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For Coronary Artery Disease, Angioplasty versus Bypass Surgery

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Angioplasty

Angioplasty, is also known as balloon angioplasty and percutaneous transluminal angioplasty, is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis.

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What happens during angioplasty?

Most people have angioplasties in a hospital in a special room called a cardiac catheterization, or cath, lab. You will be awake and lying down. You’ll get medicine to help you relax through an intravenous (IV) line. This is a small tube that goes into a vein in your hand or arm.

Angioplasty is done through a blood vessel in your arm, wrist, or groin. Your doctor will:

Make a small opening in that area to insert a thin tube (a catheter) into a blood vessel.

Thread the tube through the vessel to your heart, using x-rays as a guide.

Inject contrast dye inside your arteries. The dye highlights your heart and blood vessels in the x-rays.

Replace the first tube with another one that has a small, deflated balloon on the end.

Guide the balloon inside the blockage and inflate it to push the plaque flat against the artery wall. This makes the artery wider and improves blood flow.

Sometimes put a small, mesh tube into the artery to help keep it open. The tube is called a stent. Some stents have a coating of medicine that helps prevent blood clots from forming.

Definition:

Angioplasty - Wikipedia

In the term angioplasty, “angio” means blood vessel, and “plasty” is opening up. In PCI, the “P” stands for percutaneous or “through the skin” while coronary refers to the location of blood vessels around the heart. Angioplasty is a conventional treatment for coronary heart disease (CHD) and heart attacks (acute coronary syndrome). In these conditions, there is a buildup of plaque, or atherosclerosis, on the walls of the arteries. As plaque accumulates, the arteries narrow and can become blocked.

In a heart attack, the plaque may rupture, spilling cholesterol into an artery, potentially leading to a clot that stops blood flow. During a standard angioplasty, the doctor makes an incision in the groin or wrist and inserts a tube, or catheter, into an artery. Next, they thread the catheter upwards and into the affected blood vessel around the heart. Usually, the catheter contains an inflatable balloon that displaces the plaque or clot, effectively opening up the artery.

Doctors use live X-rays and a contrast dye to guide the catheter and assess the arteries they need to treat. Compared with heart surgery, angioplasty is a minimally invasive as it does not involve opening up the chest.

Doctors may recommend angioplasty to:

  • treat an abnormal stress test
  • increase blood flow to the heart
  • reduce chest pain, or angina
  • improve blood supply to the heart muscle during or after a heart attack
  • support more activity for people with chest pain

 Types

There are two main types of angioplasty:

Balloon angioplasty, which involves using the pressure of an inflating balloon to clear plaque that is blocking an artery. This is rarely done alone except in cases when doctors are unable to place a stent in the required position.

Stent placement in the artery, which involves a tube, or stent, made out of wire mesh. Stents help to prevent an artery narrowing again after angioplasty.

Stents may be made of bare metal or have a coating of medication. When they include medication, they are called drug eluting stents (DES) and are less likely to plug up again.

DES are now used almost exclusively with very little use of bare metal stents.

Research from 2018 estimates that doctors in the U.S. implant over 1.8 million stents each year.

Recovery

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When angioplasty is complete, the cardiologist removes the catheters and bandages. Soreness, bruising, and possibly bleeding are common around the area where catheters entered the body.

Typically, a person will recover in the hospital for a few hours or overnight before going home. They must not drive as they may still have sedative medications in their system. They will also have restrictions on lifting for about a week afterward.

People can often return to work within a week, but their doctor will advise on how active they can be and when. The follow-up visit after angioplasty is a key aspect of the treatment. The doctor will review the individual’s recovery, adjust medications as they need, and develop an ongoing treatment plan for their cardiovascular health.

Technique:

Angioplasty is the treatment of choice for acute myocardial infarction. Two main approaches used for catheterization are transfemoral: classical and transradial. The transbrachial approach is not routinely done; however, the choice of procedure depends on patient’s characteristics and expertise available.

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Transradial Approach:

  • Transradial Approach

The radial artery is very superficial so it can be easily punctured, and manual compression controls bleeding. Anatomically, there are no nearby major nerves or vessels present. Thus, there is a minimal risk of neurovascular injuries. However, the diameter of the radial artery is very small and small size catheters are required. Compared to transfemoral approach, transradial approach is cost-effective and associated with early discharge from the hospital. With advancement in interventional cardiology’s hardware, transradial approach emerged as a good alternative to classical transfemoral approach. Transradial approach is associated with low risk of access site bleeding or hematoma formation, pseudoaneurysm formation, morbidity and mortality, and lower risk of hand ischemia due to the good collateral blood supply of hand by ulnar artery via palmer arch. Assessment of palmar arches can be done with the help of Allen’s test or pulse oximetry examination. Transradial approach is associated with longer duration of the procedure, greater radiation exposure, anatomical variations leading to catheterization failure, and radial artery spasm which can be managed with local injection of vasodilatory medication such as nitrates and calcium channel blockers.

  • Transfemoral Approach

The transfemoral approach is the more classical procedure and associated with easy access, less radiation time, and less contrast use. However, access site complications are more common, especially in obese patients. The complexities include access site bleeding, hematoma, major retroperitoneal bleeding requiring a blood transfusion, arteriovenous fistula formation and pseudoaneurysm and neurovascular injuries. The femoral artery is the only source of blood to the leg, so there are more chances of ischemia compared with the transradial approach.

Conclusion:

The growing population of diabetic patients has increased the number of individuals suffering from cardiovascular diseases. Moreover, people are becoming more aware about the advantages of angioplasty surgical procedure. Angioplasty surgical procedure can prevent heart attacks. In addition, angioplasty can be done via two different procedures. Both the procedures help in reducing the pain in the chest as well increases the blood flow through the previously narrowed or blocked coronary artery.


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Craig Hill

Craig began writing for prgazette.com in 2005, resulting in engaging and fascinating editorials about science and wellness progress. Craig’s inspirational and accurate science and health articles have made her very popular with the viewers. Craig graduated at the University of Illinois at Urbana-Champaign with a Bachelor of Arts degree at October in 2004. He then completed a science college internship in Fermilab, followed using a communications internship in Caterpillar. Ever since that moment, he has been writing in an independent capability for several science, health, technology, along with other books.

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