Angioplasty

Aka: Angioplasty, Percutaneous Coronary Intervention, PTCA, PCI, Coronary Balloon Angioplasty, Drug-eluting Stent, Bare-Metal Stent, Coronary Artery Stenting

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II. Indications

  1. Cardiac Ischemia
  2. Myocardial Infarction

III. Precautions: Perioperative Stent Implications

  1. See Antiplatelet Therapy for Vascular Disease
  2. PTCA required to stabilize acute cardiovascular status prior to surgery
    1. Surgery with low risk of bleeding: Stent and continue dual-Antiplatelet Therapy
    2. Time to surgery 14 to 29 days: Balloon Angioplasty
    3. Time to surgery 30 to 365 days: Bare-Metal Stent
    4. Time to surgery >365 days: Drug-eluting Stent

IV. Efficacy

  1. Initial: 95% effective in coronary ischemia
  2. Balloon Angioplasty without stent
    1. Overall restenosis rate: 40% in first 6-9 months
    2. Procedure mortality rate: 1 to 2.5%
    3. Emergency CABG rate: 1.9 to 5.8%
  3. Angioplasty with bare metal stent
    1. Overall restenosis rate: 30% in first 6-9 months
    2. Procedure mortality rate: <0.25%
    3. Emergency CABG rate: <0.3 to 0.6%
  4. Angioplasty with drug eluting stent
    1. Overall restenosis rate: <10% in first 6-9 months
    2. Procedure mortality rate: <0.25%
    3. Emergency CABG rate: <0.3 to 0.6%
    4. Drug eluting stents have a higher rate of thrombus formation in first 6-12 months
      1. Hence the use of dual antiplatelet agents for the first 6-12 months
      2. See adverse effects below
    5. Initial studies: 6.9% re-stenosis at 9 months

V. Adverse Effects: Thrombosis at drug eluting stent site

  1. See Antiplatelet Therapy for Vascular Disease (includes Gastrointestinal Prophylaxis)
  2. May be related to polymer used to bind the drugs to the stent
  3. Platelet ADP Receptor Antagonist with Aspirin 81 mg for at least 6-12 months (depending on stent-type)
    1. Minimizing Aspirin dose decreases serious bleeding events
    2. Significantly reduces cardiovascular events
    3. Benefit of Ticagrelor, Prasugrel over Clopidogrel, but at higher bleeding risk and 30x cost
      1. Rezaei (2017) Int J Cardiol 235:61-66 [PubMed]
    4. However, Clopidogrel may offer similar efficacy after the first week post-stenting
      1. Sibbing (2017) Lancet 390(10104):1747-57 [PubMed]
  4. Dual therapy beyond one year does not appear to lower cardiovascular event risk in most patients
    1. Dual Antiplatelet Therapy does increase bleeding risk
    2. Consult with cardiology to switch back to Aspirin alone at 81 mg orally daily
    3. Lee (2014) Circulation 129: 304-12 [PubMed]
  5. Peri-operative management within one year of drug eluting stent placement
    1. See Antiplatelet Therapy for Vascular Disease
    2. Delay elective surgeries for >6-12 months from PTCA placement
    3. Less invasive procedures (e.g. endoscopy) can be performed without stopping dual agents
    4. Protocol for more invasive urgent procedures
      1. Continue Aspirin 81 mg throughout perioperative period
      2. Stop Clopidogrel 5 days before surgery and restart on same day of surgery postoperatively
        1. First dose on restarting Clopidogrel should be loading dose of 300 mg
  6. References
    1. Kopacky (2008) Mayo Selected Topics in Internal Medicine, Lecture
    2. Mehta (2001) Lancet 358:527-33 [PubMed]

VI. Preparations: Drug-eluting Stents

  1. Stainless steel stents
    1. Cypher (Sirolimus-eluting stent)
    2. Taxus (Paclitaxel-eluting stent)
  2. Cobalt-chromium stents
    1. Endeavor (Zotarolimus-eluting stent)
    2. Xience (Everolimus-eluting stent)
    3. Promus (Everolimus-eluting stent)

VII. References

  1. Dehmer (2009) Am Fam Physician 80(11): 1245-53 [PubMed]
  2. Hannan (2008) Circulation 117(16): 2071-8 [PubMed]
  3. Serruys (2001) N Engl J Med 344:1117-24 [PubMed]
  4. Moses (2003) N Engl J Med 349:1315-23 [PubMed]

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Related Studies

Ontology: Angioplasty, Balloon, Coronary (C0002997)

