BALLOON ANGIOPLASTY, STENTING, & ATHERECTOMY
Interventions
Recanalization therapy
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In the practice of cardiology, recanalization describes a series of medical procedure that are used to restore blood flow in a narrowed or occluded blood vessel. State of the art recanalization procedures include balloon angioplasty, stenting, and atherectomy. Recanalization is performed by an interventional cardiologist to treat serious atherosclerosis disease in arteries, and may also be used to treat sources of deep venous obstruction in veins.
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What is balloon angioplasty?
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Balloon angioplasty is a minimally invasive medical procedure in which a narrowed or blocked blood vessel is opened with a balloon device. The immediate goal of balloon angioplasty is to restore healthy blood flow through the affected vessel, thereby improving blood flow to affected muscle or tissues. Balloon angioplasty may be used to treat the coronary arteries (that supply the heart) or in major arteries or veins throughout the rest of the body.
When performing balloon angioplasty, your interventional cardiologist is also concerned with long-term results. Ideally a treated blood vessel will stay open forever after angioplasty, but this is not always the outcome. Cardiovascular conditions like coronary artery disease and peripheral artery disease tend to worsen over time and, in many cases, a treated artery can narrow or become blocked again. This is why we use stenting.
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What is stenting?
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Stenting is a minimally invasive medical procedure in which a stent is placed within a diseased blood vessel. A stent is a small tube made of a special metal or plastic that holds a blood vessel open. The goal of stenting is to prevent a treated artery or vein from becoming re-obstructed, and to maintain healthy blood flow through the treated vessel.
When stenting is used, balloon angioplasty and stenting are almost always performed in the same procedure. Many modern stents are drug-eluting, meaning that they are loaded with medical compounds that help keep a treated vessel open for a longer duration of time.
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What is atherectomy?
An atherectomy device is a catheter with drilling or cutting capability that is used to cut a path through major blockages in an artery. Atherectomy is another recanalization tool that your interventional cardiologist might use to help restore blood flow in diseased arteries.
In some cases of coronary or peripheral artery disease, your artery may become completely occluded and cannot be accessed with a balloon or stent without first opening a pathway through it. In other cases, your atherosclerotic disease may have a composition that is high in calcium, which may cause your artery to rupture when attempting to open with balloon angioplasty. These are both common treatment scenarios where atherectomy might be a suitable option.
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What conditions are treated with recanalization therapy?
Recanalization is a the go-to procedure in the interventional cardiologist’s toolkit to treat vascular disease in the heart, in the peripheral arteries, and in the veins of the legs. Specific conditions that can be treated with recanalization therapy include:
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Coronary artery disease
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Myocardial infarction (heart attacks)
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Peripheral artery disease
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Chronic venous disease affecting the deep veins
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May-Thurner Syndrome
The exact approach between balloon angioplasty, stenting, and/or atherectomy varies based on the location, type, and complexity of disease.
References
[1] Levine, G. N., Bates, E. R., Blankenship, J. C., Bailey, S. R., Bittl, J. A., Cercek, B., … Yancy, C. W. (2011). 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. Journal of the American College of Cardiology, 58(24), e44–e122.
[2] Gerhard-Herman, M. D., Gornik, H. L., Barrett, C., Barshes, N. R., Corriere, M. A., Drachman, D. E., … Walsh, M. E. (2017). 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary. Journal of the American College of Cardiology, 69(11), 1465–1508.
[3] Seager, M. J., Busuttil, A., Dharmarajah, B., & Davies, A. H. (2016). Editor’s Choice - A Systematic Review of Endovenous Stenting in Chronic Venous Disease Secondary to Iliac Vein Obstruction. European Journal of Vascular and Endovascular Surgery, 51(1), 100–120.
