by Health Editorial Staff
An invasive cardiology operation to restore blood flow in the arteries that carry it to the heart muscle
Angioplasty, the interventional cardiology operation discussed in the article relating to Massimo Moratti, also called PTCA (percutaneous transluminal coronary angioplasty) because it allows the blood flow to the heart to be re-established, reopening the narrowed coronary arteries for presence of atherosclerotic plaques, without the need to open the sternum with surgery, as is done in by-passes, but instead reaching the obstructed vessels directly by going up along a perforated artery through the skin.
initially became known to the general public as the balloon technique, from the instrument that was first used to reopen a narrowed coronary artery in 1976. Going up with a catheter inserted into the femoral artery (in the groin) or, less often, into the radial one (in the wrist), a deflated balloon was positioned at the level of the occluded coronary artery, which was subsequently inflated with increasing pressure until the culprit plaque ruptured of shrinkage. The vessels thus treated tend to close over time, with a phenomenon called restenosis by doctors.
Subsequently, the idea was to insert into the artery, usually after having dilated it with the balloon, a hollow cylinder formed by a metal mesh which opened, preventing the vessel from narrowing again. This instrument, which is left in that position at the end of the procedure, is called a stent. Even so, however, especially in certain categories of patients such as diabetics, kidney patients or those who had particularly small vessels, the permanence of the foreign object can trigger an inflammatory reaction in the wall of the artery, which closes it despite the presence of the stent.
A medicated stent
To overcome this problem, the so-called medicated stents have been introduced, metal retinas identical to the previous ones but covered with a drug which is released little by little and which reduces the proliferation of the cells responsible for the narrowing inside the canal. How is it done? Angioplasty is usually performed at the end after a coronary angiography, a diagnostic procedure which serves to highlight the blocked coronary arteries, while angioplasty is a therapeutic treatment which allows, when possible, to re-establish correct blood flow in the coronary arteries . It is usually carried out by inserting the instruments through the same entry route used for coronary angiography, i.e. the femoral or radial artery, but compared to the simple examination it is a more complex and risky procedure, which requires expert personnel and careful management of the patient before and after the procedure.
When and how
Angioplasty can be performed in three cases, which share the presence of an occlusion of one or more coronary arteries (ischemic heart disease):
1.Elective coronary angioplasty: the procedure can be scheduled in stable patients who have chest pain (angina) only on certain occasions, for example during exertion, and in whom the presence of areas of the heart that receive a reduced blood supply (ischemia) has been demonstrated with various tests (exercise ECG, stress echocardiography, myocardial perfusion scintigraphy). 2.Coronary angioplasty during acute coronary syndrome: the procedure is also performed urgently in the event of a heart attack. When the electrocardiogram confirms the presence of a heart attack with the characteristic sign of ST segment elevation, angioplasty should be performed as soon as possible. Even in other high-risk cases, it would still be better for the patient to undergo it within 72 hours of hospitalization.
3. Salvage coronary angioplasty: sometimes initially an attempt is made to dissolve the thrombus responsible for the infarction with drugs (thrombolysis). If this approach does not work, angioplasty should be performed as soon as possible to restore blood flow to the heart tissue.
How to do it
Angioplasty is usually performed at the end of the coronary angiography, so the preparation of the patient is the same as necessary for this test, as is the access route to the heart. The guiding catheter is brought, through the femoral or radial artery, cannulated at the groin or wrist level, to the origin of the coronary artery to be unblocked. The materials used for the procedure, such as the guide wire, the balloon and the stents, are passed inside this tube. The guide wire is made of flexible, atraumatic material, which must penetrate the coronary artery and, like a rail, facilitate the passage of other materials. The balloon and stents (metallic or medicated) are introduced closed and are opened only at the level of the narrowing. The balloon breaks the plaque blocking the artery, the stent keeps it open. First of all, the guide wire is passed inside the guide catheter and then into the coronary artery to be freed, passing the point where the narrowing is present. We then proceed with the balloon which is slid along the guide wire until it reaches the point where the plaque to be treated is located. Here the balloon is inflated at increasing pressures for a period of 20 to 30 seconds. Finally, to consolidate the result, the metallic or medicated stent is positioned using the same technique used for the balloon, which is left in place while the other materials are removed. Angioplasty is carried out in a special room dedicated to diagnostic and therapeutic procedures conducted through the so-called cardiac catheterization. It is not a painful procedure, nor does it require general anesthesia: generally the patient is only sedated. After the angioplasty the patient is kept under observation for a few hours: hospitalization usually does not last more than one or two days and the resumption of normal activities can occur after about a week.
September 26, 2023 (modified September 26, 2023 | 3:19 pm)
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