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Encyclopedia > Angioplasty

Angioplasty is the mechanical widening of a narrowed or totally-obstructed blood vessel. These obstructions are often caused by atherosclerosis. f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ...


The term "angioplasty" is a portmanteau of the words "angio" (from the Latin/Greek word meaning vessel) and "plasticos" (Greek: fit for moulding). Angioplasty has come to include all manner of vascular interventions typically performed in a minimally-invasive or "percutaneous" method. A portmanteau (IPA pronunciation: RP, US) is a word or morpheme that fuses two or more words or word parts to give a combined or loaded meaning. ... Latin was the language originally spoken in the region around Rome called Latium. ... f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an open approach where inner organs or tissue are exposed (typically with the use of a scalpel). ...

Contents

Coronary angioplasty

A coronary angiogram (an X-ray with radio-opaque contrast in the coronary arteries) that shows the left coronary circulation. The distal left main coronary artery (LMCA) is in the left upper quadrant of the image. Its main branches (also visible) are the left circumflex artery (LCX), which courses top-to-bottom initially and then toward the centre/bottom, and the left anterior descending (LAD) artery, which courses from left-to-right on the image and then courses down the middle of the image to project underneath of the distal LCX. The LAD, as is usual, has two large diagonal branches, which arise at the centre-top of the image and course toward the centre/right of the image.
A coronary angiogram (an X-ray with radio-opaque contrast in the coronary arteries) that shows the left coronary circulation. The distal left main coronary artery (LMCA) is in the left upper quadrant of the image. Its main branches (also visible) are the left circumflex artery (LCX), which courses top-to-bottom initially and then toward the centre/bottom, and the left anterior descending (LAD) artery, which courses from left-to-right on the image and then courses down the middle of the image to project underneath of the distal LCX. The LAD, as is usual, has two large diagonal branches, which arise at the centre-top of the image and course toward the centre/right of the image.

Coronary angioplasty, also known as "percutaneous transluminal coronary angioplasty", was first developed in 1977 by Andreas Gruentzig. The procedure was quickly adopted by numerous cardiologists, and by the mid-1980's, many leading medical centers throughout the world were adopting the procedure as a method to avoid bypass surgery. Angioplasty Owned by and taken of Bleiglass File links The following pages link to this file: Myocardial infarction Angioplasty Categories: GFDL images ... Angioplasty Owned by and taken of Bleiglass File links The following pages link to this file: Myocardial infarction Angioplasty Categories: GFDL images ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... The coronary circulation consists of the blood vessels that supply blood to and from the heart muscle itself. ... The left coronary artery, abbreviated LCA and also known as the left main coronary artery (often abbreviated LMCA), arises from the aorta above the left cusp of the aortic valve. ... The LCX, or left circumflex artery (or circumflex artery, or circumflex branch of the left coronary artery) follows the left part of the coronary sulcus, running first to the left and then to the right, reaching nearly as far as the posterior longitudinal sulcus. ... The LAD, or left anterior descending artery (or anterior interventricular branch of the left coronary artery, or anterior descending branch) passes at first behind the pulmonary artery and then comes forward between that vessel and the left auricula to reach the anterior interventricular sulcus, along which it descends to the... Percutaneous coronary intervention is an invasive cardiologic therapeutic procedure to treat narrowed coronary arteries (artery stenosis). ... In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an open approach where inner organs or tissue are exposed (typically with the use of a scalpel). ... Andreas R. Gruentzig, 1939-1985, was a German radiologist who first developed successful angioplasty for expanding lumens of narrowed arteries. ... ... Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ...


Angioplasty is sometimes eponymously referred to as Dottering, after Dr Charles Theodore Dotter, who, together with Dr Melvin P. Judkins, first described angioplasty in 1964[1]. As the range of procedures performed upon lumens of coronary arteries has widened, the name of the procedure has changed to percutaneous coronary intervention (PCI). An eponym is the name of a person, whether real or fictitious, who has (or is thought to have) given rise to the name of a particular place, tribe, discovery, or other item. ... Charles Theodore Dotter (1920-1985) was a vascular radiologist who is generally credited with developing interventional radiology[1]. Dotter, together with Dr Melvin P. Judkins, described angioplasty in 1964[2] ^ Payne M (2001). ... Lumen can mean: lumen (unit), the SI unit of luminous flux 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 lumen (anatomy), the cavity or channel within a tubular structure, such as the vascular lumen of a blood vessel or the lumen of a seminiferous tubule... Percutaneous coronary intervention is an invasive cardiologic therapeutic procedure to treat narrowed coronary arteries (artery stenosis). ...


