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Coronary Angioplasty - Percutaneous
Transluminal Coronary Angioplasty (PTCA)
One way to unblock a coronary artery is angioplasty, or Percutaneous
Transluminal Coronary Angioplasty (PTCA). A wire is passed through the
diseased coronary artery, to an area of the coronary artery that is
not being worked upon. Over this wire, a catheter is passed to the
segment that is to be opened up. The tip of the catheter contains a
small balloon. When the balloon is inflated, it compresses the
atheromatous plaque against the artery wall. An expandable wire mesh
tube (stent) may be implanted at the same time to maintain the stretch
of the artery from the inside.
Angioplasty and stenting is performed through a thin flexible catheter
during Cardiac Catheterization, often making heart surgery
unnecessary. While coronary angioplasty has consistently been shown to
reduce symptoms due to coronary artery disease and to reduce cardiac
ischemia, it has not been shown in large trials to reduce mortality
due to coronary artery disease.
Traditional ("bare metal") coronary stents provide a mechanical
framework that holds the artery wall open, preventing stenosis, or
narrowing, of arteries feeding critical structures like the
myocardium. Traditional stenting is superior to angioplasty alone in
keeping arteries open.
Newer stents (called drug-eluting stents) are coated with drugs that
prevent re-stenosis of the artery. Two drugs, sirolimus and paclitaxel,
have been demonstrated effective and safe in this application by stent
Risks of angioplasty include
arrhythmia, bleeding and death. These events, fortunately, are
uncommon, and the procedure is widely practiced. Coronary angioplasty
is usually performed by an interventional cardiologist, a medical
doctor with special training in the treatment of the heart using
invasive catheter-based procedures.
Angioplasty is sometimes referred to as Dottering, after Dr C.T. Dotter,
who, together with Dr M.P. Judkins, first described angioplasty
(without the balloon) in 1964 (Circulation 1964;30:654-70).
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