INOVA HEALTH SYSTEM : TREATMENT OPTIONS : Angioplasty

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Angioplasty

What is a percutaneous transluminal coronary angioplasty (also called PTCA, angioplasty, ballon angioplasty)?

Angioplasty is a procedure that opens blocked heart arteries, relieves symptoms of coronary artery disease and improves blood flow to the heart. During angioplasty, a catheter with an inflatable balloon at the tip is passed into a blocked heart artery. The balloon is inflated at the site of blockage, compressing the cholesterol buildup, and opening the narrowed part to improve blood flow. Then, the catheter with the balloon is removed.

What are the risks?

The risks of angioplasty are low. The risks include all of the complications noted for cardiac catheterization, but some of the risks -- specifically heart attack and emergency bypass surgery -- are higher because angioplasty is a more complex procedure. The risks include injury or tearing of an artery, which can cause the artery to close. This is often successfully treated with continued angioplasty or insertion of a stent. In rare cases, the tear is difficult to treat. Three percent of patients may have a heart attack, and one percent may need emergency bypass surgery. A cardiac surgery team is available at the Inova Heart Center if needed. In three to five percent of patients, the procedure is unsuccessful because the catheter cannot be advanced to the blockage or the artery cannot be fully opened. This can occur when the artery is small, has calcium deposits, or has severe bends. Click here to read more about the Inova Heart Center's outcome indicators regarding angioplasty.

What are the benefits?

Angioplasty will open blocked arteries and improve blood flow to your heart. It relieves symptoms, improves exercise duration, and in some cases stops or prevents heart attacks. It is often more effective than medications in relieving symptoms in patients with a blockage in one artery. Following an angioplasty, many patients can stop or reduce their number of heart medications.

How effective is angioplasty?

Angioplasty is initially successful in about 95% of patients. However, about one-third of patients will develop a recurrence of the blockage (called restenosis). This occurs because the angioplasty procedure is designed to crush the blockage against the artery wall. The artery's healing process can cause an overgrowth of cells and substances that cause a recurrence of the blockage. This usually occurs during the first six months. Your doctor will follow you closely for a return of symptoms and may even perform a follow-up exercise stress test. If a blockage returns, you can be treated with medications, with a second angioplasty or other interventional procedure, or possibly with bypass surgery. Only about 25% of patients will need a repeat angioplasty. Click here to read more about the successful outcomes of angioplasty at the Inova Heart Center.

Is angioplasty right for you?

Angioplasty can be used to treat almost all blockages. It is fairly simple and has a low complication rate. Inova cardiologists are very familiar with the technique. It has been the most commonly performed therapeutic invasive procedure. Its use has declined since the introduction of newer procedures such as stents, atherectomy, and laser. Stents may lower the risk of restenosis for some blockages. Angioplasty has less favorable results in blockages with calcium deposits or blockages at artery branch points. Rotational atherectomy or laser may be preferable to angioplasty in these patients.

For more specific information regarding before, during and after the procedure, click here.

Click here to see illustrations of the x-ray pictures your cardiologist reviews during before, during and after an interventional procedure.