| | | |  | | © Reed Group | | |
Coronary balloon angioplasty is a procedure designed to widen segments of coronary arteries narrowed by atherosclerotic plaque (coronary artery disease) using a catheter with a small balloon on its tip. The procedure is an alternative to coronary artery bypass surgery for restoring arterial blood flow to oxygen-deprived portions of the heart (revascularization). It is one of several methods now used to open clogged arteries; other methods include the use of stents to hold the arteries open and artherectomy, which consists of boring through the artery with a burr.
|
Source: Medical Disability Advisor
| Initially, this procedure was performed on individuals with predictable chronic pain in the chest during exertion (effort angina). Now, however, it is used for various acute coronary syndromes (unstable angina), heart attack (acute myocardial infarction), and on individuals who survive a cardiac arrest outside of the hospital.
Angioplasty may be done to relieve obstructions in one, two, or all three of the coronary arteries. It is usually performed for single-vessel disease and in some cases of double-vessel disease. Individuals with three-vessel disease often have bypass surgery rather than angioplasty because it is safer. Those with disease of the most important coronary artery (left main coronary artery) almost always have bypass surgery.
The ideal situation for angioplasty is a narrowing (stenosis) located in a straight segment of the first part of a coronary artery without angulations or branching. The narrowing is preferably short (less than 1 cm), not total (incomplete occlusion), and symmetrical without calcium or a fresh blood clot (thrombus). The extent and severity of the coronary narrowing are determined beforehand by a coronary angiogram. Recent technological advances have been made such as "steerable" guide wires and balloons that can be inflated even when narrowing is less than ideal.
Angioplasty can also be performed on bypass grafts that have become blocked. This is done only during the first year after bypass surgery, because occlusion during the first year is usually due to thickening of the dilated artery. If angioplasty is attempted on older vein grafts, heart damage may occur, because occlusion of these older grafts is often a result of build up of atherosclerotic material that can be dislodged into the distant portion of the coronary artery.
Angioplasty is not performed on mild obstructions that narrow the artery by less than 50%, because such lesions seldom cause symptoms. In addition, angioplasty may actually accelerate progress of such lesions.
Contraindications to angioplasty include lesions that are more than 2 cm long, twisted (tortuous) vessels, certain branching configuration (where there is risk of occluding one branch while dilating the other), total occlusions older than 3 months, and old vein grafts (risk of embolization). |
Source: Medical Disability Advisor
| Angioplasty is done under local anesthesia in a cardiac catheterization laboratory. Aspirin is usually administered before the procedure to thin the blood and reduce the risk of the formation of an acute blood clot at the angioplasty site.
A balloon-tipped catheter is inserted through the skin (percutaneously), guided into the aorta and advanced under a fluoroscope to the mouth of the coronary artery to be dilated. It is then further advanced into the vessel to the point of the narrowing, where it is inflated to a specific pressure with a small amount of fluid for 30 to 60 seconds. Repeat x-rays of the artery are taken to ascertain if the vessel has been adequately opened. The procedure usually requires repeat balloon inflations. |
Source: Medical Disability Advisor
| Coronary symptoms are relieved in 80% of cases of balloon angioplasty (Popma 1365). A recurrence of narrowing (restenosis) of the artery 6 to 9 months after the procedure leads to myocardial infarction, progression of atherosclerosis, or death in about 1% to 2% of cases each year (Popma 1365). Coronary symptoms that develop longer than 9 months after balloon angioplasty are likely due to new disease in a different vessel rather than to restenosis. However, survival is very good following balloon angioplasty, with a 10-year survival rate of 95% for those with single-vessel disease and 81% for those with multi-vessel disease (Popma 1365). |
Source: Medical Disability Advisor
| Symptoms of coronary artery disease are relieved in about 80% of balloon angioplasties, but in 30% to 35% of cases, the balloon will have to be reinflated due to residual atherosclerotic plaque. Only about 25% of cases achieve a satisfactory widening of the artery (less than 20% stenosis) on the first balloon inflation (Popma 1364).
The most common serious nonfatal complication of angioplasty is abrupt closure of the vessel at the site of balloon inflation. This occurs in about 2.1% to 6% of individuals and requires use of a stent or coronary artery bypass surgery to avert heart damage (acute myocardial infarction, or AMI), which occurs in 1.0% to 2.1% of cases, and/or death, which occurs in about 0.9% to1.1% of cases. Stroke occurs in 0.5% of balloon angioplasties (Popma 1365).
Other more minor complications include arrhythmias, kidney insufficiency, and perforation of a coronary artery. |
Source: Medical Disability Advisor
| Within the first week after angioplasty, individuals should avoid lifting more than 10 to 15 pounds and bending as much as possible to reduce the chances of late bleeding from the entry site in the groin. If an acute myocardial infarction occurs or urgent bypass surgery is necessary, other work restrictions may be needed. |
Source: Medical Disability Advisor
| Popma, J. J., and R. E. Kuntz. "Percutaneous Coronary and Valvular Intervention." Heart Disease: A Textbook of Cardiovascular Medicine. Eds. E. Braunwald, D. P. Zipes, and P. Libby. 6th ed. Philadelphia: W.B. Saunders, 2001. 1364-1365. |
Source: Medical Disability Advisor