Array ( [0] => {{Short description|Procedure to widen narrow arteries or veins}} [1] => {{Use mdy dates|date=February 2016}} [2] => {{missing information|Rotablation (drilling) for calcified plaque|date=September 2020}} [3] => {{Infobox medical intervention [4] => | Name = Angioplasty [5] => | Image = Angioplasty-scheme.svg [6] => | Caption = Balloon angioplasty [7] => | ICD10 = [8] => | ICD9 = {{ICD9proc|00.6}}, {{ICD9proc|36.0}} {{ICD9proc|39.50}} [9] => | MeshID = D017130 [10] => | LOINC = {{LOINC|36760-7}} [11] => | OtherCodes = [12] => }} [13] => [14] => '''Angioplasty''', also known as '''balloon angioplasty''' and '''percutaneous transluminal angioplasty''' ('''PTA'''), is a [[minimally invasive procedure|minimally invasive]] [[endovascular surgery|endovascular]] [[Medical procedure|procedure]] used to widen narrowed or obstructed arteries or veins, typically to treat arterial [[atherosclerosis]]. [15] => [16] => A deflated balloon attached to a catheter (a [[balloon catheter]]) is passed over a guide-wire into the [[stenosis|narrowed]] [[blood vessel|vessel]] and then inflated to a fixed size. The balloon forces expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow. A [[stent]] may be inserted at the time of ballooning to ensure the vessel remains open, and the balloon is then deflated and withdrawn.{{Cite journal|title=Primary Patency With Stenting Versus Balloon Angioplasty for Arteriovenous Graft Failure: A Systematic Review and Meta-Analysis|journal = The Journal of Invasive Cardiology|volume = 31|issue = 12|pages = E356–E361|last1=K|first1=Marmagkiolis|last2=C|first2=Iliescu|date=December 2019|language=en|pmid=31786526|last3=Mmr|first3=Edupuganti|last4=M|first4=Saad|last5=Kd|first5=Boudoulas|last6=A|first6=Gupta|last7=N|first7=Lontos|last8=M|first8=Cilingiroglu}} Angioplasty has come to include all manner of [[Blood vessel|vascular]] interventions that are typically performed [[percutaneous]]ly. [17] => [18] => == Uses and indications == [19] => [20] => === Coronary angioplasty === [21] => {{Further|Percutaneous coronary intervention}} [22] => [[File:Ha1.jpg|thumb|A [[coronary angiogram]] (an X-ray with radio-opaque contrast in the coronary arteries) that shows the left [[coronary circulation]]. 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 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.]] [23] => [24] => A coronary angioplasty is a therapeutic procedure to treat the [[stenotic]] (narrowed) [[coronary artery|coronary arteries]] of the [[heart]] found in [[coronary heart disease]]. These stenotic segments of the coronary arteries arise due to the buildup of [[cholesterol]]-laden [[Atheroma|plaque]]s that form in a condition known as [[atherosclerosis]].{{Cite web|url=https://www.nhlbi.nih.gov/health-topics/atherosclerosis|title=Atheroscleoris|website=NHLBI|access-date=January 22, 2020|archive-date=October 5, 2017|archive-url=https://web.archive.org/web/20171005113430/https://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/atrisk|url-status=live}} A [[percutaneous coronary intervention]] (PCI), or coronary angioplasty with stenting, is a non-surgical procedure used to improve the blood flow to the heart. [25] => [26] => Coronary angioplasty is indicated for coronary artery diseases such as [[unstable angina]], [[NSTEMI]], [[STEMI]] and spontaneous coronary artery perforation.{{Citation|last1=Chhabra|first1=Lovely|title=Angioplasty|date=2019|url=http://www.ncbi.nlm.nih.gov/books/NBK499894/|work=StatPearls|publisher=StatPearls Publishing|pmid=29763069|access-date=2020-01-20|last2=Zain|first2=Muhammad A.|last3=Siddiqui|first3=Waqas J.|archive-date=October 24, 2022|archive-url=https://web.archive.org/web/20221024092217/https://www.ncbi.nlm.nih.gov/books/NBK499894/|url-status=live}} PCI for stable coronary disease has been shown to significantly relieve symptoms such as [[angina]], or chest pain, thereby improving functional limitations and quality of life.{{Cite journal|last=Arnold|first=Suzanne V.|date=2018|title=Current Indications for Stenting: Symptoms or Survival CME|journal=Methodist DeBakey Cardiovascular Journal|volume=14|issue=1|pages=7–13|doi=10.14797/mdcj-14-1-7|issn=1947-6094|pmc=5880567|pmid=29623167}} [27] => [28] => === Peripheral angioplasty === [29] => [30] => Peripheral angioplasty refers to the use of a balloon to open a blood vessel outside the coronary arteries. It is most commonly done to treat [[atherosclerosis|atherosclerotic]] narrowings of the abdomen, leg and [[renal]] arteries caused by [[peripheral artery disease]]. Often, peripheral angioplasty is used in conjunction with guide wire, peripheral [[Stent#peripheral artery stent|stenting]] and an [[atherectomy]].