Sometimes a small mesh tube, or "stent", is introduced into the blood vessel or artery to prop it open using percutaneous methods. Angioplasty with stenting is a viable alternative to heart surgery.[2] It has consistently been shown to reduce symptoms due to coronary artery disease and to reduce cardiac ischemia, but has not been shown in large trials to reduce mortality due to coronary artery disease, except in patients being treated for a heart attack acutely (also called primary angioplasty). There is a small but definite reduction of mortality with this form of treatment compared with medical therapy, which usually consists of the administration of thrombolytic ("clot busting") medication.[3][4] Endoscopic image of self-expanding metallic stent in esophagus, which was used to palliatively treat esophageal cancer. ... Endoscopic image of self-expanding metallic stent in esophagus, which was used to palliatively treat esophageal cancer. ... Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ...


Procedure

The angioplasty procedure usually consists of most of the following steps and is performed by physicians, nurses, radiological technologists and cardiac invasive specialist; all whom have extensive and specialized training in these types of procedures. // A nurse is a health care professional who is engaged in the practice of nursing. ... Radiology is the branch of medical science dealing with the medical use of x-ray machines or other such radiation devices. ...

  1. Access into the femoral artery in the leg (or, less commonly, into the radial artery or brachial artery in the arm) is created by a device called an "introducer needle". This procedure is often termed percutaneous access.
  2. Once access into the artery is gained, a "sheath introducer" is placed in the opening to keep the artery open and control bleeding.
  3. Through this sheath, a long, flexible, soft plastic tube called a "guiding catheter" is pushed. The tip of the guiding catheter is placed at the mouth of the coronary artery. The guiding catheter also allows for radiopaque dyes (usually iodine based) to be injected into the coronary artery, so that the disease state and location can be readily assessed using real time x-ray visualization.
  4. During the x-ray visualization, the cardiologist estimates the size of the coronary artery and selects the type of balloon catheter and coronary guidewire that will be used during the case. Heparin (a "blood thinner" or medicine used to prevent the formation of clots) is given to maintain blood flow.
  5. The coronary guidewire which is an extremely thin wire with a radiopauqe flexible tip that is inserted into through the guiding catheter and into the coronary artery. While visualizing again by real-time x-ray imaging, the cardiologist guides the wire through the coronary artery to the site of the stenosis or blockage. The tip of the wire is then passed across the blockage. The cardiologist controls the movement and direction of the guide wire by gently manipulating the end that sits outside the patient through twisting of the guidewire.
  6. While the guidewire is in place, it now acts as the pathway to the stenosis. The tip of the angioplasty or balloon catheter is hollow and is then inserted at the back of the guidewire--thus the guidewire is now inside of the angioplasty catheter. The angioplasty catheter is gently pushed forward, until the deflated balloon is inside of the blockage.
  7. The balloon is then inflated, and it compresses the atheromatous plaque and stretches the artery wall to expand.
  8. If an expandable wire mesh tube (stent) was on the balloon, then the stent will be implanted (left behind) to support the new stretched open position of the artery from the inside.[5]

fgfuog;oh;hl;ihgkufkhgfhgfjhgfhjfdgjfdgfd Femoral artery and its major branches - right thigh, anterior view. ... In human anatomy, the radial artery is the main blood vessel, with oxygenated blood, of the lateral aspect of the forearm. ... The brachial artery is a blood vessel of the upper arm. ... In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an open approach where inner organs or tissue are exposed (typically with the use of a scalpel). ... Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ... An Atheroma (plural: atheromata) is an unhealthy tissue growth which develops within the walls of arteries over time. ... Endoscopic image of self-expanding metallic stent in esophagus, which was used to palliatively treat esophageal cancer. ...


Coronary stenting

Traditional ("bare metal") coronary stents provide a mechanical framework that holds the artery wall open, preventing stenosis, or narrowing, of coronary arteries. PTCA with stenting has been shown to be superior to angioplasty alone in patient outcome by keeping arteries patent for a longer period of time.[6] Endoscopic image of self-expanding metallic stent in esophagus, which was used to palliatively treat esophageal cancer. ...


