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Balloon/Stent Angioplasties

Percutaneous Transluminal angioplasty refers to a technique of dilating (opening) significantly blocked arteries from inside; thus avoiding the need for much more extensive surgical intervention. 

Balloon Angioplasty

In balloon angioplasty a deflated balloon catheter is placed across the narrowed segment of the artery and then the balloon is inflated to a high pressure; thus transmitting circumferential pressure and compressing the plaque. This "normalizes" the internal luminal size. Over the ensuing several weeks to months, "natural" healing takes place. Depending upon a multitude of factors, about one-third of the arteries re-narrow and need a repeat angioplasty; about two-thirds of the arteries tend to stay open on an indefinite basis.

Excimer Laser Angioplasty

Excimer laser angioplasty refers to a technique in which a laser beam is transmitted via contact to the plaque that helps evaporate the blockage; thus creating a channel. Supplemental balloon dilatation is performed in this channel to achieve an adequate internal luminal size.

Directional Atherectomy 

Directional atherectomy refers to a technique in which part of the blockage is mechanically shaved off and removed from inside the artery and then additional balloon angioplasty or stent angioplasty may be needed. In certain specialized circumstances, when the blockages are very long and hard, a rotating diamond burr (rotational angioplasty) can be used. Increasingly, thin metal coils are being used to expand the blocked arteries.

Stent Angioplasty

Typically, a thin, slotted, stainless steel, metal tube is crimped over a balloon and taken across the narrowed segment of the artery; then high pressure is used to inflate the balloon and, thus, a slotted, metal tube (stent) is deployed across the narrowed segment. The stent provides a mechanical scaffolding and prevents the possible complete blockage of the artery that may occur due to unexpected tear with balloon angioplasty. The use of stent angioplasty, when considered appropriate, improves the chances of success, both immediately and on a long-term basis. Special blood thinning medications are necessary with stent angioplasty.

Post Procedure

Under most circumstances, following balloon angioplasty/stent angioplasty patients are observed for a period of 24 hours and usually discharged home the next day. Under most circumstances, routine activities can be resumed within a few days of the balloon/stent angioplasty; however, heavy strenuous activities are not advised following stent angioplasty for about four weeks. Also, a dental workup is not recommended for two to three months after stent angioplasty and, if it is necessary, precautionary antibiotics are advised. The stents do not interfere with metal detectors in airports.

Benefits of PTCA/STENT 

• Minimally invasive technique.
• Brief downtime.
• Avoidance of extensive surgery.
• Easy to repeat if necessary.
• Symptomatic relief with improvement in quality.
• Reduction in medications following a successful outcome.

Potential Complications

Major complications occur in 1-5% of patients undergoing the above procedures. These include:

• Risk of total occlusion of the artery with possible heart attack and bypass surgery on an emergency basis.
• Risk of stroke during catheterization.
• Less than 0.5% chance of loss of life.
• Bleeding complications.
• Possibility of deterioration of kidney function, especially in people with underlying kidney disease and diabetes. This is related to the contrast material necessary for angiography/ angioplasty.