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Intervention:
Angioplasty
ICD-10 code:
ICD-9 code: 00.6 36.0 39.50
MeSH D017130
Other codes:

Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel; typically as a result of atherosclerosis. Tightly folded balloons are passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres).

The word is composed of the medical combining forms of the Greek words αγγειος aggeîos meaning "vessel" and πλαστός plastós meaning "formed" or "moulded". Angioplasty has come to include all manner of vascular interventions typically performed in a minimally invasive or percutaneous method.


Contents

[edit] 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, etc.

[edit] 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 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.

Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty is a therapeutic procedure to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build up of cholesterol-laden plaques that form due to atherosclerosis. PCI is usually performed by an interventional cardiologist.

Treatment with PCI for patients with stable coronary artery disease does not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy[1].

[edit] 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.

[edit] 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.[2] The SAPPHIRE trial also discloses that Jay Yadav was the inventor of the Angioguard embolic protection device used in the trial and held Angioguard stock at the time of purchase by Cordis, a sub-unit of Johnson and Johnson. Dr. Yadav was subsequently fired from the Cleveland Clinic in 2006 for improperly disclosing conflicts of interest[3].

[edit] Cerebral arteries angioplasty

In 1983, the Russian neurosurgeon Zubkov and colleagues reported the first use of transluminal balloon angioplasty for vasospasm after aneurysmal SAH.[4][5]

[edit] See also

[edit] References

  1. ^ Boden, W. E., R. A. O'Rourke, et al. (2007). "Optimal medical therapy with or without PCI for stable coronary disease." N Engl J Med 356(15): 1503-16.
  2. ^ Yadav JS, Wholey MH, Kuntz RE, et al. (October 2004). "Protected carotid-artery stenting versus endarterectomy in high-risk patients". N. Engl. J. Med. 351 (15): 1493–501. doi:10.1056/NEJMoa040127. PMID 15470212. 
  3. ^ http://www.theheart.org/article/733003.do
  4. ^ Zubkov IuN, Nikiforov BM, Shustin VA (Sep-Oct 1983). "1st attempt at dilating spastic cerebral arteries in the acute stage of rupture of arterial aneurysms". Zh Vopr Neirokhir Im N N Burdenko 5: 17-23. PMID 6228084. 
  5. ^ Zubkov YN, Nikiforov BM, Shustin VA (Sep-Oct 1984). "Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH". Acta Neurochir (Wien) 70 (1-2): 65-79. PMID 6234754. 

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