Percutaneous Transluminal Coronary Angioplasty (PTCA)
Percutaneous Transluminal Coronary Angioplasty (PTCA) is a minimally invasive medical procedure used to treat coronary artery disease (CAD). CAD occurs when plaque builds up in the coronary
arteries, which are responsible for supplying oxygen-rich blood to the heart muscle. This buildup of plaque can narrow the arteries, reducing blood flow to the heart and potentially leading to
chest pain (angina), heart attack, or other complications.
PTCA aims to restore blood flow by opening up the narrowed or blocked coronary arteries. The procedure involves the following steps:
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Catheter insertion: The patient is typically given a local anesthetic, and a small incision is made in the groin or wrist to access a blood vessel. A guidewire is inserted
into the blood vessel, followed by a thin, flexible tube called a catheter.
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Advancing the catheter: The catheter is guided through the blood vessels and into the coronary arteries using X-ray imaging. The physician carefully advances the catheter
until it reaches the narrowed or blocked section of the artery.
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Balloon inflation: A deflated balloon is mounted on the tip of the catheter and positioned at the site of the blockage. The balloon is then inflated, causing the plaque and
artery walls to compress. This creates a wider opening in the artery, allowing for improved blood flow.
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Stent placement (optional): In many cases, a small mesh tube called a stent is placed at the site of the blockage to help keep the artery open. The stent is mounted on the
balloon and expands as the balloon inflates. Once the balloon is deflated and removed, the stent remains in place to hold the artery open.
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Catheter removal: After the balloon and, if applicable, the stent have been successfully placed, the catheter and guidewire are carefully withdrawn from the blood vessels, and
the incision site is closed.
PTCA is a relatively safe and effective procedure for treating CAD, often providing immediate relief from angina symptoms and reducing the risk of heart attack. However, it is not a cure for CAD,
and patients will still need to manage their condition with medications and lifestyle modifications to reduce the risk of future complications.
Topic Highlights:-
- PTCA or balloon angioplasty is a non-surgical procedure to treat a narrowed coronary artery.
- The placement of a stent is a common procedure used in PTCA to prevent restenosis.
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This visual presentation discusses the coronary arteries, atherosclerosis - a common cause of artery blockage, and explains in detail angiography, balloon angioplasty, and coronary stenting.
Transcript:-
The heart is a fist size muscular organ pumping large amounts of blood through its chambers. It depends on small arteries called coronary arteries for nutrients and oxygen. They are the first arteries
to arise from the aorta . They encircle the heart and are situated on its surface. There are two main coronary arteries. The larger artery – the left main coronary artery – branches into the left
anterior descending supplying the front of the heart, and the left circumflex artery supplying the left side and the back of the heart. The right coronary artery supplies the back of the heart.
Like all arteries, healthy coronary arteries are flexible and smooth, and their inner lining allows a free flow of blood. Over time, fats, cholesterol , calcium and other material circulating in the
blood are deposited in the innermost layers of the arterial wall forming plaques . This results in the narrowing and stiffening of arteries called atherosclerosis . Arteries affected with
atherosclerosis lose their elasticity and become brittle with the deposition of calcium. With time, the plaques may rupture resulting in blood clots, which may further narrow the artery.
A decrease in the diameter of the artery decreases the amount of oxygenated blood to the heart. Reduced oxygenation to the heart muscle may result in characteristic chest pain called angina . Severe
blockage of an artery may result in the death of the heart muscle being supplied by the artery causing a heart attack.
Percutaneous Transluminal Coronary Angioplasty or PTCA is a non-surgical procedure that uses a balloon tipped catheter to widen blocked arteries. Stents are usually combined with angioplasty to help
it remain open reducing the chance of reblockage.
Before the procedure, blood tests, ECG and angiography are performed. For an ECG, twelve to 15 electrodes are attached to the arms, legs, neck and chest. The electrodes are glued to the body and
record electrical activity of the heart. A mild sedative is given before angiography. An intravenous line is inserted into blood vessels in the groin or arm. A catheter is then inserted into the blood
vessel. It is carefully guided into the heart with the help of an X-ray machine . Contrast material is then injected and X-rays are taken. The pictures are called angiograms .
Before the procedure, it is important for the patient to discuss his current medications, history of allergy and bleeding problems. Patients are instructed to avoid food and fluids 4-6 hours before
the procedure. Angioplasty is performed in a room similar to that where angiography is performed.
For angioplasty, the part of the groin or arm used for catheterization is sterilized. The procedure is done under local anesthesia. A long, thin hollow flexible tube called the guide catheter is
inserted into the femoral artery through a small incision in the leg. This catheter is passed through the aorta to the heart and into the coronary arteries.
After the guide catheter reaches the site of the blockage, a second, thinner catheter is inserted into it. There is a small, deflated balloon at the tip of the second catheter. This catheter is
positioned at the site of the blockage. The balloon is then inflated for several seconds. The process is repeated several times. Balloons are inflated in size and duration depending on the size and
location of the plaque. The expansion of the balloon pushes the plaque against the artery walls. The artery is thus widened and blood flow improves.
Sometimes, stent angioplasty is done to keep the artery open. A stent is a small, expandable wire mesh tube. Though stents are made of metal, they are rather flexible which helps them fit the normal
curvature of the arteries. A balloon tipped catheter with stent is then threaded to the site of the blockage. The balloon is inflated, expanding the stent. Then the balloon is deflated and removed
while the stent is implanted into the walls of the blocked artery. The tissue of the blood vessel soon covers the stent. The stents may be coated with medication, which is slowly released to prevent
arteries from reblockage. Such stents are called drug-eluting stents.
Angioplasty does not require a major incision since it is a non-surgical procedure and reduces the risks posed by surgery. It does not require general anesthesia. Angioplasty has proved its success
with a large percentage of people relieved of angina without any major complications following the procedure.
Bleeding may rarely occur at the incision site. The procedure may damage the artery requiring an emergency bypass surgery . Sometimes the repaired arteries may require repeat angioplasty or surgery
due to restenosis .
Angiography is repeated to insure that the procedure was successful. The patient will receive blood-thinning medications to decrease the chances of reblockage. The patient is usually instructed to
remain in bed for 6 to 24 hours. During this period, the patient is closely monitored for any complications. A follow-up exam is scheduled to study the improved functioning of the diseased artery.
Though the procedure can successfully repair the damaged artery, it does not treat the underlying cause of the damage. Therefore it is important to take sufficient care to prevent further damage. Take
medications as instructed by the doctor. Give up smoking and control diet. Keep hypertension under control. Maintain healthy height to weight ratio. Moderate exercise as advised by the doctor helps
prevent angina.
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