Angioplasty with or without vascular stenting is a minimally invasive procedure performed to improve blood flow in the body’s arteries and veins.
In an angioplasty procedure, imaging techniques are used to guide a balloon-tipped catheter, a long, thin plastic tube, into an artery or vein and advance it to the narrow or blocked part of a patient’s vascular system. The balloon is then inflated to open the vessel, after which it is deflated and removed.
During angioplasty, a small wire mesh tube called a stent may be permanently placed in the newly opened artery or vein to help it remain open. There are two types of stents: bare stents (wire mesh) and covered stents (also commonly called stent grafts), which may contain drugs to reduce the incidence of restenosis.
Using image guidance, an inflatable balloon mounted at the tip of a catheter is inserted through the skin into an artery and advanced to the site of an arterial blockage, where the balloon is inflated and deflated. In this process, the balloon expands the artery wall, increasing blood flow through the artery.
Many angioplasty procedures also include the placement of a stent, a small, flexible tube made of plastic or wire mesh to support the damaged artery walls. Stents can be self-expandable or balloon expandable. Balloon expandable stents are typically placed over a balloon-tipped catheter so that when the balloon is expanded, it pushes the stent in place against the artery wall. When the balloon is deflated and removed, the stent remains permanently in place, acting like a scaffold for the artery. Self-expandable stents are easy to deploy, but may require additional angioplasty with balloon to obtain satisfactory dilation (opening) of the diseased vessel. Covered stents or stent-grafts have additional advantages over bare stents and are becoming more commonly used.
Drug-coated (also called drug-eluting) stents have recently been approved for clinical use in the coronary (heart) arteries by the U.S. Food and Drug Administration (FDA). These stents are coated with a medication that is slowly released to help keep the blood vessel from re-narrowing, a condition called restenosis.
At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed. Angioplasty patients must lie in bed with legs straight for several hours after the procedure. In some cases, the physician may use a device that seals the small hole in the artery, called a closure device, which allows the patient to move around more quickly.
The length of the procedure may vary depending on the time spent evaluating the vascular system prior to any therapy, as well as the complexity of the treatment.