Definition (MSH) Dilation of an occluded coronary artery (or arteries) by means of a balloon catheter to restore myocardial blood supply.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D015906
English Angioplasty, Coronary Balloon, Balloon Angioplasty, Coronary, Coronary Angioplasty, Transluminal Balloon, Coronary Balloon Angioplasty, Angioplasties, Coronary Balloon, Balloon Angioplasties, Coronary, Coronary Balloon Angioplasties, Balln angioplasty coronary art, Transluminal Coronary Balloon Dilation, Balloon Dilation, Coronary Artery, Angioplasty, Balloon, Coronary, percutaneous transluminal coronary angioplasty (PTCA), ptca, balloon angioplasty, coronary artery balloon dilation, coronary balloon angioplasty, coronary angioplasty, Balloon angioplasty of coronary artery
Swedish Ballongvidgning av kranskärl
Czech PCI, balónková angioplastika, balonková angioplastika
Finnish Sepelvaltimon pallolaajennus
Russian ANGIOPLASTIKA KORONARNAIA CHRESKOZHNAIA VNUTRIPROSVETNAIA, CHRESKOZHNAIA TRANSLIUMINAL'NAIA KORONARNAIA ANGIOPLASTIKA, KORONARNAIA ANGIOPLASTIKA TRANSLIUMINAL'NAIA BALLONNAIA, BALLONNAIA DILATATSIIA KORONARNOI ARTERII, ANGIOPLASTIKA KORONARNAIA BALLONNAIA, TRANSLIUMINAL'NAIA KORONARNAIA BALLONNAIA DILATATSIIA, АНГИОПЛАСТИКА БАЛЛОННАЯ КОРОНАРНАЯ, ANGIOPLASTIKA BALLONNAIA KORONARNAIA, АНГИОПЛАСТИКА КОРОНАРНАЯ ЧРЕСКОЖНАЯ ВНУТРИПРОСВЕТНАЯ, АНГИОПЛАСТИКА КОРОНАРНАЯ БАЛЛОННАЯ, БАЛЛОННАЯ ДИЛАТАЦИЯ КОРОНАРНОЙ АРТЕРИИ, КОРОНАРНАЯ АНГИОПЛАСТИКА ТРАНСЛЮМИНАЛЬНАЯ БАЛЛОННАЯ, ТРАНСЛЮМИНАЛЬНАЯ КОРОНАРНАЯ БАЛЛОННАЯ ДИЛАТАЦИЯ, ЧРЕСКОЖНАЯ ТРАНСЛЮМИНАЛЬНАЯ КОРОНАРНАЯ АНГИОПЛАСТИКА
French Dilatation coronarienne par ballonnet, Angioplastie coronaire par ballonnet, Angioplastie coronarienne par ballonnet, Angioplastie coronarienne transluminale par ballonnet, Dilatation endoluminale par ballonnet d'artère coronaire, Angioplastie coronaire transluminale par ballonnet, Dilatation coronaire par ballonnet
Spanish Angioplastia Coronaria con Balón, Angioplastia Coronaria Transluminal por Balón, Angioplastia Coronaria de Balón
Portuguese Angioplastia Coronária Transluminal por Balão, Angioplastia Coronária com Balão, Angioplastia Coronária Transluminal Percutânea, Angioplastia Coronária de Balão
Polish Przezskórna angioplastyka wieńcowa, Przezskórna plastyka naczyń wieńcowych, PTCA, Interwencyjna angiografia wieńcowa, Rozszerzanie balonowe tętnic wieńcowych, Angioplastyka wieńcowa balonowa, Angioplastyka balonowa wieńcowa, Przezskórna interwencja wieńcowa
Japanese 冠状血管形成術-経管バルーン, 経皮的冠動脈形成術, バルーン冠状血管形成術, 冠動脈バルーン形成術, 冠状動脈バルーン拡張法, 経皮経管冠状血管形成術, 経皮経管的冠動脈形成術, 経管バルーン冠状血管形成術, 経腔的経皮的冠状血管形成術, 血管形成術-経皮経管的冠動脈, バルーン冠動脈形成術, バルーン拡張法-冠動脈, バルーン拡張法-冠状動脈, 冠動脈バルーン拡張法, 冠動脈形成術-バルーン, 冠動脈形成術-経皮的, 冠動脈形成術-経皮経管的, 冠状血管形成術-バルーン, 冠状血管形成術-経腔的経皮, 経皮的冠状血管形成術-経腔的, 血管形成術-バルーン-冠状, 血管形成術-バルーン冠状, 血管形成術-冠動脈バルーン, 血管形成術-経腔的-経皮的冠状, 血管形成術-経腔的経皮的冠状
Italian Angioplastica coronarica con palloncino
Norwegian Ballongplastikk av kransårer
Croatian ANGIOPLASTIKA, BALONSKA, KORONARNA
German Angioplastie Ballon, Koronar-, Angioplastie, koronare Ballon-, Angioplastie, transluminale, perkutane Koronar-, Ballon-Dilatation, Koronararterien-, Koronarangioplastie, transluminale Ballon-, Koronardilatation, perkutane transluminale, PTCA, Perkutane transluminale Koronarangioplastie, Transluminale koronare Ballondilatation
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Angioplasty (C0162577)