{{Cite journal|title=Percutaneous Angioplasty Versus Atherectomy for Treatment of Symptomatic Infra-Popliteal Arterial Disease|journal = Cardiovascular Revascularization Medicine |volume = 19|issue = 4|pages = 423–428|last1=O|first1=Abdullah|last2=J|first2=Omran|date=June 2018|language=en|pmid=29269152|last3=T|first3=Enezate|last4=E|first4=Mahmud|last5=N|first5=Shammas|last6=J|first6=Mustapha|last7=F|first7=Saab|last8=M|first8=Abu-Fadel|last9=R|first9=Ghadban|doi = 10.1016/j.carrev.2017.09.014|s2cid = 36093380}} [31] => [32] => ===Chronic limb-threatening ischemia=== [33] => [34] => Angioplasty can be used to treat advanced [[peripheral artery disease]] to relieve the [[claudication]], or leg pain, that is classically associated with the condition.{{Citation|last1=Topfer|first1=Leigh-Ann|title=New Technologies for the Treatment of Peripheral Artery Disease|date=2016|url=http://www.ncbi.nlm.nih.gov/books/NBK519606/|work=CADTH Issues in Emerging Health Technologies|publisher=Canadian Agency for Drugs and Technologies in Health|pmid=30148583|access-date=2020-01-30|last2=Spry|first2=Carolyn|archive-date=June 18, 2022|archive-url=https://web.archive.org/web/20220618161812/https://www.ncbi.nlm.nih.gov/books/NBK519606/|url-status=live}} [35] => [36] => The bypass versus angioplasty in severe ischemia of the leg (BASIL) trial investigated infrainguinal [[vascular bypass|bypass surgery]] first compared to angioplasty first in select patients with severe lower limb ischemia who were candidates for either procedure. The BASIL trial found that angioplasty was associated with less short term morbidity compared with bypass surgery, however long term outcomes favor bypass surgery.{{Cite journal|title=Bypass Versus Angioplasty in Severe Ischaemia of the Leg (BASIL): Multicentre, Randomised Controlled Trial|journal = Lancet|volume = 366|issue = 9501|pages = 1925–34|last1=Dj|first1=Adam|last2=Jd|first2=Beard|date=2005-12-03|language=en|pmid=16325694|last3=T|first3=Cleveland|last4=J|first4=Bell|last5=Aw|first5=Bradbury|last6=Jf|first6=Forbes|last7=Fg|first7=Fowkes|last8=I|first8=Gillepsie|last9=Cv|first9=Ruckley|s2cid = 54229954|doi = 10.1016/S0140-6736(05)67704-5}} [37] => [38] => Based on the BASIL trial, the ACCF/AHA guidelines recommend balloon angioplasty only for patients with a life expectancy of 2 years or less or those who do not have an [[Vascular bypass|autogenous vein]] available. For patients with a life expectancy greater than 2 of years life, or who have an autogenous vein, a bypass surgery could be performed first.{{Cite journal|title=2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines|journal = Journal of the American College of Cardiology|volume = 58|issue = 19|pages = 2020–45|last1=Tw|first1=Rooke|last2=At|first2=Hirsch|date=2011-11-01|language=en|pmid=21963765|pmc = 4714326|last3=S|first3=Misra|last4=An|first4=Sidawy|last5=Ja|first5=Beckman|last6=Lk|first6=Findeiss|last7=J|first7=Golzarian|last8=Hl|first8=Gornik|last9=Jl|first9=Halperin|doi = 10.1016/j.jacc.2011.08.023}} [39] => [40] => ==== Renal artery angioplasty ==== [41] => [42] => [[Renal artery stenosis]] is associated with [[hypertension]] and loss of [[renal failure|renal function]].{{Cite journal|title=Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: An Updated Systematic Review|journal = Annals of Internal Medicine|volume = 165|issue = 9|pages = 635–649|last1=G|first1=Raman|last2=Gp|first2=Adam|date=2016-11-01|language=en|pmid=27536808|last3=Cw|first3=Halladay|last4=Vn|first4=Langberg|last5=Ia|first5=Azodo|last6=Em|first6=Balk|doi = 10.7326/M16-1053|doi-access=free}} Atherosclerotic obstruction of the [[renal artery]] can be treated with angioplasty with or without [[stent]]ing of the renal artery. There is a weak recommendation for renal artery angioplasty in patients with renal artery stenosis and flash edema or congestive heart failure.{{Cite journal|last1=van den Berg|first1=Danielle T. N. A.|last2=Deinum|first2=Jaap|last3=Postma|first3=Cornelis T.|last4=van der Wilt|first4=Geert Jan|last5=Riksen|first5=Niels P.|date=July 2012|title=The efficacy of renal angioplasty in patients with renal artery stenosis and flash oedema or congestive heart failure: a systematic review|journal=European Journal of Heart Failure|volume=14|issue=7|pages=773–781|doi=10.1093/eurjhf/hfs037|issn=1879-0844|pmid=22455866|doi-access=free}} [43] => [44] => === Carotid angioplasty === [45] => {{Main|Carotid artery stenting}} [46] => [47] => [[Carotid artery stenosis]] can be treated with angioplasty and [[carotid stenting]] for patients at high risk for undergoing [[carotid endarterectomy]] (CEA).{{Cite journal|last1=Ahn|first1=Sun Ho|last2=Prince|first2=Ethan A.|last3=Dubel|first3=Gregory J.|date=September 2013|title=Carotid Artery Stenting: Review of Technique and Update of Recent Literature|journal=Seminars in Interventional Radiology|volume=30|issue=3|pages=288–296|doi=10.1055/s-0033-1353482|issn=0739-9529|pmc=3773038|pmid=24436551}} Although carotid endarterectomy is typically preferred over carotid artery stenting, stenting is indicated in select patients with radiation-induced stenosis or a carotid lesion not suitable for surgery.