Coronary Angioplasty: Key Information

What is Coronary Angioplasty and When is it Indicated?

Coronary angioplasty is a cardiac intervention involving the dilation of a narrowed (stenosed) coronary artery, caused by an atheroma plaque, using a balloon catheter inflated within the artery. The primary indications are coronary obstructions reducing blood supply to the heart muscle, and myocardial infarction resulting from acute coronary artery occlusion. The procedure nearly always involves stent implantation – a small metal prosthesis deployed within the coronary artery to optimize the outcome. A significant advancement occurred in 2002 with the introduction of drug-eluting stents, reducing restenosis (renarrowing) from 30% to 3-4%, significantly improving patient outcomes.

Angioplasty is a Life-Saving Intervention

Angioplasty, when performed promptly, is a life-saving procedure, contributing to a greater than fourfold reduction in mortality. For heart attacks, it's the gold standard treatment. Technological advancements, improved post-surgical drug therapies, and increased operator experience have gradually reduced the need for coronary artery bypass grafting (CABG). CABG remains necessary for severe coronary artery obstructions or heart valve replacement.

What are the Risk Factors for Atherosclerosis and What Type of Prevention is Possible?

Besides family history, atherosclerosis risk factors include smoking, diabetes, hypertension, and hypercholesterolemia. Prevention strategies, for both healthy individuals and those diagnosed with atherosclerosis, center on a healthy lifestyle, proper diet, adequate physical activity, and tobacco abstinence. Effective therapies with reduced side effects are available to manage hypertension, diabetes, and high cholesterol.

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What Tests are Necessary to Establish a Diagnosis of Atherosclerosis?

Doppler ultrasound, a simple, inexpensive, non-invasive technique, accurately assesses various vascular areas: carotid artery, abdominal aorta, renal arteries, and lower limbs, but not coronary arteries. Until recently, coronary artery visualization required invasive coronary angiography, involving catheter insertion into a peripheral artery (femoral or radial) to inject contrast agent visible on X-rays. However, a heart scan, a non-invasive examination requiring contrast agent injection into a peripheral vein, often suffices. Cardiac magnetic resonance imaging (MRI) doesn't visualize coronary arteries but provides valuable information on heart function. Myocardial scintigraphy (using a weakly radioactive radiopharmaceutical) is less commonly used due to these newer diagnostic technologies.

What is the Latest Research and Innovation in this Field?

Research focuses on understanding the pathophysiological mechanisms of vascular atherosclerosis to develop new prevention strategies. Regarding coronary angioplasty, studies are underway on new coronary artery visualization methods, both non-invasive (coronary CT scanning) and invasive (optical coherence tomography). Research also explores next-generation stents and therapeutic regimens to further improve procedure outcomes.

The New Generation of Stents: Ultra-Thin and Resorbable

Significant technological innovation involves creating resorbable stents usable in delicate, thinner coronary arteries (less than 2 millimeters, common in women), which are more challenging to treat.

Currently, 98% of angioplasty patients receive drug-eluting stents (to prevent vessel wall inflammation) of varying thicknesses: 91, 74, and 60 micrometers. A study comparing these in arteries less than 2 millimeters showed the ultra-thin (60 microm) stent yielded the best three-year results, with a 2.1% reintervention rate (less than half the 5.3% and 4% rates for 91 and 74 microm stents, respectively).

The new generation of fully resorbable stents addresses limitations of permanent metallic stents. Made from a magnesium alloy, these stents release medication, prevent platelet aggregation (a property of magnesium), thus thrombus formation, and completely resorb within a year. The vessel wall repairs itself, regaining physiological functionality and motility.

What is the Follow-up After Coronary Angioplasty?

Follow-up after angioplasty (or CABG) involves clinical monitoring for symptoms of myocardial ischemia. Periodic stress tests (e.g., electrocardiogram or stress ECG) assess condition. If needed, a coronary CT scan may be performed. If serious disease progression is evident, repeat invasive coronary angiography is recommended.

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