Angioplasty
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Angioplasty is the mechanical widening of a narrowed or totally obstructed blood vessel. These obstructions are often caused by atherosclerosis. The term angioplasty is a portmanteau of the words "angio" (from the Latin/Greek word meaning "vessel") and "plasticos" (Greek: fit for moulding). Angioplasty has come to include all manner of vascular interventions typically performed in a minimally invasive or percutaneous method.
Coronary Angioplasty
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 of 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.
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.
Peripheral Angioplasty
Peripheral angioplasty refers to the use of mechanical widening in opening blood vessels other than the coronary arteries. It is often called percutaneous transluminal angioplasty or PTA for short. PTA is most commonly done to treat narrowings in the leg arteries, especially the common iliac, external iliac, superficial femoral and popliteal arteries. PTA can also be done to treat narrowings in veins.
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
Generally, carotid artery stenosis is treated with angioplasty and stenting for high-risk patients in many hospitals. It has changed since the FDA has approved the first carotid stent system (Cordis) in July 2004 and the second (Guidant) in August 2004. The system comprises a stent along with an embolic capture device designed to reduce or trap emboli and clot debris. Angioplasty and stenting is increasingly being used to also treat carotid stenosis, with success rates similar to carotid endarterectomy surgery. Simple angioplasty without stenting is falling out of favor in this vascular bed. SAPPHIRE, a large trial comparing carotid endarterectomy and carotid stenting with the Cordis stent found stenting non-inferior to carotid endarterectomy.[1]
2011 ACCF/AHA Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[2]
Laser Angioplasty (DO NOT EDIT)[2]
| Class III (No Benefit) |
| "1. Laser angioplasty should not be used routinely during PCI[3][4][5]. (Level of Evidence: A)" |
| Class IIb |
| "1. Laser angioplasty might be considered for fibrotic or moderately calcified lesions that cannot be crossed or dilated with conventional balloon angioplasty[6]. (Level of Evidence: C)" |
Cutting Balloon Angioplasty (DO NOT EDIT)[2]
| Class III (No Benefit) |
| "1. Cutting balloon angioplasty should not be performed routinely during PCI[3][7][8]. (Level of Evidence: A)" |
| Class IIb |
| "1. Cutting balloon angioplasty might be considered to avoid slippage induced coronary artery trauma during PCI for in-stent restenosis or ostial lesions in side branches[7]. (Level of Evidence: C)" |
Related Chapters
External Links
References
- ↑ Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004;351:1493-501. PMID 15470212.
- ↑ 2.0 2.1 2.2 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 Bittl JA, Chew DP, Topol EJ, Kong DF, Califf RM (2004). "Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty". Journal of the American College of Cardiology. 43 (6): 936–42. doi:10.1016/j.jacc.2003.10.039. PMID 15028347. Retrieved 2011-12-10. Unknown parameter
|month=ignored (help) - ↑ Reifart N, Vandormael M, Krajcar M, Göhring S, Preusler W, Schwarz F, Störger H, Hofmann M, Klöpper J, Müller S, Haase J (1997). "Randomized comparison of angioplasty of complex coronary lesions at a single center. Excimer Laser, Rotational Atherectomy, and Balloon Angioplasty Comparison (ERBAC) Study". Circulation. 96 (1): 91–8. PMID 9236422. Retrieved 2011-12-10. Unknown parameter
|month=ignored (help) - ↑ Stone GW, de Marchena E, Dageforde D, Foschi A, Muhlestein JB, McIvor M, Rizik D, Vanderlaan R, McDonnell J (1997). "Prospective, randomized, multicenter comparison of laser-facilitated balloon angioplasty versus stand-alone balloon angioplasty in patients with obstructive coronary artery disease. The Laser Angioplasty Versus Angioplasty (LAVA) Trial Investigators". Journal of the American College of Cardiology. 30 (7): 1714–21. PMID 9385898. Retrieved 2011-12-10. Unknown parameter
|month=ignored (help) - ↑ Noble S, Bilodeau L (2008). "High energy excimer laser to treat coronary in-stent restenosis in an underexpanded stent". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 71 (6): 803–7. doi:10.1002/ccd.21490. PMID 18324694. Retrieved 2011-12-10. Unknown parameter
|month=ignored (help) - ↑ 7.0 7.1 Albiero R, Silber S, Di Mario C, Cernigliaro C, Battaglia S, Reimers B, Frasheri A, Klauss V, Auge JM, Rubartelli P, Morice MC, Cremonesi A, Schofer J, Bortone A, Colombo A (2004). "Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis: results of the restenosis cutting balloon evaluation trial (RESCUT)". Journal of the American College of Cardiology. 43 (6): 943–9. doi:10.1016/j.jacc.2003.09.054. PMID 15028348. Retrieved 2011-12-10. Unknown parameter
|month=ignored (help) - ↑ Mauri L, Bonan R, Weiner BH, Legrand V, Bassand JP, Popma JJ, Niemyski P, Prpic R, Ho KK, Chauhan MS, Cutlip DE, Bertrand OF, Kuntz RE (2002). "Cutting balloon angioplasty for the prevention of restenosis: results of the Cutting Balloon Global Randomized Trial". The American Journal of Cardiology. 90 (10): 1079–83. PMID 12423707. Retrieved 2011-12-10. Unknown parameter
|month=ignored (help)
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