What are Angioplasty and Vascular Stenting?
Angioplasty, with or without vascular stenting, is a minimally invasive procedure performed to improve blood flow in the body’s arteries and veins and is usually performed in an interventional radiology suite.
In an angioplasty procedure, imaging techniques (typically fluoroscopy) are used to guide a balloon-tipped catheter, a long, thin plastic tube, into an artery or vein and advance it to where the vessel is narrow or blocked. The balloon is then inflated to open the vessel, 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).
What are some common uses of the procedures?
Angioplasty with or without vascular stenting is commonly used to treat conditions that involve a narrowing or blockage of arteries or veins throughout the body, including:
- Narrowing of large arteries (aorta and its branches) due to atherosclerosis
- Venous narrowing involving the central veins (in the chest, abdomen or pelvis). In some cases, stenting of the narrowed vein is also needed.
- Narrowing in dialysis fistula or grafts. When there is decreased flow in the graft or fistula making it inadequate for dialysis, angioplasty is generally the first line of treatment. Stenting or stent grafting may also be needed in some cases.
- Renal Vascular Hypertension: high blood pressure caused by a narrowing of the kidney arteries. Angioplasty with stenting is a commonly used method to open one or both of the arteries that supply blood to the kidneys. Treating renal arterial narrowing is also performed in some patients to protect or improve the kidney function.
- Carotid Artery Stenosis: a narrowing of the neck arteries supplying blood to the brain.
- Peripheral Artery Disease (PAD)
- Coronary Artery Disease
How is the procedure performed?
This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted.
A very small skin incision is made at the site. A sheath is first inserted into the artery, or vein, if the narrowed blood vessel is a vein.
Guided by x-rays, the catheter is then inserted through the skin and maneuvered through the artery until it reaches the site of the blockage. Once the catheter is in place, contrast material will be injected into the artery and an angiogram will be taken of the blocked artery to help identify the site of the blockage.
With x-ray guidance, a guide wire will then be moved to the site, followed by the balloon-tipped catheter. Once it reaches the blockage, the balloon will be inflated for a short period of time. The same site may be repeatedly treated or the balloon may be moved to other sites.
Additional x-rays will be taken to determine how much the blood flow has improved. When your physician is satisfied that the artery has been opened enough, the balloon catheter, the guide wire and catheter will be removed.
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 (opens up itself upon deployment) or balloon expandable (balloon needed to open the stent). 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.
Drug-coated (also called drug-eluting) stents have recently been approved for clinical use 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.
The length of the procedure varies depending on the time spent evaluating the vascular system prior to any therapy, as well as the complexity of the treatment.