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What Is The Balloon Angioplasty Procedure?
Balloon angioplasty is a minimally invasive procedure to treat blocked or narrowed arteries. It involves inserting a tiny balloon into a blood vessel and inflating it to treat blockages and improve blood flow.
Angioplasty is one of the main treatments for coronary artery disease (CAD). People may receive the procedure to treat chest pain due to narrow or blocked coronary arteries. The coronary arteries are the main blood vessels providing blood to the heart.
Doctors use the term "angioplasty" to describe the insertion and inflation of a tiny balloon into the artery. However, doctors often insert a stent post-procedure in modern angioplasties. A stent is a small tube made from wire mesh that keeps the artery open, improving blood flow.
Read on to learn more about balloon angioplasty, including what it involves, when doctors recommend it, and more.
A balloon angioplasty can last anywhere from 30 minutes to several hours. The procedure does not cause much pain and takes place in a catheter lab instead of an operating theater.
Doctors may provide medication to relax an individual ahead of surgery.
Doctors carry out a balloon angioplasty as follows:
Doctors typically carry out balloon angioplasties to open blocked arteries due to atherosclerosis.
Atherosclerosis is the buildup of fat, cholesterol, and other substances in the arteries. Over time, too much of a waxy, fatty substance called cholesterol in the blood can form a hard plaque along the walls of these arteries, reducing blood flow to the heart.
Depending on the location of the plaque, this can lead to CAD or peripheral artery disease (PAD), as well as complications such as heart attack, heart failure, and acute limb events that may require amputation.
Coronary artery diseaseCAD refers to a consistently reduced blood flow. This can make the heart muscles weak and lead to heart failure, in which the heart does not pump blood as it should.
Doctors may not recommend balloon angioplasty for some people with CAD. The coronary artery may be too small or blocked completely, so the balloon cannot move past the blockage. However, in some cases, the doctor can gradually widen the artery. If balloon angioplasty is not suitable, bypass surgery may be an option.
A person's doctor can advise on whether they recommend angioplasty or other treatments for CAD.
Learn more about treatments for CAD.
AnginaThe most common CAD symptom is tightness and pain in the chest, also known as angina.
In some cases, doctors may treat chronic angina with medication, but angina due to major blockages or angina that is worsening or changing typically requires revascularization (procedure to clear clogged arteries) with angioplasty or surgery.
Other uses of balloon angioplastyDoctors may use balloon angioplasty in other arteries in the body, such as in the legs in PAD and in the carotid arteries, where blockages increase the risk of stroke.
Doctors may also recommend balloon angioplasties for some people with blocked brain and neck arteries to reduce their risk of a stroke.
Balloon angioplasty can reduce severe angina, as well as help people resume physical activity limited due to angina.
The procedure can relieve symptoms of PAD and improve blood flow to the legs.
In a heart attack, balloon angioplasty is a lifesaving procedure that restores blood flow to the heart, preventing further heart damage and improving survival.
Balloon angioplasty is a safe procedure. There may be soreness or bruising, but the procedure is relatively painless and often effective.
In rare cases, a balloon angioplasty causes severe bleeding, blood clots, or another artery blockage.
A person's doctor can advise them when to last eat or drink before the procedure.
It is important for a person to discuss their medications with their doctor. They may need to stop taking some blood thinners such as warfarin. The timing of any doses of diabetes medication may also need adjusting.
A person's doctor can provide more information about any adjustments they may need to make to their medication beforehand.
Many people can go home on the same day as the procedure. However, some people may need to stay overnight, depending on the complexity of the procedure.
Some people may have driving and exercise restrictions after the procedure. An individual can speak with their doctor about when it is safe to drive and resume physical activity.
However, most people can resume their regular daily activities after seven days.
If a person has a stent, a doctor will prescribe blood-thinning medications to reduce their risk of blood clots and help keep the stent open. It is important to continue taking medication until a doctor advises otherwise.
Here are some common about balloon angioplasty.
What is the difference between a stent and a balloon angioplasty?A balloon angioplasty involves stretching open a narrowed artery by inflating a tiny balloon inside it. A stent involves placing a wire mesh inside the artery to hold it open. Doctors often place a stent in the artery following balloon angioplasty.
How successful is balloon angioplasty?The success of balloon angioplasty differs based on which artery doctors perform it in and whether they insert a stent afterward. A person's doctor can inform them about how successful they expect the procedure to be.
What is the survival rate for balloon angioplasty?The survival rate for coronary balloon angioplasty is 98.8%, according to a 2023 paper. However, the risk of complications is higher in adults over 65 years of age, people with kidney disease, people with diabetes, women, and people with severe heart disease.