Definition (MSH) Reconstruction or repair of a blood vessel, which includes the widening of a pathological narrowing of an artery or vein by the removal of atheromatous plaque material and/or the endothelial lining as well, or by dilatation (BALLOON ANGIOPLASTY) to compress an ATHEROMA. Except for ENDARTERECTOMY, usually these procedures are performed via catheterization as minimally invasive ENDOVASCULAR PROCEDURES.
Definition (MEDLINEPLUS)

If you have coronary artery disease, the arteries in your heart are narrowed or blocked by a sticky material called plaque. Angioplasty is a procedure to restore blood flow through the artery.

You have angioplasty in a hospital. The doctor threads a thin tube through a blood vessel in the arm or groin up to the involved site in the artery. The tube has a tiny balloon on the end. When the tube is in place, the doctor inflates the balloon to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.

Doctors may use angioplasty to

  • Reduce chest pain caused by reduced blood flow to the heart
  • Minimize damage to heart muscle from a heart attack

Many people go home the day after angioplasty, and are able to return to work within a week of coming home.

NIH: National Heart, Lung, and Blood Institute
Definition (NCI_NCI-GLOSS) A procedure to enlarge the opening in a blood vessel that has become narrowed or blocked by plaque (a buildup of fat and cholesterol on the inner wall of the blood vessel). Examples of angioplasty are balloon angioplasty and laser angioplasty.
Definition (NCI) An endovascular procedure used to widen diseased arteries resulting in increasing blood flow through the area.
Definition (CSP) diverse group of surgical procedures to remove or flatten constrictive deposits on the inner walls of blood vessels, thereby improving blood flow.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D017130
SnomedCT 2119009, 418285008, 282719006, 265857002
LNC LP33382-0, MTHU011020
English Angioplasties, intraluminal angioplasty, Angioplasty - action, Cryoplasty, Angioplasty - action (qualifier value), angioplasty, angioplasty (treatment), Angioplasty, NOS, Angioplasty, Angioplasty of blood vessel (procedure), Angioplasty of blood vessel
Japanese 血管形成, ｹｯｶﾝｹｲｾｲ, ﾚｲｷｬｸｹｯｶﾝｹｲｾｲ, 冷却血管形成
Swedish Angioplastik
Czech angioplastika, Angioplastika
Finnish Angioplastia
Russian ANGIOPLASTIKA, ENDOLIUMINAL'NAIA PLASTIKA, АНГИОПЛАСТИКА, ЭНДОЛЮМИНАЛЬНАЯ ПЛАСТИКА
Spanish Crioplastia, angioplastia, angioplastia de vaso sanguíneo, angioplastia de vaso sanguíneo (procedimiento), angioplastia (procedimiento), Angioplastia
Portuguese Crioplastia, Angioplastia Percutânea Transluminal, Angioplastia
Dutch cryoplasty, angioplastiek, Angioplastiek
Italian Crioplastica, Angioplastica
French Cryoplastie, Angioplastie
German Kryoplastie, Angioplastie, Gefäßplastik
Croatian ANGIOPLASTIKA
Polish Operacja plastyczna naczynia krwionośnego, Angioplastyka
Hungarian Cryoplastica, Angioplastica
Norwegian Angioplastikk
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Placement of stent in coronary artery (C0521232)

Concepts Therapeutic or Preventive Procedure (T061)
ICD9 36.06
SnomedCT 36969009, 366879003, 149177005
English Insertn coronary artery stent, Placement of stents in coronary artery, Ins nondrug elut cor st, Coronary arterial stent insertion, Insertion of non-drug-eluting coronary artery stent(s), Insertion of coronary artery stent(s), Insertion of coronary artery stent (procedure), Insertion of coronary artery stent, Placement of stent in coronary artery (procedure), Placement of stent in coronary artery, Placement of stents in coronary artery (procedure)
Italian Inserzione di stent nell'arteria coronarica
Japanese 冠動脈ステント挿入, ｶﾝﾄﾞｳﾐｬｸｽﾃﾝﾄｿｳﾆｭｳ
Spanish colocación de tutores de Stent en la arteria coronaria, colocación de tutores endoluminales en la arteria coronaria (procedimiento), colocación de tutores endoluminales en la arteria coronaria, colocación de stents en la arteria coronaria, colocación de stent en arteria coronaria, colocación de tutor endoluminal en arteria coronaria, colocación de stent en arteria coronaria (procedimiento), colocación de tutor endoluminal en arteria coronaria (procedimiento), Inserción de endoprótesis en arteria coronaria
Czech Zavedení stentu do koronární arterie
Hungarian Arteria coronaria stent behelyezés
Portuguese Inserção de stent na artéria coronária
Dutch coronaire arteriestentplaatsing
French Insertion de stent artériel coronaire
German Einfuehrung eines Stents in eine Koronararterie
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Percutaneous Coronary Intervention (C1532338)