Newer drug-eluting stents (DES) are traditional stents that are coated with drugs, which, when placed in the artery, release certain drugs over time. It has been shown that these types of stents help prevent restenosis of the artery through several different physiological mechanisms, which rely upon the suppression of tissue growth at the stent site and local modulation of the body's inflammatory and immune responses. Three drugs, sirolimus, everolimus and paclitaxel, have been demonstrated safety and efficacy in this application in controlled clinical trials by stent device manufacturers. [citation needed] However, in 2006 three broad European trials seem to indicate that drug-eluting stents may be susceptible to an event known as "late stent thrombosis", where the blood-clotting inside the stent can occur one or more years post-stent. While this event is rare, it is extremely dangerous and is fatal in about one-third of cases when the thrombosis occurs. [7][8] An example of a drug-eluting stent. ... Sirolimus is a relatively new immunosuppressant drug used to prevent rejection in organ transplantation, and is especially useful in kidney transplants. ... Everolimus is a new mTOR inhibitor drug used as an immunosuppressant to prevent rejection of organ transplants. ... Paclitaxel is a drug used in the treatment of cancer. ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ...


Risks

Risks of angioplasty 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. [citation needed] Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ...


Angioplasty has become considerably safer over the years and is now commonly performed. Although it is associated with some risks[9] these are considerably less than for open-heart bypass surgery with its resulting post-operative pain. However the likelihood of recurrence of angina, and requirement for repeated procedures has been higher with angioplasty. The latest trial (ARTS II) has suggested that PCI with DES may be superior, at least in the short term. Coronary artery bypass surgery Roux-en-Y gastric bypass surgery This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ...


Some chest discomfort occasionally may be experienced and it is for this reason that the patient is awake during minimally invasive angioplasty; the reporting of any symptom allows the cardiologist to take necessary immediate action. Bleeding from the insertion point in the groin is common, in part due to the use of anti-platelet clotting drugs. Some bruising is therefore to be expected, but occasionally a hematoma may form. This may delay hospital discharge as flow from the artery into the hematoma may continue (pseudoaneurysm) which requires repair. Infection at the skin puncture site is rare and dissection (tearing) of the access blood vessel is uncommon. Allergic reaction to the contrast dye used is possible, but has been reduced with the newer agents. Deterioration of kidney function can occur in patients with pre-existing kidney disease, but kidney failure requiring dialysis is rare. Vascular access complications are less common and less serious when the procedure is performed via the radial artery. A 250 ml bag of newly collected platelets. ... A bruise or contusion or ecchymoses is a kind of injury, usually caused by blunt impact, in which the capillaries are damaged, allowing blood to seep into the surrounding tissue. ... Hematoma on an elbow, nine days after a blood sample was taken Hematoma on a forearm, one day after repeated shocks A hematoma, or haematoma, is a collection of blood, generally the result of hemorrhage, or, more specifically, internal bleeding. ... Dissected rat showing major organs. ... Pancreatitus can be caused by an Allergic Reaction to a food. ...


In the long term, the most common risk is of the stent restenosis, as discussed above. This has been reduced considerably with the use of newer stents coated with certain medicines (drug-eluting stents). The most serious risk is the rare provocation (3%) of a heart attack during or shortly after the procedure; this may require emergency open cardiac surgery. Angioplasty carried out shortly after a myocardial infarction has a risk of causing a stroke of 1 in 1000, which is less than the 1 in 100 risk encountered by those receiving thrombolytic drug therapy. Restenosis literally means the reoccurrence of stenosis. ... Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Stroke (or cerebrovascular accident or CVA) is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. ...


The overall risks of death with angioplasty is approximately 1%, but the underlying severity of the heart disease, fitness of the patient and presence of other illness affect each individual’s risk. Hence for those with relatively minor heart disease, preserved good cardiac function, reasonable level of fitness and absence of other illnesses, the risk will be considerably less.


When failures of PTCA occur, they are often treated using coronary artery bypass grafting (CABG). A coronary artery bypass graft (CABG) or heart bypass is a surgical procedure performed in patients with coronary artery disease (see atherosclerosis) for the relief of angina and possible improved heart muscle function. ...


Peripheral angioplasty

Peripheral angioplasty refers to the use of mechanical widening in opening blood vessels other than the coronary arteries. It is often called percutaneous transluminal angioplasty or PTA for short. PTA is most commonly done to treat narrowings in the leg arteries, especially the common iliac, external iliac, superficial femoral and popliteal arteries. PTA can also be done to treat narrowings in veins.


Renal artery angioplasty

Atherosclerotic obstruction of the renal artery can be treated with angioplasty of the renal artery (percutaneous transluminal renal angioplasty, PTRA). Renal artery stenosis can lead to hypertension and loss of renal function. Human kidneys viewed from behind with spine removed The renal arteries normally arise off the abdominal aorta and supply the kidneys with blood. ... Renal artery stenosis is the narrowing of the renal artery. ... This article does not cite any references or sources. ... Renal failure is the condition in which the kidneys fail to function properly. ...


