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 device manufacturers.
Risks of angioplasty include myocardial infarction, cardiac 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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