An individual can discuss the risk of complications with their doctor before the procedure.
A balloon angioplasty is an effective, safe, relatively pain-free procedure to reduce blockages in the artery due to atherosclerosis. A doctor inserts a balloon through a series of catheters and inflates it to stretch open the blood vessel. Sometimes, they insert a wire mesh stent to open the artery.
Balloon angioplasty can treat atherosclerosis in various parts of the body. In the coronary arteries, it can treat heart attacks and angina due to CAD. In the legs, it can treat PAD.
What Is Atherosclerosis?
Atherosclerosis is a narrowing of the arteries caused by a buildup of cholesterol plaque. It may lead to stroke, heart attacks, dementia, and other health challenges.
When plaque builds up and the arteries become hard and inflamed, blood has trouble flowing through them to the rest of the body. This prevents your organs and tissues from getting the oxygenated blood they need to function.
Atherosclerosis is preventable and treatable, although not reversible.
Atherosclerosis is a "silent" condition during its early stages, meaning it doesn't usually manifest with any evident symptoms until a significant blood flow blockage occurs.
Once symptoms develop, these may include:
Read more on the signs of atherosclerosis.
Did you know?
Atherosclerosis is a form of arteriosclerosis, otherwise known as hardening of the arteries. The terms "atherosclerosis" and "arteriosclerosis" are sometimes used interchangeably, but they represent different conditions.
Read more about the difference between atherosclerosis and arteriosclerosis.
Atherosclerosis develops slowly and it's often related to lifestyle habits, including diet patterns and reduced physical activity. Aging may also be a factor in atherosclerosis, but it doesn't mean significant atherosclerosis always goes hand in hand with aging.
Chronic high cholesterol is the main contributing factor to atherosclerosis. Cholesterol is found naturally in the body and in certain foods.
If cholesterol levels in the blood are persistently elevated, it may lead to artery clogging. Over time, cholesterol in the arteries becomes a hard plaque that starts to restrict blood circulation and may damage blood vessels leading to blood clots.
Blood clots may move through blood flow and travel to other regions of the body. When they block blood flow to vital organs, like the brain, they can lead to serious complications.
Read more about the effects of cholesterol on the body.
Other contributing factors for atherosclerosis may include:
A physical exam is the first step toward diagnosing atherosclerosis. A medical professional may check for:
Learn more about the difference between a stroke and an aneurysm.
A cardiologist may listen to your heart to check for atypical sounds and order more tests if they suspect atherosclerosis.
These tests may include:
You cannot reverse atherosclerosis, but management may help slow its progression.
Treatment for atherosclerosis typically involves lifestyle changes. Depending on its severity, risk factors, and symptoms, you may also need medications and surgery.
MedicationsMedications can slow down the progression of atherosclerosis. These may include:
Aspirin can be particularly effective for people with a history of atherosclerotic cardiovascular disease, including heart attack and stroke.
Discussing aspirin use for cardiovascular risk with a healthcare professional is highly advisable. Taking aspirin without the guidance of a doctor may lead to internal bleeding in some people.
SurgeryIf symptoms are severe or if muscle or skin tissue is in jeopardy, a healthcare professional may recommend surgery.
Possible surgeries for treating atherosclerosis include:
Helpful lifestyle changes to slow down atherosclerosis may include:
Atherosclerosis is the narrowing of your arteries by the accumulation of plaque. This plaque buildup is the result of chronic high cholesterol levels.
Once you develop atherosclerosis, the condition isn't reversible. However, lifestyle changes, medications, and sometimes surgery may slow down its progression and prevent complications.
Common complications associated with atherosclerosis include strokes and heart attacks.
Stopping Aspirin One Month After Coronary Stenting Procedures Significantly Reduces Bleeding Complications In Heart Attack Patients
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The primary efficacy endpoint of clinically-relevant bleeding, defined as BARC types 2, 3 or 5 bleeding, was assessed in the intention-to-treat population between one-month and twelve-months post-PCI in patients who were event-free after one month of ticagrelor and aspirin. Switching to ticagrelor monotherapy at one month resulted in a 55-percent reduction in the hazard of clinically relevant bleeding compared with continuing ticagrelor plus aspirin over the ensuing 11 months.
view moreCredit: Mount Sinai Health System
Withdrawing aspirin one month after percutaneous coronary intervention (PCI) in high-risk heart patients and keeping them on ticagrelor alone safely improves outcomes and reduces major bleeding by more than half when compared to patients taking aspirin and ticagrelor combined (also known as dual antiplatelet therapy or DAPT), which is the current standard of care.
