Angioplasty

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Angioplasty (PTA = percutaneous transluminal angioplasty) is a treatment method for widening closed or narrowed blood vessels. The doctor uses a special catheter that he inserts into the vascular system. The best known form is percutaneous transluminal angioplasty of the coronary arteries (PTCA). Here you can read everything you need to know about angioplasty, how it works and what risks it entails.

What is Angioplasty?

Angioplasty is a therapeutic method from vascular medicine for the treatment of narrowing of the blood vessels. The doctor pushes a flexible guide wire along a narrowing in the blood vessel and expands it using an inflatable balloon (balloon dilatation).

Angioplasty is also known as percutaneous transluminal angioplasty, or PTA for short: “percutaneous” means that access to the vessel is through the skin; "Transluminal" means that the catheter is advanced within the vascular cavity.

When to do an angioplasty

The formation of plaques on the inner wall of the blood vessels disturbs or even completely interrupts the blood flow - this is what the doctor calls stenosis. The narrowed vessel is made passable again by means of angioplasty. This is important, for example, in coronary artery disease (CHD) or later stages of peripheral arterial occlusive disease (PAD). In some cases, however, angioplasty is not enough to remove the constriction. Open surgery is then necessary.

What do you do during an angioplasty?

Angioplasty is usually done in the hospital. If necessary, the patient is given a sedative and a local anesthetic at the puncture site. The doctor then inserts a flexible plastic tube, the balloon catheter, into the arterial vascular system through an artery. He usually uses the large inguinal artery for this, but sometimes also an artery in the crook of the elbow or on the wrist.

The doctor now pushes the catheter in the vascular system to the affected vascular segment. He determines exactly where the constriction is by injecting a contrast medium into the vessels and taking X-rays - this way he can see where the catheter is in the vascular system at any point in the treatment.

In the area of ​​the stenosis, the balloon is inflated, thereby expanding the constriction. The plaque, which is the cause of the narrowing of the cavity, is not removed, but pressed into the vessel wall.

If the stenosis cannot be widened by balloon dilatation alone, the doctor also inserts a stent over the guide wire. It is a tubular vascular prosthesis made of metal. It is either inflated via the balloon or unfolds itself. The stent remains in the vessel even after the angioplasty and keeps it open.

Finally, the doctor carefully pulls the catheter back through the vessels and removes it. A pressure bandage is applied to the puncture site so that it does not bleed again. The entire treatment usually takes about 30 to 45 minutes.

PTCA stent: bare metal or drug eluting?

When choosing the right stent, the doctor has two options: The so-called bare metal stent (BMS), as the name suggests, is made of bare metal. After insertion, it is overgrown by the cells of the inner wall of the vessel over time. This lowers the risk that the blood will be stimulated to clot through direct contact with a foreign body. However, the overgrowth of the stent with new cells can easily lead to a renewed stenosis of the vessel.

The drug eluting stent (DES), on the other hand, is coated with substances that inhibit the growth of cells on its surface, for example immunosuppressants or cytostatics. This reduces the risk of a new stenosis. Conversely, however, there is a risk that the blood will tend to form blood clots (thrombosis) due to prolonged contact with the metal foreign body material.

Which stent is now suitable for which patient depends on the individual risk of thrombosis or renewed stenosis.

What are the risks of angioplasty?

Angioplasty is now a routine and safe procedure when performed by a qualified and experienced doctor. However, as with any medical intervention, complications can arise. These include:

• Sense of tension, slight pain after the anesthesia has subsided
• Bruise (hematoma) at the injection site
• allergic reactions to the contrast, anesthetic or pain reliever (such as nausea, itching, skin rash), extremely rarely severe allergic reactions such as cardiovascular disorders, respiratory disorders, cramps
• Formation of blood clots, possibly with occlusion of a subsequent vascular segment (embolism)
• very rarely heavy bleeding or secondary bleeding at the injection site
• extremely rarely inflammation of the puncture site
• very rarely vascular, nerve or soft tissue damage

In people with an overactive thyroid gland (hyperthyroidism), the function of the thyroid gland can be disturbed. A metabolic disorder may develop in diabetics who take medication containing metformin.

Angioplasty of the coronary arteries, the PTCA, can lead to cardiac arrhythmias and, in the worst case, to a heart attack.

What do I have to consider after an angioplasty?

Following the groin angioplasty, you will usually have to stay in bed for several hours. This will help prevent excessive bleeding. In addition, you are not allowed to take a hot bath or shower for 12 hours. You should also not smoke for the next 24 hours. Also avoid major physical exertion in the next few days.

If a stent has been inserted, your doctor will prescribe anticoagulant medication. You should conscientiously take this according to his prescription.

If angioplasty was performed on a leg vessel and you experience numbness, coldness, or change in skin color on the leg in the days or weeks after it, you should contact your doctor immediately.

Also tell your doctor if you experience pain where the balloon catheter was inflated.

How successful is angioplasty?

In some patients, vascular narrowing occurs again in the same place in the months after the angioplasty (this happens a little less often when a stent is inserted). Accordingly, if symptoms recur, you should consult your doctor to have the vascular status checked. If necessary, another angioplasty or another therapy method is necessary.

The following applies specifically to PTCA: If you develop heart problems again in the weeks or months that follow, you should contact your doctor immediately. He can then recognize a possible renewed constriction and treat it accordingly.

Keep in mind that angioplasty only treats one symptom. A healthy lifestyle and the treatment of possible underlying diseases (such as diabetes) are necessary for a permanent improvement in blood circulation.

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