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PTCA Angioplasty Introduction

Introduction to PTCA Angioplasty

Since the first percutaneous transluminal coronary PTCA Angioplasty performed by Andreas Gruntzig in 1977 the technology has evolved significantly. Progress of PTCA has seen the development of many devices, some of which are still in use and many others that have fallen in disuse. The main limitation of the plain old balloon angioplasty (POBA) was the problem of elastic vascular recoil causing abrupt vessel closure and restenosis. The patho-mechanism of restenosis that occurs following balloon

PTCA angioplasty involves negative vascular remodeling, elastic recoil and thrombosis at the site of injury {Moreno, 1999}. While the thrombus formation can be reduced by use of antiplatelet drugs, the restenosis threat remains. Early restenosis occurred in as many as 30% of angioplasty cases. This led to the development of the metal stent to exert radial force on the vessel wall and thus prevent elastic recoil. Although stents reduced restenosis, their use led to the realisation of a different and new challenge of in stent restenois (ISR). This occurs mainly due to neointima formation {Mach, 2000,Mudra et al, 1997, Hoffman et al, 1996, Kearney et al, 1997} that is principally composed of proliferating smooth muscle cells (SMC) and extra cellular matrix {Geary et al, 2003, Grewe et al, 1999}. By the late 1990s, it was acknowledged that although the incidence of ISR was lower than that of restenosis following balloon angioplasty
{Serruys et al, 1991}, it occurred in 15–30% of patients, and possibly more frequently in certain subgroups {Holmes et al, 2002}.

Drug eluting balloons
Old-style balloon angioplasty married to the latest in drug-eluting technology, resulting in a drug eluting balloon (DEB), may be an effective alternative to stenting, in particular to overcome the problems of restenosis and ISR. Such a device would potentially overcome the drawbacks of stenting, polymer-related delayed endothelialization, and stent delivery, while at the same time providing homogenous drug delivery to the vessel wall, allowing earlier endothelialization and flexibility of use in complex lesions. However, its limitations include the failure to provide a mechanical scaffold for the prevention of acute recoil and the problem of not being able to treat dissection flaps.

PTCA BALLOON CATHETER OVERVIEW:

Balloon catheters are used in a wide range of minimally invasive diagnostic and therapeutic procedures, including dilating vessels, opening blockages, delivering stents, and more.

There are many factors to consider when designing a balloon catheter, including the application, type of balloon, type of catheter, and device performance requirements.

Applications
The application for which the catheter will be used is the primary driver of catheter design. Common applications for balloon catheters include:

  • Renal denervation
  • Cryoablation
  • Balloon sinuplasty
  • Transcatheter aortic valve implantation (TAVI)
  • Drug delivery
  • Stent delivery
  • Balloon occlusion
  • Balloon angioplasty
  • Esophageal dilation
  • Atherectomy
  • Balloon carpal tunnelplasty
  • Kyphoplasty

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