Percutaneous transluminal coronary angioplasty (PTCA), or angioplasty, is an invasive procedure performed to reduce or eliminate blockages in coronary arteries. The goal of PTCA is to restore blood flow to blood-deprived heart tissue, reduce the need for medication, and eliminate or reduce the number of episodes of angina (chest pain).
Opening a blockage, or a plaque, in a coronary artery typically involves the use of an angioplasty balloon. When the blockage is calcified or so dense that a balloon cannot be placed, other devices are used. Plaque can be cut out, ablated with a laser, or bored out using a surgical drill bit. Often, a stent is implanted after angioplasty to keep the artery open and prevent restenosis (regrowth of plaque).
The arteries are accessed through a needle puncture made in the groin (femoral artery) or arm (brachial artery). Usually the femoral artery is used. More than one blockage can be treated during a single session, depending on the location of the blockages and the patient's condition. The procedure can take 30 minutes to several hours, depending on the number of blockages being treated
Pre-procedure : -
Physicians should be notified if the patient has an allergy to shellfish or intravenous dye, or has diabetes or kidney disease. These patients may not tolerate the iodine-based dye used in angioplasty, and an agent that carries less risk for severe allergic reaction or kidney failure may be used
High-risk patients (e.g., those with unstable angina, diabetes, kidney disease) may be admitted to the hospital the night before the procedure to receive intravenous hydration and a steroid to lower the risk for complications. Angioplasty patients often are given aspirin at least 2 hours before the procedure. Aspirin-sensitive patients may be given another antiplatelet drug, such as ticlopidine or clopidogrel (Plavix®).
Angioplasty is performed in a catheterization laboratory equipped with x-ray equipment and monitors. Before going into the catheterization lab, a mild sedative is given to the patient and the insertion area may be shaved. In the catheterization lab, the insertion area is cleansed with a sterilizing solution, covered with sterile drapes, and numbed with a local anesthetic.
An incision is made and a pencil-sized plastic sheath is inserted. Flexible catheters are passed through the sheath to the blocked coronary artery. The devices used to open the artery (e.g., balloon, laser, burr) are advanced to the blockage through the catheters. An iodine-based dye or other contrast agent is injected to make the arteries and blockage(s) visible on a monitor. Physicians use a monitor to guide them during the procedure.
What Is Coronary Angioplasty ?
Coronary angioplasty performed in India is a medical procedure in which a balloon is used to open a blockage in a coronary (heart) artery narrowed by atherosclerosis. This procedure improves blood flow to the heart.
Atherosclerosis is a condition in which a material called plaque builds up on the inner walls of the arteries. This can happen in any artery, including the coronary arteries, which carry oxygen-rich blood to your heart. When atherosclerosis affects the coronary arteries, the condition is called coronary artery disease (CAD).
Balloon Angioplasty and Stents :
Coronary artery disease (CAD) affects almost 1.3 million Americans, making it the most common form of heart disease. CAD most often results from a condition known as atherosclerosis, which happens when a waxy substance forms inside the arteries that supply blood to your heart. This substance, called plaque, is made of cholesterol, fatty compounds, calcium, and a blood-clotting material called fibrin. As the plaque builds up, the artery narrows, making it more difficult for blood to flow to the heart.
As the blockage gets worse, blood flow to the heart slows and a condition called angina pectoris may develop. Patients often say that angina is like a squeezing, suffocating, or burning feeling in their chest. The pain usually happens when the heart has an extra demand for blood, such as during exercise or times of emotional stress. In time, the narrowed or blocked artery can lead to a heart attack.
What is balloon angioplasty?
Interventional cardiologists perform angioplasty, which opens narrowed arteries. They use a long, thin tube called a catheter that has a small balloon on its tip. They inflate the balloon at the blockage site in the artery to flatten or compress the plaque against the artery wall. Angioplasty is also called percutaneous transluminal coronary angioplasty (PTCA).
Cerebral Angioplasty : -
During an angioplasty, your vascular surgeon inflates a small balloon inside a narrowed blood vessel. The balloon helps to widen your blood vessel and improve blood flow
The procedure takes two hours or more to complete, this really depends upon how tortuous, or curvy your blood vessels are.
Angioplasty and stenting is usually done through a small incision or puncture or sometimes a small incision in your skin, called the access site.
A catheter is inserted in the artery in your groin. Using X-ray guidance, your physician then guides the catheter through your blood vessels to the blocked area. The tip of the catheter carries the angioplasty balloon or stent.
A dye that can be seen on x-rays (radiopaque dye) is injected, and x-rays are taken so that the narrowed area can be located. After the stent and filter are placed, the catheter is removed.
In most angioplasty procedures, a stent is placed in the blocked artery. A stent is a small metal mesh tube that is implanted in the arteries to help keep the blood vessel open. Stents may be coated with drugs that help keep the artery open.
How to Prepare for the Test ?
You should not eat or drink anything for 8 hours before the test starts. You may need to stay in the hospital the night before the test. Otherwise, you will check in to the hospital the morning of the test.
You will wear a hospital gown. You must sign a consent form before the test. Your health care provider will explain the procedure and its risks. Tell your doctor if you are allergic to seafood, if you have had a bad reaction to contrast material in the past, if you are taking Viagra, or if you might be pregnant
How the Test Will Feel ?
You are awake during the test. You may feel some pressure at the site where the catheter is inserted. Occasionally, a flushing sensation occurs after the dye is injected. After the test, the catheter is removed. You might feel a firm pressure at the insertion site, used to prevent bleeding. If the catheter is placed in your groin, you will usually be asked to lie flat on your back for a few hours after the test to avoid bleeding. This may cause some mild back discomfort.
Why the Test is Performed ?
Coronary angiography is done to find a blockage in the coronary arteries, which can lead to heart attack. It may be done if you have unstable angina, atypical chest pain, aortic stenosis, or unexplained heart failure
Risks : -
Risks of the procedure include the following :-
Trauma to the artery causing a hematoma
Low blood pressure
Allergic reaction to contrast medium
In general, there is a risk of bleeding, infection, and pain at the IV site.
There is always a very small risk that the soft plastic catheters could actually damage the blood vessels.
Blood clots could form on the catheters and later block blood vessels elsewhere in the body.
The contrast material could damage the kidneys (particularly in patients with diabetes).
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