• The ABCs of Angioplasty: Terms You Should Know

    Angioplasty is a treatment for cardiovascular disease. During angioplasty, a specialist, such as an interventional cardiologist, opens the clogged or blocked artery with a very thin tube called a catheter that is threaded through a blood vessel to the site of a blockage. The catheter has a balloon attached that expands to push away the material that is causing the blockage. The material is called plaque. Because angioplasty is performed with just a small incision in the groin or wrist (rather than requiring major surgery), it is considered a minimally invasive way to treat cardiovascular disease and restore the flow of blood to the heart, brain, kidneys or legs.

    Elective angioplasty is used to clear one or more significant artery blockages that are not life threatening but that may be causing heart disease symptoms, such as chest pain (angina), shortness of breath, or chronic fatigue, high blood pressure in the case of kidney (renal) artery disease, or pain, swelling or sores in the legs. Tiny metal cylinders, called stents, may use used to prevent the artery from collapsing or becoming clogged or blocked again in the future.

    Terms to Describe Cardiovascular Disease

    Atherosclerosis is a disease that progresses over time as fatty deposits called plaque build up in the blood vessels. If the build-up blocks or nearly blocks the blood vessel, it can stop or restrict the flow of blood to the tissue and organs in the body that need oxygen from the blood to function. Atherosclerosis is more commonly referred to as heart disease or cardiovascular disease, but it is important to know that it happens in blood vessels throughout the body, not just the heart (coronary) arteries.

    Diffuse atherosclerosis refers to the build-up of plaque in blood vessels throughout the body. If a blood vessel is critically restricted or blocked in one part of the body -- for example, the leg -- it is very important to look throughout the body for other problems, such as in the heart arteries or in the carotid artery leading to the brain.

    Multi-vessel coronary artery disease is another term used to describe plaque build-up in more than one artery (vessel) leading to the heart.

    The Vocabulary of Blocked Blood Vessels

    Borderline coronary blockage is when the build-up of plaque in an artery does not completely block the artery but it may still require surgery or angioplasty and stenting. Why might a borderline blockage still require treatment? Because blood flow may restricted, increasing the risk of problems in the future. If your blockage is borderline, your doctor will carefully consider all of the information available to help you make the best treatment choice.

    Click here for more information on the tests doctors use to decide if angioplasty and stenting are the best treatment for your circumstances.

    Ischemia occurs when blood flow to the body’s tissue and organs is restricted. Your heart, brain and kidneys are particularly vulnerable to irreparable damage that can happen quickly if they do not receive the oxygen they need and receive from the blood.

    Lesions are places in the blood vessels that have become blocked due to a build-up of plaque and blood clots. Your interventional cardiologist looks for lesions during an angiogram. He or she may use angioplasty and stenting to treat the lesions.

    Culprit lesions are lesions that have restricted blood flow to the point of causing a problem, such as a heart attack or unstable angina.

    The Language of Angioplasty

    Minimally invasive is a term used to describe procedures that treat blockages in the blood vessels with a catheter that inserted into a blood vessel through the skin in the groin or the wrist instead of opening the area with a scalpel during surgery.

    PCI stands for percutaneous coronary intervention. It is another term for procedures that include angioplasty and stenting in the heart (coronary) arteries. Rather than making incisions with a scalpel as in open-heart surgery, PCI is performed by inserting a catheter through a puncture point in the wrist or groin and threading it through the blood vessels to reach the area with a blockage to open up the artery and possibly implant a stent.

    Primary PCI is emergency angioplasty and possibly stenting to stop or treat a heart attack by restoring blood flow through the blocked artery. It is the treatment of choice if an interventional cardiologist is available to perform the procedure within 90 minutes of the heart attack. If the hospital does not have these resources, it is recommended that you go to another one that does. In some cases it may be the best treatment even after 90 minutes. In an emergency, if you do not know which hospitals do and don’t offer primary PCI, then go to the nearest ER. They may have system in place to transfer you to a hospital that does offer primary PCI if needed.

    Elective PCI is angioplasty and possibly stenting when you and your heart are not in immediate danger. Instead, you elect to have the procedure because to relieve chest pain and other symptoms.

    Percutaneous describes how the catheter is inserted into the body - a needle puncture in the skin at the groin or wrist rather than cutting the skin with a scalpel.

    A stent is a tiny, metal mesh tube that is placed with a catheter and permanently embedded within the artery wall to prop open and prevent it from collapsing. Your doctor may choose one three types of stents (bare metal, drug-eluting or bioresorbable). The type of stent used depends on the size of the artery and the location of the blockage. Your cardiologist will also consider any tests or other treatments that you may have scheduled in the near future. This is because you will need to take care of your stent by taking aspirin and an antiplatelet medication for anywhere from a few months to more than a year. How long you will need to take these medications will depend on the type of stent you receive and your medical history.

    Stenting is the procedure performed by interventional cardiologist to implant a stent to keep narrowed or blocked blood vessels open after they have been opened by angioplasty.

    In Other Words: Getting the Blood Flowing

    Revascularization is restoring the flow of blood through blood vessels that have become narrowed or blocked due to atherosclerosis or a blood clot. Open-heart surgery (CABG) and PCI are the two methods of revascularization.

    Complete revascularization restores blood flow in all blood vessels that are significantly narrowed. While treating blood vessels that are severely narrowed or blocked your doctor may discover other blood vessels that are significantly narrowed and decide to treat them as well for a complete revascularization. Some research shows that complete revascularization can improve your chance of long-term survival. However, working on more blood vessels also increases your risk of complications, so it may not be the best choice for everyone. It is important to note that the degree of narrowing in the blood vessels that requires treatment with angioplasty and bypass surgery is still a matter of debate.

    Incomplete revascularization is restoring blood flow only in some of the blood vessels that are severely narrowed or blocked. This approach minimizes the immediate risks in patients with other conditions that may increase their risk of complications during the procedure.