Coronary Balloon Angioplasty and Stents
(Percutaneous Coronary Intervention, PCI)
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
- Coronary balloon angioplasty and stents facts
- What is balloon angioplasty?
- How does coronary artery disease develop?
- How is coronary artery disease diagnosed?
- How is coronary artery disease treated?
- What are the complications of percutaneous coronary intervention?
- How do patients recover after percutaneous coronary intervention?
- What are the long-term results of percutaneous coronary intervention?
- Find a local Cardiologist in your town
Coronary balloon angioplasty and stents facts
- Coronary angioplasty is accomplished using a balloon-tipped catheter inserted through an artery in the groin or arm to enlarge a narrowing in a coronary artery.
- Coronary artery disease occurs when cholesterol plaque builds up (arteriosclerosis) in the walls of the arteries to the heart.
- Angioplasty is successful in opening coronary arteries in well over 90% of patients.
- Up to 30% to 40% of patients with successful coronary angioplasty will develop recurrent narrowing at the site of balloon inflation.
- The use of newer devices such as intracoronary stents and atherectomy, as well as newer pharmacologic agents has resulted in higher success rates, reduced complications, and reduced recurrence after percutaneous coronary intervention.
What is balloon angioplasty?
Balloon angioplasty of the coronary artery, or percutaneous transluminal coronary angioplasty (PTCA), was introduced in the late 1970's. PTCA is a non-surgical procedure that relieves narrowing and obstruction of the arteries to the muscle of the heart (coronary arteries). This allows more blood and oxygen to be delivered to the heart muscle. PTCA, is now referred to as percutaneous coronary intervention, or PCI, as this term includes the use of balloons, stents, and atherectomy devices. Percutaneous coronary intervention is accomplished with a small balloon catheter inserted into an artery in the groin or arm, and advanced to the narrowing in the coronary artery. The balloon is then inflated to enlarge the narrowing in the artery. When successful, percutaneous coronary intervention can relieve chest pain of angina, improve the prognosis of individuals with unstable angina, and minimize or stop a heart attack without having the patient undergo open heart coronary artery bypass graft (CABG) surgery.
In addition to the use of simple balloon angioplasty, the availability of stents, in a wire-mesh design, have expanded the spectrum of people suitable for percutaneous coronary intervention, as well as enhanced the safety and long-term results of the procedure. Since the early 1990's, more and more patients are treated with stents, which are delivered with a percutaneous coronary intervention balloon, but remain in the artery as a "scaffold". This procedure has markedly reduced the numbers of patients needing emergency CABG to below 1%, and particularly with the use of the new "medicated" stents (stents coated with medications that help prevent plaque formation), has reduced the rate of recurrence of the blockage in the coronary artery ("restenosis") to well below 10%. At present, the only patients treated with just balloon angioplasty are those with vessels less than 2mm (the smallest diameter stent), certain types of lesions involving branches of coronary arteries, those with scar tissue in old stents, or those who cannot take the blood thinner medication known asclopidogrel bisulfate (Plavix), which is taken over the long-term following the procedure.
Various "atherectomy" (plaque removal) devices were initially developed as adjuncts to percutaneous coronary intervention. These include the use of the excimer laser for photoablation of plaque, rotational atherectomy (use of a high-speed diamond-encrusted drill) for mechanical ablation of plaque, and directional atherectomy for cutting and removal of plaque. Such devices were initially thought to decrease the incidence of restenosis, but in clinical trials were shown to be of little additional benefit, and now are only used in selective cases as an adjunct to standard percutaneous coronary intervention (percutaneous artery intervention).
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