How Balloon Angioplasty is Done Animation - Coronary Angiography Procedure | Stenting in Heart Video
Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle.
The procedure begins with the doctor injecting some local anesthesia into the groin area and putting a needle into the femoral artery, the blood vessel that runs down the leg. A guide wire is placed through the needle and the needle is removed. An introducer is then placed over the guide wire, after which the wire is removed. A different sized guide wire is put in its place.
Next, a long narrow tube called a diagnostic catheter is advanced through the introducer over the guide wire, into the blood vessel. This catheter is then guided to the aorta and the guide wire is removed. Once the catheter is placed in the opening or ostium of one the coronary arteries, the doctor injects dye and takes an x-ray.
If a treatable blockage is noted, the first catheter is exchanged for a guiding catheter. Once the guiding catheter is in place, a guide wire is advanced across the blockage, then a balloon catheter is advanced to the blockage site. The balloon is inflated for a few seconds to compress the blockage against the artery wall. Then the balloon is deflated.
The doctor may repeat this a few times, each time pumping up the balloon a little more to widen the passage for the blood to flow through. This treatment may be repeated at each blocked site in the coronary arteries. A device called a stent may be placed within the coronary artery to keep the vessel open. Once the compression has been performed, contrast media is injected and an x-ray is taken to check for any change in the arteries. Following this, the catheter is removed and the procedure is completed.
Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty or simply angioplasty, is a non-surgical procedure used to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the buildup of the cholesterol-laden plaques that form due to atherosclerosis. PCI is usually performed by an interventional cardiologist, though it was developed and originally performed by interventional radiologists.
During PCI, a cardiologist feeds a deflated balloon or other device on a catheter from the inguinal femoral artery or radial artery up through blood vessels until they reach the site of blockage in the heart. X-ray imaging is used to guide the catheter threading. Angioplasty usually involves inflating a balloon to open the artery and allow blood flow. Stents or scaffolds may be placed at the site of the blockage to hold the artery open.
Coronary artery bypass grafting (CABG), commonly known as Heart Bypass, which bypasses stenotic arteries by grafting vessels from elsewhere in the body, is an alternative treatment. However, the coronary revascularization by CABG is associated with an increased risk of stroke. Most studies have found that CABG offers advantages in reducing death and myocardial infarction in people with multivessel blockages compared with PCI. PCI has proven to be as effective and less costly than CABG in people with myocardial ischemia that does not improve with medical treatment.
The term balloon angioplasty is commonly used to describe percutaneous coronary intervention, which describes the inflation of a balloon within the coronary artery to crush the plaque into the walls of the artery. While balloon angioplasty is still done as a part of nearly all percutaneous coronary interventions, it is rarely the only procedure performed.
Other procedures done during a percutaneous coronary intervention include:
Implantation of stents
Rotational or laser atherectomy
Brachytherapy (use of radioactive source to inhibit restenosis)
The angioplasty procedure usually consists of most of the following steps and is performed by a team made up of physicians, physician assistants, nurse practitioners, nurses, radiographers, and cardiac invasive specialists; all of whom have extensive and specialized training in these types of procedures.
Access into the femoral artery in the leg (or, less commonly, into the radial artery or brachial artery in the arm) is created by a device called an "introducer needle". This procedure is often termed percutaneous access.
Once access into the artery is gained, a "sheath introducer" is placed in the opening to keep the artery open and control bleeding.
Through this sheath, a long, flexible, soft plastic tube called a "guiding catheter" is pushed. The tip of the guiding catheter is placed at the mouth of the coronary artery. The guiding catheter also allows for radio-opaque dyes (usually iodine-based) to be injected into the coronary artery, so that the disease state and location can be readily assessed using real time X-ray visualization.
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