Angioplasty

Opening blocked arteries without major surgery was first performed in 1977. Only ten years later, nearly a quarter of a million of these procedures, called angioplasty, had been performed.

Beginning like an angiogram, balloon angioplasty uses a special catheter which has a balloon-like bladder at the tip that is filled with a fluid and then expanded when it is at the site of a blockage. Unlike the angiogram, where the patient can follow much of what is happening, in angioplasty most patients do not see the procedure. The principle is quite simple, if pressure can push the plaque back against the artery walls, the obstruction can be made smaller and the blood can pass through more easily.

Unfortunately, nature doesn't always respond the way we would like it to. In some cases. the plaque deposits reform almost at once, creating the same blockage. In some cases the problem becomes worse. In nine cases out of ten, arteries will have increased flow, but within 3 years, more than 60% of these procedures will have to be redone, 40% with another angioplasty and 22% with by-pass surgery. Blockages may also begin to form in new locations. If the causes of the problem, usually related to diet, lack of exercise and smoking, are not altered, angioplasty is likely to only provide temporary relief of more serious problems.

Angioplasty relieves chest pain for half to three quarters of the people who undergo it, but the risks and complications are much greater than those for an angiogram. Only a very few people, about one tenth of one percent, die from complications of angioplasty. Because of the chance of complications, usually a cardiac surgeon, prepared to perform immediate open-heart surgery, will be present and ready to operate. Between 3% and 5% of angioplasty patients will need immediate by-pass surgery. The application of anti-clotting agents during angioplasty has brought about an improved success rate.

There are variations of balloon catheterization which use laser beams to melt the plaque deposits and stents, which may only be temporary, as by-pass surgery is frequently needed later.

The stent is a tiny wire-mesh cylinder. looking something like a ball-point pen spring, that is inserted into a clogged coronary artery to hold it open. In about 40 percent of cases, however, the artery eventually becomes clogged again, often within six months. It's a process called restenosis. Many patients must undergo repeated angioplasties to have their arteries opened and reopened again.

Inserting a stent into the newly opened artery cuts the restenosis rate to 20 percent. However, these patients sometimes suffer 'in-stent restenosis', where artery-clogging scar tissue forms in and around the stent itself. Because the scar tissue is harder than plaque, balloon angioplasty is often useless in treating in-stent restenosis.

In early 2001, a new treatment method became available, called coronary brachytherapy. This involves threading a string of tiny, radioactive beads to the site of the clog. Initially developed in cancer treatment, radiation therapy kills the scar cells, halting their growth. And because the treatment can be accurately targeted and the dose precisely controlled, nearby tissue is not exposed to potentially damaging radiation.

Atherectomy is another procedure that involves a high speed shaving device, or fine abrasive head, to pare the plaque off in very fine layers from the inside. Sometimes called roto-rooters, these work in much the same way as sewer pipe cleaners. The risk factors in laser and other atherectomy are higher than for balloon angioplasty.

The October, 2006 issue of Dr. John McDougall's newsletter has an excellent article on angioplasty and stents.

Next: Coronary Artery Bypass Surgery

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©1994, 1996, 2002
Dr. Neal Pinckney
Healing Heart Foundation
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