Angioplasty is a technique used to reopen the arteries of the heart (coronary arteries) narrowed or blocked without resorting to major surgery. Practiced for the first time in 1977, angioplasty is now an intervention as common as bypass surgery. This technique is sometimes called percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). Angio means that a "blood vessel of interest" and plasty means "repair ". Angioplasty can also be used in other parts of the body, typically to treat peripheral vascular disease.

Balloon Angioplasty

Preparation for intervention:
A person must be treated by angioplasty should not eat after midnight the day before angioplasty, but may drink clear liquids. Patients can usually continue to take their medication, provided first talking to their doctor. Those taking medications for "blood thinners" such as warfarin * must inform the doctor as it may be necessary to stop taking them five days before the intervention. Patients taking insulin may have to reduce the dose of insulin. It must also notify the doctor if you are allergic to iodine or shellfish, since the surgeon injects a dye-based iodine during angioplasty. Some blood tests are sometimes necessary preliminary before angioplasty. Smoking is prohibited for 24 hours before and after angioplasty, of course it is best to quit completely to ensure better results.

The patient who underwent angioplasty remains conscious, but he received a local anesthetic. Intervention is sometimes uncomfortable, but usually it is not painful. The surgeon a small incision in the groin or arm and inserts a flexible hollow tube (catheter) into a main artery. It then injects a substance contrast radiolabeled with iodine in the blood can easily observe the arteries to radiography, the X-ray machine that takes pictures every five seconds as the surgeon moves the catheter up the blocked artery. When the catheter reached the site of obstruction, the surgeon introduces the probe in the balloon catheter. When the probe reaches the balloon segment narrowed blood vessel, the surgeon inflates the balloon. The fat deposits are then compressed against the artery walls, thus increasing its diameter. The operation can last from 30 minutes to two hours.

New methods of angioplasty sometimes used in combination with the probe balloon:
1. The stents (also known as extenders or guardians) are small hollow metal tubes that can be inserted and deployed using the balloon to keep the artery open. Approximately 30% of those treated by an angioplasty balloon catheter to return to classic after less than six months to unblock the artery again because it has narrowed again (restenosis), where the balloon was inflated . The use of stents reduces this percentage by half. The establishment of a stent will soon be the standard treatment.

2. The drug-coated stents are stents that have undergone special treatment and which, once implemented and deployed, gradually release a drug into the arterial wall. They further reduce the risk of having to repeat the intervention and it is used particularly in subjects at risk of arterial restenosis after initial intervention.

3. The directional atherectomy is a technique in which the surgeon uses a miniature rotating blade to remove fat deposits and dispose of the body.

4. The rotational atherectomy allows spraying resistant fat deposits with a diamond tip drill.

5. The intracoronary radiation to irradiate the segment of the artery dilated with angioplasty balloon probe; studies have shown that this experimental technique decreases by 70% the risk of restenosis of the artery.

After intervention:
Most people are admitted to the hospital and their condition was monitored overnight after angioplasty. In general, they can go home early the next day. They must verify that there is no bleeding at the entry point of the catheter and absolutely contact the doctor if the wound is bleeding, is purulent or discolored, or if they experience chest pain or entry point of the catheter. The patient should avoid any efforts for a week. Patients who received a stent usually have to take another medication to "thin" the blood called clopidogrel plus acetylsalicylic acid at least during the first months to prevent clots from forming on the metal stent. It may also be preferable to postpone dental care because of the risk of endocarditis.

Angioplasty or coronary artery bypass graft (CABG) surgery?
The bypass is an effective but more invasive to restore blood flow to the heart It usually stop heartbeat and cooling of the heart, the patient being kept alive with a heart-lung machine . It must also take segments of vein usually in one or both legs which serve as grafts for bypass.

Angioplasty offers the advantage of restoring normal caliber of the artery without the need for a large surgery. In contrast, angioplasty involves a risk of restenosis. This means that the artery becomes blocked again by the formation of scar tissue and possibly new plates. If resistant angioplasty restenosis six months, there are good chances that the results are permanent, but the risk of restenosis is significantly greater after angioplasty and after CABG.

For against, angioplasty allows patients to receive other treatments later. When the artery clogging again after CABG, the number of venous or arterial segments is sometimes insufficient to take a second graft. In addition, a second angioplasty results in a less severe trauma to the body a second open heart operation.

Sometimes the circumstances require a choice. For example, people who have many serious blockages, a diffuse disease, particularly if they are diabetic, may have advantage to bypass surgery. Moreover, in most hospitals, it does not perform angioplasty in patients with several major arteries are blocked. Indeed, during angioplasty, the artery is completely blocked on a temporary basis when the balloon is inflated. If other arteries are blocked, the patient may suffer a heart attack. In patients aged over 80 or suffering from another serious condition, an open heart operation may be too severe trauma. Therefore, in such cases, angioplasty may be a better choice, regardless of the number of blocked arteries.

Angioplasty is a procedure safer than bypass surgery. Fewer than one in 100 dies from complications of angioplasty. As for serious non-fatal complications, they occur in 1% to 5% of patients. These complications include:

1) A tear in the lining of the artery causing an obstruction and a total risk of heart attack - the device can usually repair this tear
2) A stroke caused by a clot that dislodges while the catheter is inside the body
3) Bleeding or bruising (blue)
4) Renal complications, particularly among people who suffer from kidney disease and diabetes, and this complication is caused by the substance-based contrast iodine used for radiography. You can administer fluids and medications intravenously before and during surgery to reduce this risk.


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