Angioplasty: Treatment, Effects & Risks

Angioplasty (or percutaneous transluminal angioplasty) is a procedure used to reopen or widen blocked or narrowed blood vessels. For this purpose, so-called balloon catheters are used, which are placed in the constriction and inflated.

What is angioplasty?

Angioplasty is a procedure used to reopen or widen blocked or narrowed blood vessels. So-called balloon catheters are used for this purpose. Angioplasty can be used to widen constrictions caused by blood clots or vascular calcification. Angioplasty is very rarely performed as part of an operation. More commonly, it is used as a procedure called percutaneous transluminal angioplasty (PTA).

Function, effect, and goals

Percutaneous transluminal coronary angioplasty is used to open or dilate occluded coronary arteries. In this procedure, a special guiding catheter is inserted through the forearm or inguinal artery, and a balloon catheter is then advanced into it. This balloon is inflated at the constriction point so that the constriction is widened and the blood can flow freely again. Calcium deposits can thus be pressed into the vessel wall. A stent (a wire mesh that keeps the vessel open) is then implanted. The stent is placed on the balloon catheter, brought to the constricted area and placed. The result can then be checked on the X-ray screen by administering contrast medium several times. To prevent a bruise from forming at the puncture site, the physician applies a pressure bandage. In addition, anticoagulant medication must be taken to prevent blood clots from forming on the stent. This form of angioplasty is mainly used for coronary artery disease or acute myocardial infarction. However, it does not make sense to open a vessel if the infarction occurred more than two days ago. In the course of angioplasty, a so-called balloon dilatation can also be performed. Here, pathologically narrowed blood vessels are dilated with the help of a balloon attached to a vascular catheter. This is then inflated under high pressure at the constricted site. The catheter is inserted via the leg artery and advanced to the constriction site. This allows arteriosclerotic changes to be stretched so that blood flow is less obstructed. In order to restore the normal wideness of the vessel, the procedure often has to be repeated several times. This method is mainly used in cases of aortic isthmus stenosis, cerebral circulatory disorders, after a stroke or peripheral arterial occlusive disease. It is also possible to coat the surface of the balloon with a drug, and the cytostatic drug paclitaxel is mainly used here. This drug is intended to prevent the enlarged area from overgrowing. At the moment, drug-coated balloon catheters are mainly used in the coronary area or in femoral arteries, renal vessels or arteries in the lower leg. To determine whether stent implantation, bypass surgery or balloon dilatation is necessary, a cardiac catheterization is first performed. During this examination, the heart vessels can be visualized and the physician can assess how efficient the heart chambers are. A contrast medium is injected into the coronary vessels via a catheter, so that the arteries and their secondary branches appear on the X-ray screen and constrictions can be detected. PTA is particularly suitable for short constrictions. However, the vessel must be open again behind the narrowing. If longer narrowings are detected, bypass surgery is usually necessary. If the vessel diameter increases by at least twenty percent due to the balloon dilatation and the patient is symptom-free, the treatment can be considered successful. Immediately after angioplasty, this is the case in about 80 percent of all short occlusions. If no reocclusion occurs in the next three to six months, significant symptom improvement can be expected in the long term. However, balloon dilation is not an ideal solution because the deposits that are pushed into the vessel wall can also damage it.

Risks, side effects, and hazards

Angioplasty is performed under general or local anesthesia.Before the procedure, patients are injected with drugs to dilate the coronary vessels or to inhibit clotting. Patients do not feel the advancement of the guiding catheter, as there are no nerve fibers in the inner lining of the vessel. The position of the catheter is constantly monitored by X-ray and placed over the constriction. When the contrast medium is injected, patients often experience a feeling of tension in the area of the heart. In addition, when the balloon is inflated, there is sometimes a feeling of pressure in the chest cavity, which is often also experienced as unpleasant. Similar discomfort occurs when the stent is inserted. However, these usually disappear after a few days. In addition, when angioplasty is performed, there is a possibility that the inner vessel wall will tear and the vessel lumen will be obstructed. If the vessel perforates, bleeding into the pericardium may occur, requiring cardiac surgery. However, the risk of needing surgery after a PTA is very low. If a vessel is dilated in close proximity to a branch, it is possible that a side branch may be occluded. Other possible complications include:

  • Bulging of the vessel wall
  • Emboli
  • Cardiac arrhythmias
  • Stroke
  • Thyroid function disorders due to the contrast agents
  • Nerve injuries
  • Bruise
  • Formation of an arteriovenous fistula

Because some complications may occur within hours of treatment, patients must remain in the hospital for about six hours. In the course of the next six months, vasoconstriction may occur again. For this reason, another cardiac catheterization is performed after three to six months.