{{Cite journal|title=Revascularization of Radiation-Induced Carotid Artery Stenosis With Carotid Endarterectomy vs. Carotid Artery Stenting: A Systematic Review and Meta-Analysis|journal = Cardiovascular Revascularization Medicine |volume = 19|issue = 5 Pt B|pages = 638–644|last1=S|first1=Giannopoulos|last2=P|first2=Texakalidis|date=July 2018|language=en|pmid=29422277|last3=Ak|first3=Jonnalagadda|last4=T|first4=Karasavvidis|last5=S|first5=Giannopoulos|last6=Dg|first6=Kokkinidis|doi = 10.1016/j.carrev.2018.01.014|s2cid = 46801250}} [48] => [49] => === Venous angioplasty === [50] => [51] => Angioplasty is used to treat venous stenosis affecting [[Hemodialysis|dialysis]] access, with drug-coated balloon angioplasty proving to have better 6 month and 12 month patency than conventional balloon angioplasty.{{Cite journal|title=A Systematic Review and Meta-Analysis of Drug-Coated Balloon Versus Conventional Balloon Angioplasty for Dialysis Access Stenosis|journal = Journal of Vascular Surgery|volume = 70|issue = 3|pages = 970–979.e3|last1=Ij|first1=Yan Wee|last2=Hy|first2=Yap|date=September 2019|language=en|pmid=31445651|last3=Lt|first3=Hsien Ts'ung|last4=S|first4=Lee Qingwei|last5=Cs|first5=Tan|last6=Ty|first6=Tang|last7=Tt|first7=Chong|doi = 10.1016/j.jvs.2019.01.082|doi-access=free}} Angioplasty is occasionally used to treat residual [[subclavian vein]] stenosis following [[Decompression (surgery)|decompression surgery]] for [[thoracic outlet syndrome]].{{Cite journal|title=Combination Treatment of Venous Thoracic Outlet Syndrome: Open Surgical Decompression and Intraoperative Angioplasty|journal = Journal of Vascular Surgery|volume = 40|issue = 4|pages = 599–603|last1=Db|first1=Schneider|last2=Pj|first2=Dimuzio|date=October 2004|language=en|pmid=15472583|last3=Nd|first3=Martin|last4=Rl|first4=Gordon|last5=Mw|first5=Wilson|last6=Jm|first6=Laberge|last7=Rk|first7=Kerlan|last8=Cm|first8=Eichler|last9=Lm|first9=Messina|doi = 10.1016/j.jvs.2004.07.028|doi-access=free}} There is a weak recommendation for deep venous stenting to treat obstructive chronic venous disease.{{Cite journal|last1=Seager|first1=M. J.|last2=Busuttil|first2=A.|last3=Dharmarajah|first3=B.|last4=Davies|first4=A. H.|date=January 2016|title=Editor's Choice-- A Systematic Review of Endovenous Stenting in Chronic Venous Disease Secondary to Iliac Vein Obstruction|journal=European Journal of Vascular and Endovascular Surgery|volume=51|issue=1|pages=100–120|doi=10.1016/j.ejvs.2015.09.002|issn=1532-2165|pmid=26464055|doi-access=free}} [52] => [53] => == Contraindications == [54] => [55] => Angioplasty requires an access vessel, typically the [[femoral artery|femoral]] or [[radial artery]] or [[femoral vein]], to permit access to the vascular system for the wires and [[catheter]]s used. If no access vessel of sufficient size and quality is available, angioplasty is contraindicated. A small vessel diameter, the presence of posterior calcification, occlusion, hematoma, or an earlier placement of a [[vascular bypass|bypass origin]], may make access to the vascular system too difficult.{{citation needed|date=January 2022}} [56] => [57] => Percutaneous transluminal coronary angioplasty (PTCA) is contraindicated in patients with left main coronary artery disease, due to the risk of spasm of the left main coronary artery during the procedure.{{Citation|last1=Malik|first1=Talia F.|title=Percutaneous Transluminal Coronary Angioplasty (PTCA)|date=2019|url=http://www.ncbi.nlm.nih.gov/books/NBK535417/|work=StatPearls|publisher=StatPearls Publishing|pmid=30571038|access-date=2020-01-23|last2=Tivakaran|first2=Vijai S.|archive-date=July 7, 2022|archive-url=https://web.archive.org/web/20220707005115/https://www.ncbi.nlm.nih.gov/books/NBK535417/|url-status=live}} Also, PTCA is not recommended if there is less than 70% stenosis of the coronary arteries, as the stenosis it is not deemed to be hemodynamically significant below this level. [58] => [59] => == Technique == [60] => [61] => [[File:Balloon-Tipped Catheter.png|thumb|Balloon-tipped catheter.]] [62] => [63] => [[File:Angioplasty - Balloon Inflated with Stent.png|thumb|Balloon inflated with stent]] [64] => [65] => [[File:Balloon-catherter.png|right|thumb|Diagram of a balloon catheter]] [66] => [67] => Access to the vascular system is typically gained [[percutaneous]]ly (through the skin, without a large surgical incision). An [[introducer sheath]] is inserted into the blood vessel via the [[Seldinger technique]].