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Percutaneous Transluminal Angioplasty and Balloon Catheters #MMPMID33351412
Majeed H; Chowdhury YS
StatPearls-/-ä 2024[Jan]; ä (ä): ä PMID33351412show ga
Worldwide, atherosclerosis is the most common cause of morbidity and mortality manifesting as cardiovascular disease, carotid artery disease, peripheral vascular disease, and renal artery stenosis. Angioplasty is a minimally invasive endovascular procedure to widen these stenosed arteries. Angioplasty procedures are mainly directed against atherosclerotic plaque to mold and remodel the plaque and subsequently (derived from the Greek terms aging- vessel and plasso-mold). Recent advances in interventional radiology have made it possible to potentially treat almost all anatomic lesions with endovascular means, since its inception in 1964, when Dr.Charles Dotter percutaneously dilated localized stenosis of the subsartorial artery in an 82-year-old female with a guidewire and coaxial Teflon catheter, the tools, and techniques of angioplasty have greatly evolved from simple angioplasty with balloon dilation to stent placement and atherectomy procedures. Some of the types of stents used are: 1. Coronary angioplasty: Bare metal stent. Drug-eluting stent. Early generation drug-eluting stents: Sirolimus-eluting stent and Paclitaxel-eluting stent. Durable polymer drug-eluting stents: Everolimus-eluting stent, Zotarolimus eluting stent, Ridaforolimus-eluting stent. Bioabsorbable polymer drug-eluting stents. Thin-strut bioabsorbable polymer DES. Ultra-thin strut DES: Orsiro stent. Polymer free DES. Others: Combo stent - sirolimus elution from biodegradable polymer matrix which is abluminal in shape with a CD34 antibody layer. The choice of stent depends on local availability and interventional cardiologist's expertise - Everolimus-eluting stents, Zotarolimus-eluting stent, ridaforolimus-eluting stents, and the biodegradable stent are usually the first choice. A bare-metal stent is preferred in cases where the patient is actively bleeding, or the duration of dual antiplatelet therapy cannot be >30 days e.g., non-cardiac surgery within 4-6 weeks of PCI. 2. Carotid angioplasty: Self Expanding Stents. Cobalto alloy braided mesh stent. Nitinol open-cell stents (cylindrical or tapered). Nitinol closed-cell stents. Hybrid nitinol stent. New Hybrid Carotid Stent. There is no clear guideline on which stent is ideal; there is a trend towards a tailored approach where the choice of stent and procedure is made based on individual carotid anatomy, plaque complexity, anatomopathological variables, and local availability and technical expertise. 3. Peripheral arteries: Balloon-expandable stents. Self-expandable stents. Covered stents. Drug-eluting stents. Drug coated balloon stent. Dual therapy stents. Bioabsorbable vascular scaffold. Bioengineered stent. The choice of an appropriate stent depends on the access site, lesion location, stent availability, plaque complexity, and vascular anatomy evaluation, and expertise of the operator. Angioplasty is sometimes combined with atherectomy procedures to remove the plaque using specialized devices. Types of atherectomy procedures are Mechanical: Directional, Rotational, or Orbital devices or Laser evaporative methods that require the use of costly disposable devices. Evidence regarding their efficacy is lacking, and their use is still under investigation in specific niche indications.
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