Types of Angioplasty

Angioplasty is used to widen arteries, which are narrowed by stenoses or occlusions. This procedure is helpful in many ways, like, clearing of plaque from coronary arteries, emergency relief from a heart attack that is in progress, and widening narrowed arteries in limbs, such as the femoral or iliac artery to the leg. It is also useful in relieving chest pain, caused by narrowing down of coronary arteries. Angioplasty performed earlier was done by dilating the blood vessel with the introduction of larger stiff catheters, through the narrowed space. However, complications involved in this procedure gave motive to scientists and researchers, to develop a means of widening the vessel using a minimally sized device. Now lasers may be used to assist in the break up of fat or calcium plaque and catheters may also be equipped with spinning wires or drill tips to clean out the plaque. The various types of angioplasty are as follows.

Balloon Angioplasty
Balloon angioplasty uses a thin tube, or catheter, which is passed into an artery, through a cut in the upper leg or the arm. The catheter is maneuvered into the artery, and a balloon on the tip of the catheter is inflated. The balloon thus pushes against the plaque and flattens it, thus widening the artery. This improves the flow of blood in the artery. It is normal for a patient to have pain in the chest, when the balloon is inserted. The movements of the catheter can be easily seen and recorded by the doctors, on an X-ray screen. This helps in guiding the tube through the heart and into a narrowed coronary artery.

Laser Angioplasty
In the laser angioplasty technique, a thin and flexible plastic tube called a catheter, with a laser at its tip, is used. It is inserted into an artery that opens into coronary arteries blocked by plaque, a build-up of cholesterol, cells and other fatty substances in an artery's inner lining. Then the plastic tube is advanced through the artery to the blockage in the coronary artery, and it emits pulsating beams of light from where the laser is in position. These lasers help in vaporizing the plaque. The laser technology can be used alone, or in combination with balloon angioplasty. If used along with balloon angioplasty, the balloon is inserted first to attack the hard plaque.

Atherectomy
In case of atherectomy, special instruments are used to cut away the plaque. This technique is very useful in the treatment of blockages that may be too hard or inaccessible for balloon angioplasty. People with plaque buildups in the carotid arteries are at higher risk for stroke. Atherectomy is an effective procedure that can help patients by removing the plaque, which in turn reduces the risk of stroke. The different forms of atherectomy are:

• Extraction Atherectomy: In this procedure, a tiny rotating blade is used, which works in the almost the same way as a cutter on a food processor, to cut away blockages.
• Rotational Atherectomy: In this procedure, a high-speed, diamond-tipped drill is used to penetrate the fatty deposits.
• Directional Atherectomy: In this procedure, a device that is a combination of a balloon and a shaving blade is used, to shave off the deposits.

Stenting
Stents were first approved in 1993, and since then, have gained widespread acceptance. They are small and expandable metal devices, which are inserted by a catheter into a narrowed artery. This process is done after the angioplasty procedure is complete. Stents are left in place, in order to keep the artery from closing again. They are generally used in combination with balloon angioplasty. It is possible that rarely a patient can develop blood clots, as a result of the use of stents. This problem generally occurs in people with weak hearts.

Angioplasty is advantageous as the artery is returned to normal size without resorting to major surgery.