{{Cite journal|title=Evaluation of Central Venous Access With Accelerated Seldinger Technique Versus Modified Seldinger Technique|journal = The Journal of Emergency Medicine|volume = 56|issue = 1|pages = 23–28|last1=L|first1=Thaut|last2=W|first2=Weymouth|date=January 2019|language=en|pmid=30503723|last3=B|first3=Hunsaker|last4=D|first4=Reschke|doi = 10.1016/j.jemermed.2018.10.021|s2cid = 54484203}} [[Fluoroscopy|Fluoroscopic guidance]] uses magnetic resonance or X-ray fluoroscopy and [[radiopaque]] [[contrast dye]] to guide angled wires and [[catheter]]s to the region of the body to be treated in real time.{{Cite journal|last1=Saeed|first1=Maythem|last2=Hetts|first2=Steve W.|last3=English|first3=Joey|last4=Wilson|first4=Mark|date=January 2012|title=MR fluoroscopy in vascular and cardiac interventions (review)|journal=The International Journal of Cardiovascular Imaging|volume=28|issue=1|pages=117–137|doi=10.1007/s10554-010-9774-1|issn=1569-5794|pmc=3275732|pmid=21359519}} Tapered guidewire is chosen for small occlusion, followed by intermediate type guidewires for tortuous arteries and difficulty passing through extremely narrow channels, and stiff wires for hard, dense, and blunt occlusions.{{cite journal | vauthors = Dash D | title = Guidewire crossing techniques in coronary chronic total occlusion intervention: A to Z | journal = Indian Heart Journal | volume = 68 | issue = 3 | pages = 410–20 | date = 2016 | pmid = 27316507 | pmc = 4912030 | doi = 10.1016/j.ihj.2016.02.019 | url = }} [68] => [69] => To treat a narrowing in a blood vessel, a wire is passed through the [[stenosis]] in the vessel and a [[Balloon catheter|balloon on a catheter]] is passed over the wire and into the desired position.{{Cite journal|last1=Ali|first1=Ronan|last2=Greenbaum|first2=Adam B.|last3=Kugelmass|first3=Aaron D.|date=2012-01-14|title=A Review of Available Angioplasty Guiding Catheters, Wires and Balloons - Making the Right Choice|url=https://www.icrjournal.com/articles/angioplasty-guiding-catheters|journal=Journal - A Review of Available Angioplasty Guiding Catheters, Wires and Balloons - Making the Right Choice|language=en-gb|access-date=January 22, 2020|archive-date=January 25, 2020|archive-url=https://web.archive.org/web/20200125171042/https://www.icrjournal.com/articles/angioplasty-guiding-catheters|url-status=live}} The positioning is verified by fluoroscopy and the balloon is inflated using water mixed with contrast dye to 75 to 500 times normal [[blood pressure]] (6 to 20 atmospheres), with most coronary angioplasties requiring less than 10 atmospheres.{{Cite journal|title=Inflation Pressure Requirements During Coronary Angioplasty|journal = Catheterization and Cardiovascular Diagnosis|volume = 21|issue = 3|pages = 144–7|last1=Jk|first1=Kahn|last2=Bd|first2=Rutherford|date=November 1990|language=en|pmid=2225048|last3=Dr|first3=McConahay|last4=Go|first4=Hartzler|doi = 10.1002/ccd.1810210304}} A [[stent]] may or may not also be placed. [70] => [71] => At the conclusion of the procedure, the balloons, wires and catheters are removed and the vessel puncture site is treated either with direct pressure or a [[vascular closure device]].{{Cite journal|last1=McTaggart|first1=R. A.|last2=Raghavan|first2=D.|last3=Haas|first3=R. A.|last4=Jayaraman|first4=M. V.|date=2010-06-01|title=StarClose Vascular Closure Device: Safety and Efficacy of Deployment and Reaccess in a Neurointerventional Radiology Service|journal=American Journal of Neuroradiology|language=en|volume=31|issue=6|pages=1148–1150|doi=10.3174/ajnr.A2001|issn=0195-6108|pmid=20093310|pmc=7963929|doi-access=free}} [72] => [73] => Transradial artery access (TRA) and transfemoral artery access (TFA) are two techniques for percutaneous coronary intervention.{{Cite journal|last1=Mason Peter J.|last2=Shah Binita|last3=Tamis-Holland Jacqueline E.|last4=Bittl John A.|last5=Cohen Mauricio G.|last6=Safirstein Jordan|last7=Drachman Douglas E.|last8=Valle Javier A.|last9=Rhodes Denise|last10=Gilchrist Ian C.|date=2018-09-01|title=An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association|journal=Circulation: Cardiovascular Interventions|volume=11|issue=9|pages=e000035|doi=10.1161/HCV.0000000000000035|pmid=30354598|s2cid=53031413|doi-access=free}} TRA is the technique of choice for management of acute coronary syndrome (ACS) as it has significantly lower incidence of bleeding and vascular complications compared with the TFA approach. TRA also has a mortality benefit for high risk ACS patients and high risk bleeding patients. TRA was also found to yield improved quality of life, as well as decreased healthcare costs and resources. [74] => [75] => == Risks and complications == [76] => 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: [77] => * [[Embolization]], or the launching of debris into the bloodstream [78] => * [[Internal bleeding|Bleeding]] 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. [79] => * [[Hematoma]] or [[pseudoaneurysm]] formation at the access site{{Cite journal|last1=Jongkind|first1=Vincent|last2=Akkersdijk|first2=George J. M.