Angioplasty

Angioplasty, also percutaneous transluminal angioplasty (PTA, percutaneous: Latin through intact skin; transluminal: Gradient Latin within the clearing of the vessel; angioplasty: Greek αγγειοπλαστία, originally " pottery ", " the vessel creating " here in the sense of " widening ", compare angiogenesis, vasculogenesis ), a method for extension or reopening of the narrowed or blocked blood vessels ( arteries is usually, rarely, vein ) using balloon angioplasty or other procedures ( laser, thrombectomy, etc.).

The balloon catheters are almost always placed from the groin over a guide wire and guiding catheter into the stenosis ( narrowing ) and inflated with pressure (8-12 bar), thus the bottleneck is usually repair and surgery avoided. In addition, frequent stent ( wire mesh, which seemed the vessel from the inside and keep it open to ) implanted ( stent angioplasty ).

At the coronary arteries is called a percutaneous transluminal coronary angioplasty ( PTCA).

Coronary angioplasty

As Percutaneous transluminal coronary angioplasty ( PTCA), Percutaneous coronary intervention also (German: percutaneous coronary intervention, PCI) are called without an open surgical techniques for expanding a constricted or reopening of an occluded coronary artery.

PTCA is performed in the context of a cardiac catheterization after coronary angiography. Through one of the femoral artery ( femoral artery ) or on the forearm artery (arteria radialis ) introduced special guide catheter, a balloon catheter is advanced. There is a balloon that is expanded bar in vascular constriction ( stenosis) with about 8-12 at its distal end. The narrowing is extended therethrough and an undisturbed blood flow allows. Particularly convenient is the elasticity of the vessels advantage: the plaque located at the Kalkan bearings are pressed into the vessel wall and remain there. To prevent restenosis, a stent is often implanted today. The preventive system of a stent can here significantly improve the prognosis. Depending on the Stenoseort, vessel size, pre-existing conditions such as diabetes mellitus drug -coated stents, in rare cases, eg when re- tightness in a stent ( in-stent restenosis) and coated with medication balloons are used.

Rare laser or diamond drill ( rotablation ) are used instead of the balloon catheter in order to remove the stenosis or to prepare for a classic PTCA.

A PTCA is performed as a planned intervention in chronic coronary heart disease to improve symptoms and as a life-saving emergency intervention in acute myocardial infarction ( then referred to as acute PTCA). Occluded Artery Trial According to a vessel opening is no longer useful, since if the infarction more than two days have passed. Is not possible to PTCA, a coronary artery bypass is performed.

Balloon dilatation

Under the balloon as part of a PTA is understood in interventional radiology, cardiology and angiology a method for distention morbidly constricted blood vessels by means of an attached to a vascular catheter balloon, which is only at the narrowed point slowly under high pressure ( 6-20 bar ) unfolds. Here, for example, the catheter introduced via a femoral artery (leg artery) and advanced to the narrowed point under x-ray control. The procedure is used to narrow the V.A. by atherosclerotic changes ( " hardening of the arteries " ) arise as dilate that they are not more or less severely impede the flow of blood. Was developed, the procedure of the German cardiologist Andreas Grüntzig.

Modern methods in the field of plastics processing enable the construction and further development of such balloons to adjust the quality to meet the needs of patients. Important here is the flexibility of the balloon and its compressive strength. A worldwide common form is the Monorail balloon catheter according to Prof. Tassilo Bonzel.

Application

For use, the method is of important for the respective organ supply arteries ( arteries ) as

• The descending aorta ( aortic coarctation in, ISTA)
• The carotid arteries (with cerebrovascular accident or stroke ),
• The renal arteries ( inter alia, in a form of high blood pressure),
• The pelvic and femoral arteries ( peripheral arterial occlusive disease, peripheral arterial disease ) or
• The coronary arteries (with coronary heart disease, CHD).

Drug Eluting Balloons

The drug- coated balloon catheter or drug -eluting balloon catheter (English drug-eluting balloon, short DEB, or drug -coated balloon ) is an evolution of conventional balloon catheter. The balloon surface is in this case coated with a drug which is applied at the site of vessel narrowing. Currently, the cytostatic drug paclitaxel used. The drug is intended to prevent a vasoconstrictor overgrowth of the extended site. In contrast to the stent therapy not mechanically acting foreign body remains in the body after surgery. The use is at present limited in-stent restenosis and arterial branches ( bifurcations ) in the coronary and renal vessels, femoral and lower leg arteries in the peripheral region.

Complications

The inner part of the vessel wall ( intima ) can tear ( dissection), the vessel lumen may in this case be completely transferred, in the worst case. In a vessel perforation may occur is bleeding into the pericardial sac with possible tamponade or into the tissue. If necessary. manual intervention vessel or kardiochirurgisch here.

With the dilatation of a vessel near a bifurcation the dilatation of a main branch can lead to occlusion of a side branch (compare snowplow phenomenon). This is often taken tacitly accepted in the case of small branches. Are two equivalent vessels concerned, there are techniques to avoid this.