Coronary Angioplasty (PTCA, Balloon Dilatation)

What Is PTCA?

Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to widen narrowed coronary arteries and is also known as balloon dilatation or coronary angioplasty. The procedure is carried out during cardiac catheterization. The goal of the procedure is to remove the narrowing to restore adequate blood flow to the heart muscle. Today, PTCA is most often combined with stent implantation.

When Does Coronary Angioplasty Become Necessary?

Circulatory disorders of the heart muscle caused by vasoconstriction of the coronary arteries are referred to as coronary heart disease (CHD). If drug therapy does not provide sufficient symptom relief or the patient is at risk of a heart attack, balloon dilatation can be offered. Often, bypass surgery can be avoided in this way. In 90% of cases, PTCA leads to success. Even with freshly occluded vessels in acute myocardial infarction, emergency coronary angioplasty can reopen the affected vessel in 90%.

How Is Balloon Dilatation Carried Out?

A catheter is forwarded through the inguinal or forearm artery to the narrowing site. A small balloon expanded in the narrowed vessel with a saline and X-ray contrast medium mixture is at the end of this catheter, which forces the plaques (calcium deposits) further into the vessel wall. The vessel expands, and blood flow is restored.

A stent is implanted in many cases to prevent the affected vessel from narrowing again. A stent is a tubular metal mesh used to expand hollow organs. Drug-eluting stents are often implanted nowadays because some patients experience scar tissue growing into the stent. Drug-eluting stents release a special agent designed to prevent another occlusion of the vessel by the scar tissue.

Possible Coronary Angioplasty Complications

Nowadays, PTCA with or without stent implantation is a routine procedure with a low risk of complications. However, as with any surgery, complications may occur. These are:

• Bleeding
• Heart pain
• Cardiac arrhythmia
• Heart attack
• Vascular ruptures
• Contrast agent allergy
• Infections
• Thrombosis or embolism

Patients are informed about all possible complications before the procedure and can ask questions about the procedure's risks and benefits in consultation with their physician.

Healing Process and Follow-Ups After Balloon Dilatation

After the surgery, the healing process begins, which manifests in forming a layer of tissue around the stent. As with any external material, thrombus formation (blood clots) can occur. To counteract this risk, patients are given anticoagulant drugs such as heparin or aspirin.

For the treatment's long-term success, a detailed examination is recommended about six months after the procedure, which should exclude the risk of stenosis of the stent. If abnormalities are found on echocardiography and stress ECG, cardiac catheterization is repeated. If the angiography reveals a narrowing of the stent, another balloon dilatation is performed in the same session. With the repeated procedure, a lower risk can be expected.

If further narrowing occurs in the coronary arteries or the stents keep closing, cardiac bypass surgery may become necessary.

Sources:

Herold, Gerd: Innere Medizin. Köln, Eigenverlag 2012.

Arasteh, K. ; Baenkler, H.-W. ; Bieber, C. ; et al.: Innere Medizin. Stuttgart, Georg Thieme Verlag KG 2009.