|last3=Yeung|first3=Kak K.|last4=Wisselink|first4=Willem|date=November 2010|title=A systematic review of endovascular treatment of extensive aortoiliac occlusive disease|journal=Journal of Vascular Surgery|volume=52|issue=5|pages=1376–1383|doi=10.1016/j.jvs.2010.04.080|issn=1097-6809|pmid=20598474|doi-access=free}} [80] => * [[Acute radiation syndrome|Radiation-induced injuries]] (burns) from the X-rays used{{cite web |last1=Calma |first1=D |title=Cardiologists are briefed about radiation risks |url=https://www.iaea.org/newscenter/news/experts-brief-doctors-radiation-safety-heart-patients |website=IAEA |access-date=September 15, 2015 |date=2004-05-06 |archive-date=March 3, 2016 |archive-url=https://web.archive.org/web/20160303022031/https://www.iaea.org/newscenter/news/experts-brief-doctors-radiation-safety-heart-patients |url-status=live }} [81] => * [[Contrast-induced nephropathy|Contrast-induced renal injury]] [82] => * Cerebral Hyperperfusion Syndrome leading to stroke is a serious complication of carotid artery angioplasty with stenting.{{Cite journal|last1=Huibers|first1=Anne E.|last2=Westerink|first2=Jan|last3=de Vries|first3=Evelien E.|last4=Hoskam|first4=Anne|last5=den Ruijter|first5=Hester M.|last6=Moll|first6=Frans L.|last7=de Borst|first7=Gert J.|date=September 2018|title=Editor's Choice - Cerebral Hyperperfusion Syndrome After Carotid Artery Stenting: A Systematic Review and Meta-analysis|journal=European Journal of Vascular and Endovascular Surgery|volume=56|issue=3|pages=322–333|doi=10.1016/j.ejvs.2018.05.012|issn=1532-2165|pmid=30196814|doi-access=free}} [83] => [84] => Angioplasty may also provide a less durable treatment for atherosclerosis and be more prone to [[restenosis]] relative to [[vascular bypass]] or [[coronary artery bypass grafting]].{{Cite journal|title=Drug-eluting Balloon Angioplasty Versus Uncoated Balloon Angioplasty for the Treatment of In-Stent Restenosis of the Femoropopliteal Arteries|journal = The Cochrane Database of Systematic Reviews|volume = 1|pages = CD012510|last1=A|first1=Kayssi|last2=W|first2=Al-Jundi|date=2019-01-26|language=en|pmid=30684445|pmc = 6353053|last3=G|first3=Papia|last4=Ds|first4=Kucey|last5=T|first5=Forbes|last6=Dk|first6=Rajan|last7=R|first7=Neville|last8=Ad|first8=Dueck| issue=1 |doi = 10.1002/14651858.CD012510.pub2}} Drug-eluting balloon angioplasty has significantly less restenosis, late lumen loss and target lesion revascularization at both short term and midterm follow-up compared to uncoated balloon angioplasty for femoropopliteal arterial occlusive disease.{{Cite journal|last1=Jongsma|first1=Hidde|last2=Bekken|first2=Joost A.|last3=de Vries|first3=Jean-Paul P. M.|last4=Verhagen|first4=Hence J.|last5=Fioole|first5=Bram|date=November 2016|title=Drug-eluting balloon angioplasty versus uncoated balloon angioplasty in patients with femoropopliteal arterial occlusive disease|journal=Journal of Vascular Surgery|volume=64|issue=5|pages=1503–1514|doi=10.1016/j.jvs.2016.05.084|issn=1097-6809|pmid=27478005|doi-access=free}} Although angioplasty of the femoropopliteal artery with paclitaxel-coated stents and balloons significantly reduces rates of vessel restenosis and target lesion revascularization, it was also found to have increased risk of death.{{Cite journal|title=Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials|journal = Journal of the American Heart Association|volume = 7|issue = 24|pages = e011245|last1=K|first1=Katsanos|last2=S|first2=Spiliopoulos|date=2018-12-18|language=en|pmid=30561254|pmc = 6405619|last3=P|first3=Kitrou|last4=M|first4=Krokidis|last5=D|first5=Karnabatidis|doi = 10.1161/JAHA.118.011245}} [85] => [86] => == Recovery == [87] => [88] => After angioplasty, most patients are monitored overnight in the hospital, but if there are no complications, patients are sent home the following day.{{Cite journal|date=1990-11-01|title=Guidelines for Percutaneous Transluminal Angioplasty|url=https://www.jvir.org/article/S1051-0443(90)72494-3/abstract|journal=Journal of Vascular and Interventional Radiology|language=en|volume=1|issue=1|pages=5–15|doi=10.1016/S1051-0443(90)72494-3|issn=1051-0443|access-date=January 23, 2020|archive-date=October 24, 2022|archive-url=https://web.archive.org/web/20221024092223/https://www.jvir.org/article/S1051-0443%2890%2972494-3/fulltext|url-status=live}} [89] => [90] => The catheter site is checked for bleeding and swelling and the heart rate and blood pressure are monitored to detect late rupture and hemorrhage. Post-procedure protocol also involves monitoring urinary output, cardiac symptoms, pain and other signs of systemic problems. Usually, patients receive medication that will relax them to protect the arteries against [[spasm]]s. Patients are typically able to walk within two to six hours following the procedure and return to their normal routine by the following week.