Balloon angioplasty is a minimally invasive methods to widen narrowed arteries from inside the vessel. Like bypass surgery they are widely used standard procedures to treat coronary and peripheral artery disease. This procedure aims to reestablish a sufficient supply of oxygen-rich blood in the affected areas of the heart or the body. A physician performs this procedure in a catheterization laboratory (“cath lab”) under local anesthesia. Bypass surgery is an open surgery method performed under general anesthesia. The aim of all procedures is to reestablish unhindered blood circulation and a sufficient supply of oxygen.
The cardiologist accesses the vascular system via the femoral artery in the leg, or less commonly, the radial artery in the arm. A tiny cut in the skin is enough to insert an introducer sheath into the chosen vessel. The introducer sheath helps control the bleeding and provides safe access for required devices during the procedure. The cardiologist then introduces a catheter through the sheath, which is properly placed in the vascular system. Afterward, the cardiologist injects a contrast dye into the catheter in order to locate the blockage and measure its dimensions with X-ray imaging.
The cardiologist then directs a guide wire with a radiopaque tip to the narrowed area of the coronary via a guiding catheter, and push the guide wire through the lesion. The guide wire now serves to place the balloon catheter in the lesion site. After the balloon is properly placed, it is inflated by injecting a contrast dye. When the balloon is enlarged, it pushes the plaque against the wall of the coronary artery, widening the vessel. Then the cardiologist deflates the balloon and withdraws it from the body. All other devices are removed via the introduction sheath and the access to the vascular system is closed.
The cardiologist may decide to use a drug-coated balloon if there is a re-narrowing of the coronary (restenosis) or a high risk of relapse after a balloon angioplasty. The drug in the coating prevents inflammation and restenosis. Special excipients in the coating help transport the drug into the vessel wall. Conventional balloon angioplasty reopens the coronary artery mechanically, before the drug-coated balloon is used. The drug-coated balloon is directed into the prepared vessel section after the reopening and inflated. As soon as the coating is in close contact with the vessel, medical agents enter the walls. The cardiologist keeps the balloon inflated for 30 to 60 seconds to ensure that enough medication is released into the walls. Then the cardiologist slowly deflates the balloon, removing it and all other devices from the body, and carefully closes access to the vein.