These are the results from the ULTIMATE-DAPT study announced during a late-breaking trial presentation at the American College of Cardiology Scientific Sessions on Sunday, April 7, and published in The Lancet.
This is the first and only trial to test high-risk patients with recent or threatened heart attack (acute coronary artery syndromes, or ACS) taking ticagrelor with a placebo starting one month after PCI, and compare them with ACS patients taking ticagrelor with aspirin over the same period. The significant findings could change the current guidelines for standard of care worldwide.
"Our study has demonstrated that withdrawing aspirin in patients with recent ACS one month after PCI is beneficial by reducing major and minor bleeding through one year by more than 50 percent. Moreover, there was no increase in adverse ischemic events, meaning continuing aspirin was causing harm without providing any benefit," says Gregg W. Stone, MD, the study co-chair of ULTIMATE-DAPT, who presented the trial results.
"It is my belief that it's time to change the guidelines and standard clinical practice such that we no longer treat most ACS patients with dual antiplatelet therapy beyond one month after a successful PCI procedure. Treating these high-risk patients with a single potent platelet inhibitor such as ticagrelor will improve prognosis," adds Dr. Stone, who is Director of Academic Affairs for the Mount Sinai Health System and Professor of Medicine (Cardiology), and Population Health Science and Policy, at the Icahn School of Medicine at Mount Sinai.
The study analyzed 3,400 patients with ACS at 58 centers in four countries between August 2019 and October 2022. All of the patients had undergone PCI, a non-surgical procedure in which interventional cardiologists use a catheter to place stents in the blocked coronary arteries to restore blood flow. The patients were stable one month after PCI and were on ticagrelor and aspirin. Researchers randomized the patients after one month, withdrawing aspirin in 1,700 patients and putting them on ticagrelor and a placebo, while leaving the other 1,700 patients on ticagrelor and aspirin. All patients were evaluated between 1 and 12 months after the procedure.
During the study period, 35 patients in the ticagrelor-placebo group had a major or minor bleeding event, compared to 78 patients in the ticagrelor-aspirin group, meaning that the incidence of overall bleeding incidents was reduced by 55 percent by withdrawing aspirin. The study also analyzed major adverse cardiac and cerebrovascular events including death, heart attack, stroke, bypass graft surgery, or repeat PCI. These events occurred in 61 patients in the ticagrelor-placebo group compared to 63 patients in the ticagrelor-aspirin group, and were not statistically significant - further demonstrating that removing aspirin did no harm and improved outcomes.
"It was previously believed that discontinuing dual antiplatelet therapy within one year after PCI in patients with ACS would increase the risk of heart attack and other ischemic complications, but the present study shows that is not the case, with contemporary drug-eluting stents now used in all PCI procedures. Discontinuing aspirin in patients with a recent or threatened heart attack who are stable one month after PCI is safe and, by decreasing serious bleeding, improves outcomes," Dr. Stone adds. "This study extends the results of prior work that showed similar results but without the quality of using a placebo, which eliminates bias from the study."
This trial was funded by the Chinese Society of Cardiology, the National Natural Scientific Foundation of China, and Jiangsu Provincial & Nanjing Municipal Clinical Trial Project.
Mount Sinai is a World Leader in Cardiology and Heart Surgery
Mount Sinai Fuster Heart Hospital at The Mount Sinai Hospital ranks No. 1 in New York and No. 4 globally according to Newsweek's "The World's Best Specialized Hospitals." It also ranks No. 1 in New York for cardiology, heart, and vascular surgery, according to U.S. News & World Report®.
It is part of Mount Sinai Health System, which is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. We advance medicine and health through unrivaled education and translational research and discovery to deliver care that is the safest, highest-quality, most accessible and equitable, and the best value of any health system in the nation. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. Hospitals within the System are consistently ranked by Newsweek's® "The World's Best Smart Hospitals" and by U.S. News & World Report's® "Best Hospitals" and "Best Children's Hospitals." The Mount Sinai Hospital is on the U.S. News & World Report's® "Best Hospitals" Honor Roll for 2023-2024.
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Method of ResearchRandomized controlled/clinical trial
Subject of ResearchPeople
Article TitleTicagrelor Alone Versus Standard DAPT Between One and Twelve Months After PCI in ACS: The randomised, placebo-controlled, double-blind ULTIMATE-DAPT trial
Article Publication Date7-Apr-2024
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