{{cite web|url=http://professionalradiology.com/angioplasty.php|title=What should I expect after my procedure?|access-date=April 6, 2010|archive-url=https://web.archive.org/web/20100409141248/http://professionalradiology.com/angioplasty.php|archive-date=April 9, 2010|url-status=dead}} [91] => [92] => Angioplasty recovery consists of avoiding physical activity for several days after the procedure. Patients are advised to avoid heavy lifting and strenuous activities for a week.{{cite web|url=https://www.nhs.uk/conditions/coronary-angioplasty/recovery/|title=Recovery - Coronary angioplasty and stent insertion|access-date=2019-03-18|website=[[National Health Service]], UK|date=2018-06-11|archive-date=December 24, 2021|archive-url=https://web.archive.org/web/20211224154919/https://www.nhs.uk/conditions/coronary-angioplasty/recovery/|url-status=live}} Page last reviewed: 28/08/2018{{cite web|title=Coronary angioplasty and stents|publisher=Mayo Clinic|url=https://www.mayoclinic.org/tests-procedures/coronary-angioplasty/about/pac-20384761|access-date=November 1, 2020|archive-date=September 1, 2022|archive-url=https://web.archive.org/web/20220901042801/https://www.mayoclinic.org/tests-procedures/coronary-angioplasty/about/pac-20384761|url-status=live}} Patients will need to avoid physical stress or prolonged sport activities for a maximum of two weeks after a delicate balloon angioplasty.{{cite web |url=http://www.angioplastysurgery.net/recovery.php |title=Angioplasty Recovery |access-date=April 6, 2010 |archive-url=https://web.archive.org/web/20100409105655/http://www.angioplastysurgery.net/recovery.php |archive-date=April 9, 2010 |url-status=dead }} [93] => [94] => After the initial two week recovery phase, most angioplasty patients can begin to safely return to low-level exercise. A graduated exercise program is recommended whereby patients initially perform several short bouts of exercise each day, progressively increasing to one or two longer bouts of exercise.{{cite web |url=http://www.drbillsukala.com.au/exercise/exercise-after-angioplasty-stent/ |title=Exercise Guidelines After Angioplasty |access-date=November 4, 2015 |archive-date=October 29, 2015 |archive-url=https://web.archive.org/web/20151029202014/http://www.drbillsukala.com.au/exercise/exercise-after-angioplasty-stent/ |url-status=live }} As a precaution, all structured exercise should be cleared by a cardiologist before commencing. Exercise-based rehabilitation following percutaneous coronary intervention has shown improvement in recurrent angina, total exercise time, ST-segment decline, and maximum exercise tolerance.{{Cite journal|last1=Yang|first1=Xinyu|last2=Li|first2=Yanda|last3=Ren|first3=Xiaomeng|last4=Xiong|first4=Xingjiang|last5=Wu|first5=Lijun|last6=Li|first6=Jie|last7=Wang|first7=Jie|last8=Gao|first8=Yonghong|last9=Shang|first9=Hongcai|last10=Xing|first10=Yanwei|date=2017-03-17|title=Effects of exercise-based cardiac rehabilitation in patients after percutaneous coronary intervention: A meta-analysis of randomized controlled trials|journal=Scientific Reports|volume=7|pages=44789|doi=10.1038/srep44789|issn=2045-2322|pmc=5356037|pmid=28303967|bibcode=2017NatSR...744789Y}} [95] => [96] => Patients who experience swelling, bleeding or pain at the insertion site, develop [[fever]], feel faint or weak, notice a change in temperature or color in the arm or leg that was used or have [[shortness of breath]] or chest pain should immediately seek medical advice. [97] => [98] => Patients with stents are usually prescribed dual antiplatelet therapy (DAPT) which consists of a [[P2Y12 inhibitor]], such as [[clopidogrel]], which is taken at the same time as [[acetylsalicylic acid]] (aspirin).{{Cite journal|url=http://www.onlinejacc.org/content/68/10/1082|title=ACC/AHA Guideline Update on Duration of Dual Antiplatelet Therapy in CAD Patients|date=September 6, 2016|journal=Journal of the American College of Cardiology|volume=68|issue=10|pages=1082–1115|doi=10.1016/j.jacc.2016.03.513|access-date=2020-01-23|last1=Smith|first1=Sidney C.|last2=Smith|first2=Peter K.|last3=Sabatine|first3=Marc S.|last4=O'Gara|first4=Patrick T.|last5=Newby|first5=L. Kristin|last6=Mukherjee|first6=Debabrata|last7=Mehran|first7=Roxana|last8=Mauri|first8=Laura|last9=Mack|first9=Michael J.|last10=Lange|first10=Richard A.|last11=Granger|first11=Christopher B.|last12=Fleisher|first12=Lee A.|last13=Fihn|first13=Stephan D.|last14=Brindis|first14=Ralph G.|last15=Bittl|first15=John A.|last16=Bates|first16=Eric R.|last17=Levine|first17=Glenn N.