Angioplasty

The angioplasty , including percutaneous transluminal angioplasty ( PTA , percutaneously: latin through intact skin ; transluminal: Latin within the lumen of the vessel to extend ; angioplasty ancient Greek αγγειοπλαστία , original "pottery", "the vascular creation", here in the sense of "widening" , compare angiogenesis , vasculogenesis ), is a procedure for the expansion or reopening of constricted or closed blood vessels (mostly arteries , more rarely veins ) by means of balloon dilatation or other procedures (laser, thrombectomy catheter , etc.).

The balloon catheters are almost always placed into the stenosis (constriction) from the groin via a guide wire and guide catheter and inflated with pressure (8–12 bar ). This usually eliminates the constriction and avoids an operation. In addition, stents (wire mesh that splinted the vessel from the inside and are supposed to keep it open) are often implanted ( stent angioplasty ).

The coronary arteries are called percutaneous transluminal coronary angioplasty (PTCA).

Coronary angioplasty

PTCA
A before
B during and
C after dilatation
The narrowing of a side branch (arrow) is shown as a possible complication (" snow plow phenomenon ")

As transluminal percutaneous coronary angioplasty (PTCA), also English Percutaneous coronary intervention (dt .: percutaneous coronary intervention, PCI) are techniques for expanding a narrowed or reopening of an occluded coronary vessel called without open surgery.

The PTCA is performed as part of a cardiac catheter examination after a coronary angiography . A balloon catheter is advanced through a special guide catheter introduced from the inguinal artery ( arteria femoralis ) or via the forearm artery ( arteria radialis ) . At its distal end there is a balloon that is expanded in the vascular narrowing ( stenosis ) to approx. 8–12 bar . The constriction is widened and blood flow is uninterrupted. This also makes use of the elasticity of the vessels: the calcium deposits on the plaque are pressed into the vessel wall and remain there. In order to prevent a renewed narrowing, a stent is usually implanted nowadays . The preventive placement of a stent can significantly improve the prognosis. Depending on the location of the stenosis, the vessel size, previous illnesses such as diabetes mellitus , drug-coated stents are used , in rare cases, e.g. B. If a stent becomes tight again (in-stent restenosis), medication-coated balloons are also used.

Lasers or diamond burs ( rotablation ) are rarely used instead of the balloon catheter to remove the stenosis or to prepare for a classic PTCA.

PTCA is performed as a planned procedure for chronic coronary artery disease to improve symptoms and as a life-saving emergency procedure for acute myocardial infarction (then referred to as acute PTCA). In acute coronary syndrome, early PTCA can improve survival and reduce the number of re-infarctions. According to the Occluded Artery Trial , vascular opening is no longer useful if more than two days have passed since the infarction. If PTCA is not possible, coronary artery bypass is performed.

Balloon dilatation

In interventional radiology , cardiology and angiology, balloon dilatation in the context of a PTA is a method of expanding pathologically narrowed blood vessels using a balloon attached to a vascular catheter, which is only deployed at the narrowed point. To do this, the filling pressure of the balloon with aqueous liquid is slowly increased to a value of 6–20 bar. The catheter is z. B. introduced via a femoral artery (leg artery ) and advanced to the narrowed point under X-ray control. The method is used to eliminate bottlenecks that v. a. caused by atherosclerotic changes ("vascular calcification") to expand so that they do not hinder the blood flow to a greater or lesser extent. The procedure was developed by the German cardiologist Andreas Grüntzig and made known in 1977.

Modern methods in the field of plastics processing enable the construction and further development of such balloons in order to adapt the quality individually to the needs of the patient. The flexibility of the balloons and their compressive strength are important here. The monorail balloon catheter according to Tassilo Bonzel is a globally widespread form .

application

The method is used for arteries ( arteries ) that are important for the respective organ supply such as

• of the descending aorta (for coarctation of the aorta , ISTA)
• the carotid arteries (for cerebral blood flow disorders or strokes),
• the renal arteries (including some form of high blood pressure )
• the pelvic and femoral arteries (for peripheral arterial occlusive disease , PAD) or
• the coronary arteries (for coronary heart disease , CHD).

Drug Eluting Balloons

The drug-coated balloon catheter or drug-eluting balloon catheter (engl. Drug-eluting balloon , short DEB, or drug-coated balloon ) is a further development of the conventional balloon catheter. The balloon surface is coated with a drug that is applied to the site of the vasoconstriction . The cytostatic drug paclitaxel is currently used. The drug is intended to prevent vasoconstricting overgrowth of the enlarged area. In contrast to stent therapy, no mechanically acting foreign body remains in the body after the procedure. Its use is currently limited to in-stent restenosis and vascular branching (bifurcations) in the coronary area as well as renal vessels, femoral arteries and lower leg arteries in the peripheral area.

Complications

The inner part of the vessel wall ( intima ) can tear ( aortic dissection ); in the worst case, the vessel lumen can be completely obstructed. If the blood vessel is perforated, it may bleed into the pericardium with possible tamponade or into the tissue. Possibly. must be vascular or cardiac surgery.

When a vessel is expanded near a junction, the expansion of a main branch can lead to the closure of a side branch (compare snow plow phenomenon ). This is often accepted cheaply with small branches. If two vessels of equal value are affected, there are techniques to avoid this.

See also

• Thrombectomy

Web links

• Cardiovascular and Interventional Radiological Society of Europe

Individual evidence

1. ↑ David S. Wald, Joan K. Morris, Nicholas J. Wald, Alexander J. Chase, Richard J. Edwards, Liam O. Hughes, Colin Berry, Keith G. Oldroyd: Randomized Trial of Preventive Angioplasty in Myocardial Infarction. In: New England Journal of Medicine . 2013, p. 130901000028008, doi: 10.1056 / NEJMoa1305520 .
2. ↑ Chris P. Gale, Alexander Parkhomenko, Aylin Yildirir, Mohamed Sami Mourali, Raban Jeger: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) . In: European Heart Journal . tape 39 , no. 2 , January 7, 2018, ISSN  0195-668X , p. 119–177 , doi : 10.1093 / eurheartj / ehx393 ( oup.com [accessed December 23, 2018]).
3. ↑ A. Grüntzig: The percutaneous transluminal recanalization of chronic arterial occlusions with a new dilatation technique. Baden-Baden / Cologne / New York 1977.
4. ↑ Bruno Scheller et al .: Treatment of Coronary In-Stent Restenosis with a Paclitaxel-Coated Balloon Catheter. In: N Engl J Med . 2006 Nov 16; 355 (20): 2113-24. PMID 17101615 , full text
5. ↑ Bruno Scheller et al .: Two year follow-up after treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter. In: Clinical Research in Cardiology 2008 doi: 10.1007 / s00392-008-0682-5 .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !