Percutaneous Transluminal Coronary Angioplasty

PTCA or Percutaneous Transluminal Coronary Angioplasty is a minimal invasive procedure to re-establish blood flow through the coronary arteries after stenosis or blockage. It has been performed for over quarter of a decade, is a publicly well-known medical act.

As the heart is a muscle, it needs to be provided by oxygen. The coronary arteries are the main blood supplier. Due to blockage or partial blockage, the oxygen supply may be decreased. The constriction may be caused by arthroscleroses, which is mainly due to smoking, diabetes, high blood pressure, high cholesterol, obesities, etc.
A lack of oxygen in the cardiac muscle may cause chest pain or angina pectoris, either during periods of effort or during periods of rest, depending on the blockage-gradient.

After blood samples, clinical examination and electrocardiogram, the patient is being brought to the catheterisation lab, which is a room equipped with a high-resolution fluoroscopic device.
Depending on the chosen entry site, the groin, arm or wrist is being injected with a local anaesthetic. A sheath is being placed by the Seldinger-technique into the artery. Through the sheath, a catheter is being guided towards the ‘ostium’ or entry of the coronary artery in the aorta, right above the aortic valve. A small amount of contrast-agent or dye is being injected, in order to visualise the coronary artery and its blood flow. X-ray films are being made from various angles.
During the procedure, a clear view on the function of the heart muscle and coronary arteries occurs. Depending on the number, severity and location of the blockage, the cardiologist will suggest the procedure to follow.

• No blockage or normal heart-function : no further interventions are required ;
• Small blockage : the patient will be referred to his/her physician for further medical therapy ;
• Multiple blocked arteries with diffuse disease : By-pass surgery will be recommended ;
• One or two blocked arteries : whether the location is accessible, angioplasty will be the most suitable therapy.

Through the same entry site, a guiding catheter is being placed, through which therapeutic catheters can be passed and positioned very precisely at the obstruction. All therapeutic catheters are equipped with a balloon, which is deflated while being brought to the lesion. To open the obstruction, the balloon is inflated with contrast-agent. The lesion or constriction is now reopened. The balloon is deflated and will be withdrawn, after the blood flow has been controlled by a small amount of dye.

In most cases, a stent is being placed as well. A stent is a small, lattice-shaped, metal tube that is inserted permanently into the coronary artery. A stent is being put in place by a balloon. After inflating the balloon in order to expand the stent, it stays in place, as a support for the newly unblocked artery. More specific stents are eluting drugs for a certain amount of time. Those drug-eluting stents reduce the chance the arteries will become blocked again.

Long-term results

The 90 days until 6 months are most critical in developing a new stenosis. Therefore, in most cases of angioplasty, the cardiologist will prescribe anti-thrombogenic medication for this period of time. This medication increases the time of clotting and prevents the formation of new stenosis due to thrombi.