PTCA (Balloon Treatment)
PTCA stands for percutaneous transluminal coronary angioplasty.
Percutaneous: Means that the procedure is done by
introducing small caliber long tubing’s through a puncture in the skin, either
in the groin or the elbow (percutanceous means via skin, so it is not an
operation)
Transluminal: means the balloons go through the
lumen of the aorta to the coronary artery.
Coronary: means blood supplying vessels of
heart.
Angioplasty: means proper sizing and shaping of
the caliber of the blood supplying arteries. So it is almost a plastic
procedure.
What is PTCA?
PTCA is an established procedure to
improve the blood supply in the coronary arteries which are narrowed or blocked
by deposition of the fatty cholesterol rich plaques (atherosclerosis). Patients
usually get the heart attack when blood clot is formed on these plaques. PTCA
is the non-surgical alternative to coronary artery bypass surgery in narrowed
arteries. This procedure is popular as balloon therapy to the lay people.
History of PTCA
PTCA was first introduced by Andreas
Gruentzig in September 1977. Patients with narrowed or blocked arteries have to
be studied by coronary angiogram before angioplasty to see whether the block is
suitable for this non surgical procedure. The ideal cases would be single
vessel narrowing (one artery block). But now-a-days multivessel PTCA (more than
one block) has gained popularity.
How it is done?
The Procedure is carried out under
local anaesthesia either through groin or from the arm. Patient is asked to
remain very still during the procedure. After injection the local anesthesia on
the skin the procedure should be painless. But the patient may experience some
pain during giving injection and may feel a sensation of pressure when the
balloon is inflated.
Step-1 : A local anesthesia is
injected in the groin, where a small incision is made in the skin.
Step-2 : A long, thin tube called an
introducer sheath is inserted into the femoral artery. A narrower tube, called
a guiding catheter, is passed through the sheath to the heart.
Step-3 : A contrast dye is injected
through the guiding catheter to allow the doctor to see the nature of the block
and to select appropriate balloon size.
Step-4 : Then the doctor passes a
thin guide wire (like a nylon thread) through the guiding catheter under
fluoroscopic (X-ray) control and advances it to the disease artery.
Step-5 : The doctor inserts a balloon
catheter over the guidewire and positions at the site of the block. The balloon
enters through the obstruction in deflated condition.
Step-6 : Once the deflated balloon is
in place, the balloon is expanded by pressure from outside. As the balloon
expands, it compresses the fatty substances against the wall of the artery.
Step-7 : When obstruction is
optimally dilated, the balloon is taken out through the skin puncture site in
deflated condition. When the balloon is removed, the lesion remains compressed
and the blood flow is restored to the heart.
PTCA is a in-hospital procedure
requiring 2-3 days hospital stay. Attention to coronary risk factors must
continue even after successful PTCA. Aspirin, nitrates and calcium channel
blocker medicines are usually continued for least six months.
Advantages of PTCA
1. Non surgical
2. Patient remains awake
during the procedure
3. Can be repeated easily
4. Short hospital stay
5. High primary success
>90%.
Although PTCA is generally safe,
complications occasionally occur, including myocardial infarction (heart
attack) in 2-4% of patients, the need for emergency bypass surgery in 1-2%. The
most important disadvantage of the PTCA is restenosis. One third of the
patients again develop stenosis at the previous site of balloon dilation. In
some studies 40% of the dilated vessels again developed stenosis after
successful PTCA. So patients may require multiple PTCA. After PTCA artery
usually reblocks within 6 months of balloon therapy. Restenosis (reocclusion)
is more frequent among smokers and in diabetic patients. PTCA can also be done
in patients with acute myocardial infarction (heart attack) as emergency
procedure and after bypass operation. Bypass tracts (venous grafts) can also be
dilated by the balloon.
