Angioplasty (or balloon angioplasty) is an endovascular procedure to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis. An empty, collapsed balloon, known as a balloon catheter, is passed over a wire into the narrowed locations and then inflated to a fixed size. The balloon forces expansion of the stenosis (narrowing) within the vessel and the surrounding muscular wall, opening up the blood vessel for improved flow, and the balloon is then deflated and withdrawn. A stent may or may not be inserted at the time of ballooning to ensure the vessel remains open.
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 buildup 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.
Angioplasty requires an access vessel, typically the femoral or radial artery or femoral vein to permit access to the vascular system for the wires and catheters used. If no access vessel of sufficient size and quality is available, angioplasty is contraindicated. Small diameter, the presence of posterior calcification, occlusion, hematoma, or a bypass origin may all render a vessel inadequate to serve as an access point to the vascular system.
Access to the vascular system is typically gained percutaneously (through the skin, without a large surgical incision). An introducer sheath is inserted into blood vessel via the Seldinger technique. Fluoroscopic guidance and radiopaque contrast dye are used to guide angled wires and catheters to the region of the body to be treated. To treat a narrowing in a blood vessel, a wire is passed through the stenosis in the vessel and a balloon on a catheter is passed over the wire and into the desired position.
Risks and complications
Relative to surgery, angioplasty is a lower-risk option for the treatment of the conditions for which it is used, but there are unique and potentially dangerous risks and complications associated with angioplasty:
Embolization, or the launching of debris into the bloodstream
Arterial rupture from over-inflation of a balloon catheter or the use of an inappropriately large or stiff balloon, or the presence of a calcified target vessel.
Hematoma or pseudoaneurysm formation at the access site
Radiation Injuries Radiation induced injuries (burns) from the X-Rays used.
Angioplasty may also provide a less durable treatment for atherosclerosis, and be more prone to re-stenosis, relative to vascular bypass or coronary artery bypass grafting.
After angioplasty, most patients are monitored overnight in the hospital, but if there are no complications, patients are sent home the following day.
The catheter site is checked for bleeding and swelling and the heart rate and blood pressure is 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 of 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.