Angioplasty

One way to unblock a coronary artery is angioplasty, or Percutaneous Transluminal Coronary Angioplasty (PTCA). A small balloon is used to compress atheromatous plaque against the artery wall. An expandable wire mesh tube (a surgical stent) may be implanted at the same time to maintain the stretch of the artery from the inside. Angioplasty and stenting is performed through a thin flexible tube during Cardiac Catheterization, often making cardiac surgery unnecessary.

Traditional coronary stents provide a mechanical framework that holds the artery wall open, preventing stenosis, or narrowing, of arteries feeding critical structures like the myocardium. Traditional stenting is superior to angioplasty alone in keeping arteries open.

Newer stents (called drug-eluting stents) are impregnated with immune-suppressing drugs that prevent re-stenosis of the artery, a major problem after coronary angioplasty. At one time, fatty deposits in arteries and blood clots (either thrombi or emboli} were thought to precipitate acute coronary events such as myocardial infarction. More recently, endothelial disruption, rupture of atheromatous plaque and subsequent adherence of blood platelets have been shown to immediately precede these events. Drug-eluting stents work by reducing the inflammatory processes, such as platelet adherence, that follow endothelial disruption.

Risks of angioplasty include myocardial infarction, cardiac arrhythmia, bleeding and death. These events, fortunately, are uncommon, and the procedure is widely practiced. Coronary angioplasty is usually performed by an interventional cardiologist, a medical doctor with special training in the treatment of the heart using invasive catheter-based procedures.