Definition (MSH) A family of percutaneous techniques that are used to manage CORONARY OCCLUSION, including standard balloon angioplasty (PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY), the placement of intracoronary STENTS, and atheroablative technologies (e.g., ATHERECTOMY; ENDARTERECTOMY; THROMBECTOMY; PERCUTANEOUS TRANSLUMINAL LASER ANGIOPLASTY). PTCA was the dominant form of PCI, before the widespread use of stenting.
Definition (MSHNOR) Samlebegrep for perkutane teknikker for behandling av koronarokklusjon. Disse inkluderer standard ballongangioplastikk (perkutan transluminal koronar angioplastikk), erstatning av intrakoronare stenter og atheroablative teknikker (for eksempel aterektomi, endaterektomi, trombektomi og perkutan transluminal laserangioplastikk). PTCA var den mest brukte form for PCI før bruken av stenting.
Definition (NCI) The placement of an angioplasty guide wire, balloon, or other device (e.g. stent, atherectomy, brachytherapy, or thrombectomy catheter) into a native coronary artery or coronary artery bypass graft for the purpose of mechanical coronary revascularization.
Definition (NCI_CDISC) A procedure on the coronary arteries of the heart that is performed by the placement of an angioplasty guide wire, balloon, or other device (e.g. stent, atherectomy, brachytherapy, or thrombectomy catheter) into a native coronary artery or coronary artery bypass graft for the purpose of mechanical coronary revascularization.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D062645
SnomedCT 415070008
Dutch percutane coronaire interventie
German perkutane Intervention an einer Koronararterie, Perkutane koronare Revaskularisierung, Perkutane Koronarintervention
Portuguese Intervenção coronária percutânea, Intervenção Coronária Percutânea
Spanish Intervención coronaria percutánea, Intervención Coronaria Percutánea, intervención coronaria percutánea (procedimiento), intervención coronaria percutánea
Japanese 経皮的冠インターベンション, ｹｲﾋﾃｷｶﾝｲﾝﾀｰﾍﾞﾝｼｮﾝ
Czech Perkutánní koronární intervence, koronární angioplastika
Hungarian Percutan coronaria interventio
English Percutaneous Coronary Intervention, Coronary Intervention, Percutaneous, Coronary Revascularizations, Percutaneous, Percutaneous Coronary Revascularizations, Intervention, Percutaneous Coronary, Coronary Interventions, Percutaneous, Interventions, Percutaneous Coronary, Percutaneous Coronary Interventions, Percutaneous Coronary Revascularization, Revascularizations, Percutaneous Coronary, Coronary Revascularization, Percutaneous, Revascularization, Percutaneous Coronary, PERCUTANEOUS CORONARY INTERVENTION, PCI, Percutaneous coronary intervention (procedure), Percutaneous coronary intervention
French Intervention coronaire percutanée, Revascularisation coronaire percutanée, Revascularisation coronarienne percutanée, Intervention coronarienne percutanée, ICP (Intervention Coronarienne Percutanée)
Italian Rivascolarizzazione coronarica percutanea, Intervento coronarico percutaneo
Polish Interwencje wieńcowe przezskórne, PCI, Przezskórne zabiegi wieńcowe, Przezskórne interwencje wieńcowe, Zabiegi wieńcowe przezskórne
Russian РЕВАСКУЛЯРИЗАЦИЯ КОРОНАРНАЯ ЧРЕСКОЖНАЯ, ЧРЕСКОЖНОЕ КОРОНАРНОЕ ВМЕШАТЕЛЬСТВО, REVASKULIARIZATSIIA KORONARNAIA CHRESKOZHNAIA, CHRESKOZHNOE KORONARNOE VMESHATEL'STVO
Croatian Not Translated[Percutaneous Coronary Intervention]
Norwegian Perkutan koronar intervensjon, Perkutan koronar revaskularisering
Derived from the NIH UMLS (Unified Medical Language System)

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