Carotid angioplasty

Generally, carotid artery stenosis is treated with angioplasty and stenting for high risk patients in many hospitals. It has changed since the FDA has approved the first carotid stent system (Cordis) in July 2004 and the second (Guidant) in August 2004. The system comprises a stent along with an embolic capture device designed to reduce or trap emboli and clot debris. Angioplasty and stenting is increasingly being used to also treat carotid stenosis, with success rates similar to carotid endarterectomy surgery. Simple angioplasty without stenting is falling out of favor in this vascular bed. SAPPHIRE, a large trial comparing carotid endarterectomy and carotid stenting with the Cordis stent found stenting non-inferior to carotid endarterectomy. [10]. In human anatomy, the carotid artery is a major artery of the head and neck. ... In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... Carotid entarterectomy is a surgical procedure used to correct carotid stenosis (obstruction of the carotid artery by atheroma), used particularly when this causes medical problems, such as transient ischemic attacks (TIAs) or cerebrovascular accidents (CVAs, strokes). ...


See also

Charles Theodore Dotter was a vascular radiologist. ... Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ... Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. ... A cutting balloon is an angioplasty device invented by Barath et al used in percutaneous coronary interventions. ...

References

  1. ^ Dotter, C. T. and M. P. Judkins, Transluminal Treatment of Arteriosclerotic Obstruction: Description of a New Technic and a Preliminary Report of Its Application, Circulation, 1964; 30:654-70.
  2. ^ Michaels, A. D. and K. Chatterjee, Angioplasty Versus Bypass Surgery for Coronary Artery Disease, Circulation, 2002; 106:e187
  3. ^ Mercado, N, Flather, MD, Boersna, E, et al, on Behalf of the Trial Investigators CABG vs Stenting for Multivessel Disease: a Meta-analysis of ARTS-1, SoS, ERACI-2, and MASS-2, Presentation at European Society of Cardiology Congress 2003
  4. ^ W. D. Weaver, R. J. Simes, A. Betriu, C. L. Grines, F. Zijlstra, E. Garcia, L. Grinfeld, R. J. Gibbons, E. E. Ribeiro, M. A. DeWood and F. Ribichini Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review, Journal of the American Medical Association 278:23, December 17, 1997.
  5. ^ PTCA or Balloon Angioplasty
  6. ^ MM Gandhi, and KD Dawkins Clinical review: Intracoronary stents BMJ 1999;318(7184):650 (6 March)
  7. ^ L Mauri, W Hsieh, JM Massaro, KKL Ho, R D’Agostino, and DE Cutlip. Stent Thrombosis in Randomized Clinical Trials of Drug-Eluting Stents N Engl J Med 2007;356:1020-9.
  8. ^ European Society of Cardiology Science News, 2007 Thrombosis is the price for the success of drug-eluting stents
  9. ^ UK's NHS endorsed 'Best Treatments' advice on 'clinical evidence for patients from the BMJ' on Coronary angioplasty and its risks
  10. ^ Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004;351:1493-501. PMID 15470212.

The National Health Service (NHS) is the publicly-funded healthcare system of the United Kingdom. ... Evidence-based medicine (EBM) is an attempt to more uniformly apply the standards of evidence gained from the scientific method, to certain aspects of medical practice. ... The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA). ...

External links


  Results from FactBites:
 
Angioplasty and Vascular Stenting (2940 words)
Angioplasty, also called balloon angioplasty, and vascular stenting are minimally invasive procedures performed by an interventional radiologist to improve blood flow in the body's arteries.
Angioplasty and vascular stenting for peripheral vascular disease (PVD) affecting arteries in the pelvis and legs are less successful when there are multiple leg vessels that are narrowed or when small vessels have to be opened.
Angioplasty and stent placement in the carotid artery has been approved by the FDA, but there is not much long-term data to know how well this works, or if there are potential complications that can develop from stents being placed in the carotid arteries.
Coronary angioplasty and stenting: Opening clogged heart arteries - MayoClinic.com (2091 words)
Angioplasty is usually combined with implantation of a small metal coil called a stent in the clogged artery to help prop it open and decrease the chance of it narrowing again (restenosis).
Angioplasty is performed by a heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians, usually in a cardiac catheterization laboratory.
Coronary angioplasty isn't considered surgery because it's less invasive — your body isn't cut open except for a very small puncture in a blood vessel in the leg, arm or wrist through which a small, thin tube (called a catheter) is threaded and the procedure performed.
  More results at FactBites »

 
 

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