|pmid=27036918|doi-access=|archive-date=October 23, 2020|archive-url=https://web.archive.org/web/20201023082230/https://www.onlinejacc.org/content/68/10/1082|url-status=live}} Dual antiplatelet therapy (DAPT) is recommended for 1 month following bare metal stent placement, for 3 months following a second generation drug-eluting stent placement, and for 6–12 months following a first generation [[drug-eluting stent]] placement. DAPT's antiplatelet properties are intended to prevent blood clots, however they also increase the risk of bleeding, so it is important to consider each patient's preferences, cardiac conditions, and bleeding risk when determining the duration of DAPT treatment. Another important consideration is that concomitant use of [[Clopidogrel]] and [[Proton-pump inhibitor|Proton Pump Inhibitors]] following coronary angiography is associated with significantly higher adverse cardiovascular complications such as major adverse cardiovascular events (MACE), stent thrombosis and myocardial infarction.{{Cite journal|last1=Bundhun|first1=Pravesh Kumar|last2=Teeluck|first2=Abhishek Rishikesh|last3=Bhurtu|first3=Akash|last4=Huang|first4=Wei-Qiang|date=January 5, 2017|title=Is the concomitant use of clopidogrel and Proton Pump Inhibitors still associated with increased adverse cardiovascular outcomes following coronary angioplasty?: a systematic review and meta-analysis of recently published studies (2012 - 2016)|journal=BMC Cardiovascular Disorders|volume=17|issue=1|pages=3|doi=10.1186/s12872-016-0453-6|issn=1471-2261|pmc=5221663|pmid=28056809 |doi-access=free }} [99] => [100] => == History == [101] => [102] => Angioplasty was first described by the US [[interventional radiologist]] [[Charles Dotter]] in 1964.{{cite journal |vauthors=Dotter CT, Judkins MP |title=Transluminal treatment of arteriosclerotic obstruction |journal=Circulation |volume=30 |pages=654–70 |date=November 1964 |pmid=14226164 |doi=10.1161/01.CIR.30.5.654 |issue=5 |doi-access=free }} Dotter pioneered modern medicine with the invention of angioplasty and the catheter-delivered stent, which were first used to treat peripheral arterial disease. On January 16, 1964, Dotter percutaneously dilated a tight, localized stenosis of the [[subsartorial artery]] in an 82-year-old woman with painful leg ischemia and gangrene who refused leg amputation. After successful dilation of the stenosis with a guide wire and coaxial Teflon catheters, the circulation returned to her leg. The dilated artery stayed open until her death from pneumonia two and a half years later.{{cite journal | last1 = Rösch |first1=Josef | year = 2003 | title = The birth, early years, and future of interventional radiology | journal = J Vasc Interv Radiol | volume = 14 | issue = 7| pages = 841–853 | pmid = 12847192 | doi=10.1097/01.RVI.0000083840.97061.5b | first2 = Frederick S. |last2=Keller| first3 = John A.|last3=Kaufman|s2cid=14197760 | display-authors = 1 }} Charles Dotter is commonly known as the "Father of [[Interventional Radiology]]" and was nominated for the [[Nobel Prize]] in medicine in 1978. [103] => [104] => The first percutaneous coronary angioplasty on an awake patient was performed in Zurich by the German cardiologist [[Andreas Gruentzig]] on September 16, 1977.{{cite web|url=http://www.ptca.org/archive/bios/gruentzig.html|title=Andreas R. Gruentzig – Biographical Sketch|work=ptca.org|access-date=February 22, 2016|archive-date=December 15, 2012|archive-url=https://web.archive.org/web/20121215190827/http://www.ptca.org/archive/bios/gruentzig.html|url-status=live}} [105] => [106] => The first percutaneous coronary angioplasties in the United States were performed on the same day (March 1, 1978) by Simon H. Stertzer at Lenox Hill Hospital in New York and Richard K. Myler at St. Mary's Hospital in San Francisco. During the previous year, also at St. Mary's Hospital in San Francisco, Myler and Gruentzig had performed dilatations in the setting of bypass surgery to test the catheter concept before Gruentzig performed the first PTCA in his catheterization lab in Zurich. [107] => [108] => The initial form of angioplasty was 'plain old balloon angioplasty' (POBA) without stenting, until the invention of bare metal stenting in the mid-1980s to prevent the abrupt closure sometimes seen with POBA. [109] => [110] => Bare metal stents were found to cause in-stent restenosis as a result of [[neointimal hyperplasia]] and stent thrombosis, which led to the invention of drug-eluting stents with anti-proliferative drugs to combat in-stent restenosis. [111] => [112] => The first coronary angioplasty with a drug delivery stent system was performed by Stertzer and Luis de la Fuente, at the Instituto Argentino de Diagnóstico y Tratamiento (English: Argentina Institute of Diagnosis and Treatment{{cite web |url= https://www.natureindex.com/institution-outputs/argentina/argentina-institute-of-diagnosis-and-treatment-iadt/5139070034d6b65e6a001a47 |title= Argentina Institute of Diagnosis and Treatment (IADT), Argentina / Institution outputs / Nature Index |website= NatureIndex.com |access-date= 28 March 2018 |archive-date= October 24, 2022 |archive-url= https://web.archive.org/web/20221024123953/https://www.nature.com/nature-index/institution-outputs/argentina/argentina-institute-of-diagnosis-and-treatment-iadt/5139070034d6b65e6a001a47 |url-status= live }}) in Buenos Aires, in 1999. [113] => [114] => [[Ingemar Henry Lundquist]] invented the over-the-wire balloon catheter that is now used in the majority of angioplasty procedures in the world.