Angioplasty (Percutaneous transluminal coronary angioplasty or PTCA)

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This method is commonly used in treatment of one or two vessel obstruction and in selected patients of three vessel disease. A fine tube (balloon catheter) is introduced through the artery in the groin (or at the hollow of the elbow) and directed towards the blocked coronary artery. The entire procedure is visualized on the screen. Once the catheter crosses the blocked portion of the artery, the balloon is inflated and pulled back to clear the deposits responsible for the blockade. This process is done under local anesthesia. Tubular metallic stents can also be introduced through the balloon to increase and maintain dilatation in the blocked portion. Recurrence of narrowing (restenosis) in the affected artery may lead to reappearance of anginal symptoms in some cases before one year but this can be treated effectively by repeat angioplasty. If the patient does not develop restenosis or angina in first year, the further chances are significantly reduced in subsequent four years. Introduction of metallic stents at the site of blockade reduces the chance of restenosis (recurrence of narrowing). The main  risk involved in PTCA is arterial dissection (tear) and clot formation resulting in occlusion of the vessel (but the chances are minimal). Aspirin reduces the risk of clot formation (thrombosis) during and after PTCA.

Newer techniques :-

  • Atherectomy – The obstructing plaque in the artery is removed by cutting through the plaque using the atherectomy  (‘ectomy’ means to cut) catheters. Depending upon the nature of the plaque, Directional, Rotational or Extraction atherectomy catheter are used.
  • Laser – Flexible catheters are used to deliver the laser energy tothe site of obstruction in order to ablate (to dissolve) the  plaque.