treatment for high heart attack risk includes angioplasty to prevent complications and stabilize. 

Primary angioplasty restores blood flow to the heart quickly and reduces damage which improves survival rates in acute myocardial infarction cases. 

Cerebral angioplasty opens head and neck vessels to prevent stroke risk. Renal artery angioplasty treats high blood pressure from kidney vessel issues. 

Contraindications

Severe arterial disease blocks catheter, while complete artery occlusion prevents effective angioplasty. 

Patients with bleeding risk conditions need specialized procedure management techniques. 

Uncontrolled severe hypertension raises complications risk during medical procedures that requires attention. 

Left main coronary artery obstruction which requires coronary artery bypass grafting over angioplasty for more effective treatment of heart. 

Kidney impairment may worsen with contrast dye, thus consider alternatives before imaging procedures. 

Thorough assessment of health and existing conditions to ensure procedure eligibility. 

Outcomes

Angioplasty success rates are typically over 90%, especially in skilled surgeons and carefully chosen patients. 

Recovery from angioplasty is quick, with patients discharged within a day and back to normal activities within a week. 

Restenosis rates lower with drug-eluting stents releasing medication preventing scar tissue growth, generally around 5-10% incidence. Long-term survival rates post-angioplasty like CABG for certain coronary artery disease types. 

Primary angioplasty effectively restores blood flow, minimizes heart damage, improves survival rates, and reduces heart failure. 

Equipment

• Catheterization Laboratory (Cath Lab) 
• Access and Guidance Equipment 
• Contrast and Imaging Tools 
• Monitoring and Support Equipment

Patient Preparation

Review detailed medical history, including cardiac events and surgeries. Conduct physical examination to identify potential procedure complications. 

Patients must fast for 6 to 8 hours before the procedure to lower aspiration risk from eating and drinking. 

Consent form signed after discussing risks, benefits, potential complications with cardiologist. 

Patient lies on procedure table in catheterization lab sterilized environment then insertion site cleaned, sterilized and patient covered with sterile drapes. 

Fig. Angioplasty 

Step 1: Use of Local anesthesia 

Local anesthesia numbs insertion site and mild sedation relaxes patient without full unconsciousness. 

Step 2: Insertion of Sheath, Guide Wire and Catheter: 

Incision is made at insertion site, then sheath inserted into artery for procedure. 

Guide wire threaded through sheath and advanced towards coronary arteries under fluoroscopic guidance. 

Then the catheter guided over wire to coronary arteries for angiogram to locate and assess blockage extent. 

Step 3: Advancement of Balloon Catheter 

A catheter with balloon is inserted over guide wire to blocked site in the artery. It precisely targets the narrowed section. 

Step 4: Balloon Inflation: 

The balloon inflates for seconds to minutes, compresses plaque against artery wall, thus it widens artery for better circulation. 

Step 5: Removal of Equipment: 

The angiogram confirms open artery and restored blood flow in final procedure. 

Guide wire, catheter, and sheath are removed. Then pressure was applied to the site to prevent bleeding and sealed with closure device. 

Complications

Bleeding from catheter site causes bruising and hematoma. 

Damage to blood vessels or coronary arteries from catheter. 

Blockage in artery or blood clot during surgery may cause heart attack 

A tear in the coronary artery wall may occur and irregular heartbeats arise during the procedure. Displacement of plaque or clot leads to brain stroke. 

Artery re-narrowing is more common with bare-metal, reduced with drug-eluting stents. 

References

Angioplasty – StatPearls – NCBI Bookshelf (nih.gov) 

References

Angioplasty – StatPearls – NCBI Bookshelf (nih.gov)