Balloon Angioplasty: Widening Narrowed Arteries

When your coronary or peripheral arteries are narrowed by plaque that build up and narrow your arteries, you might suffer coronary and peripheral artery disease. If you do, the blood flow through your vessels is restricted and may lead to greater complications when thrombosis builds up and gets pushed through your vessels into the brain or heart. This can lead to a stroke. Therefore, your physician may recommend a balloon angioplasty: a minimally invasive method to widen narrowed arteries from inside the vessel. This procedure aims to re-establish a sufficient supply of oxygen-rich blood in the affected areas of the heart or the body. A physician performs this procedure in a catheterization laboratory (“cath lab”) under local anesthesia.

In case your physician has recommended a balloon angioplasty, you will receive detailed instructions about how to prepare for the intervention. Your cardiologist may advise the following among other things: 

• To stop taking blood-thinning medication several days before the intervention. 
• To stop eating for about 12 hours before the implantation. 
• If you take other medication regularly, ask your physician if you should continue taking the medication before your procedure. 

In addition to the information, your healthcare professional will provide, we have put together frequently asked questions and a checklist that you might want to take a look at and go over with your physician. 

To access the vascular system, the physician makes a small cut in the skin near the groin and inserts an introducer sheath — a tube through which the balloon is introduced — into the femoral artery. The introducer sheath provides open and safe access for any required instruments during the procedure. In rare cases when the blocked vessel is located in the arm, a physician creates an access point there. After the introducer sheath has been placed correctly, a catheter is introduced into the vascular system. To pinpoint the exact location of the narrowing, a physician injects a contrast medium into the catheter. X-ray is then used to study the location and the extent of the narrowed or blocked vessel section. 

A physician then inflates the catheter balloon. When it is enlarged, the balloon presses the plaque and other blocking material against the wall of the artery and opens the vessel for restoring the blood flow. After the affected segment has been successfully widened, the balloon is deflated before it is withdrawn from the body. All other instruments are removed and the puncture site is carefully sealed.

Depending on your procedure you will remain in bed at the hospital for several hours after the balloon angioplasty. You will most likely spend the night at the hospital as well. Once you are back home, monitor the insertion site for bleeding, swelling, any abnormal discoloration and watch out for unusual pain and temperature change at or near the intersection site. A small bruise near the intersection site is normal. Should you bleed excessively from the intersection, please contact your physician.

Classic balloon angioplasty, sometimes called “plain old balloon angioplasty” (POBA), widens the narrowed vessel mechanically. If there is a high risk of the vessel getting clogged again, it may be necessary to introduce a drug-coated balloon following the mechanical widening for optimal treatment. Drug-coated balloons are used to lower the risk of a re-narrowing of the vessel (restenosis). The coating comprises medication that reduces inflammation and prevents restenosis, as well as inactive substances (excipients) that release the drug into the vessel wall. Before the use of a drug-coated balloon, the vessel has to be prepared with a procedure similar to plain old balloon angioplasty. After dilating the vessel, the drug-coated balloon is placed and inflated in the prepared vessel section via a catheter. As soon as the coating is in close contact with the vessel, the drug is released into the vessel walls. The physician keeps the balloon inflated for a certain time span to ensure the tissue absorbs enough medication. Then the balloon is deflated and removed from the body. The procedure ends as described above.