{{cite web [115] => |url = http://patents.com/us-4332254.html [116] => |title = System for filling and inflating and deflating a vascular dilating cathether assembly [117] => |work = patents.com [118] => |access-date = July 8, 2013 [119] => |archive-date = March 13, 2016 [120] => |archive-url = https://web.archive.org/web/20160313104829/http://patents.com/us-4332254.html [121] => |url-status = live [122] => }} [123] => [124] => A subset of angioplasty, known as excimer laser coronary angioplasty (ELCA), uses [[excimer laser]]s to remove small amounts of tissue, including undilatable and uncrossable lesions, in the artery in order to allow the balloon to more effectively compress plaque into the artery walls.{{cite journal |author1=R. Linsker |author2=R. Srinivasan |author3=J. J. Wynne |author4=D. R. Alonso |year=1984 |title=Far-ultraviolet laser ablation of atherosclerotic lesions |journal=Lasers Surg. Med. |volume=4 |issue=1 |pages=201–206 |doi=10.1002/lsm.1900040212 |pmid=6472033 |s2cid=12827770}} Such work was first developed in 1984 following earlier work in 1980–1983, when [[Rangaswamy Srinivasan]], [[Samuel Blum]] and [[James J. Wynne]] at [[IBM]]'s [[Thomas J. Watson Research Center|T. J. Watson Research Center]] observed the effect of the ultraviolet excimer laser on biological materials. Intrigued, they investigated further, finding that the laser made clean, precise cuts that would be ideal for delicate surgeries. This resulted in a fundamental patent{{Ref patent|country=US|number=4784135|title=Far ultraviolet surgical and dental procedures|gdate=1988-10-15}} and Srinivasan, Blum and Wynne were elected to the [[National Inventors Hall of Fame]] in 2002. In 2012, the team members were honored with [[National Medal of Technology and Innovation]] by the [[President of The United States|President]] [[Barack Obama]] for their work related to the excimer laser.{{cite web |date=2012-12-21 |title=IBM News Release |url=http://www-03.ibm.com/press/us/en/pressrelease/39829.wss |access-date=21 December 2012 |publisher=IBM}} Robert Ginsburg deployed the first used of ELCA in 1984 on a patient with severe stenosis of the deep femoral artery and a threatened limb.{{Cite journal |last1=Ginsburg |first1=R. |last2=Kim |first2=D. S. |last3=Guthaner |first3=D. |last4=Toth |first4=J. |last5=Mitchell |first5=R. S. |date=January 1984 |title=Salvage of an ischemic limb by laser angioplasty: description of a new technique |journal=Clinical Cardiology |volume=7 |issue=1 |pages=54–58 |doi=10.1002/clc.4960070112 |issn=0160-9289 |pmid=6705289|doi-access=free }} [125] => {{clear}} [126] => [127] => == References == [128] => [129] => {{Reflist|30em}} [130] => [131] => == External links == [132] => {{Commons category|Angioplasty}} [133] => {{Wiktionary|angioplasty}} [134] => * [http://www.nhlbi.nih.gov/health/dci/Diseases/Angioplasty/Angioplasty_WhatIs.html National Heart Lung and Blood Institute, Diseases and Conditions Index] [135] => * http://www.angioplasty.org [136] => [137] => {{Vascular surgery procedures}} [138] => {{Portal bar|Medicine}} [139] => {{authority control}} [140] => [141] => [[Category:Interventional radiology]] [142] => [[Category:Vascular procedures]] [] => )
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Angioplasty

Angioplasty is a medical procedure used to widen narrowed or blocked blood vessels, typically the coronary arteries. This minimally invasive technique involves the insertion of a catheter with a deflated balloon into the affected artery.

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This minimally invasive technique involves the insertion of a catheter with a deflated balloon into the affected artery. The balloon is then inflated to compress the plaque or blockage against the vessel wall, restoring blood flow. In some cases, a stent - a small, metal mesh tube - may be placed in the artery to keep it open. Angioplasty is commonly performed to treat coronary artery disease, but it can also be used in other arterial conditions such as peripheral artery disease and renal artery stenosis. The procedure has significantly impacted the field of cardiology, offering an efficient alternative to traditional open-heart surgery and improving outcomes for patients with cardiovascular disease.

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