EXPLAIN IN DETAIL THE ROLE OF CAROTID ANGIOPLASTY IN ASYMPTOMATIC CAROTID DISEASE ?
A 10 INTRODUCTION
1 Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive, endovascular procedure to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis.
2 A deflated balloon attached to a catheter (a balloon catheter) is passed over a guide-wire into thenarrowed vessel and then inflated to a fixed size.
3 The balloon forces expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow.
4 Astent may be inserted at the time of ballooning to ensure the vessel remains open, and the balloon is then deflated and withdrawn.
5 Angioplasty has come to include all manner of vascular interventions that are typically performed percutaneously.
6 Is a therapeutic procedure to treat the stenotic(narrowed) coronary arteries of theheart found in coronary heart disease asThese stenotic segments are due to the buildup of cholesterol-laden plaques that form due to atherosclerosis.
7 Angioplasty requires an access vessel, typically the femoral or radial artery or femoral vein to permit access to the vascular system for the wires and catheters used.
8 If no access vessel of sufficient size and quality is available, angioplasty is contraindicated.
9 A small vessel diameter, the presence of posterior calcification, occlusion, hematoma, or abypass origin may all make access to the vascular system too difficult.
10 Access to the vascular system is typically gained percutaneously(through the skin, without a large surgical incision).
A ) An introducer sheathis inserted into blood vessel via theSeldinger technique.
B ) Fluoroscopic guidance and radiopaque contrast dyeare used to guide angled wires andcatheters to the region of the body to be treated.
C ) To treat a narrowing in a blood vessel, a wire is passed through the stenosis in the vessel and a balloon on a catheter is passed over the wire and into the desired position.
D ) The positioning is verified by fluoroscopy and the balloon is inflated using water mixed with contrast dye to 75 to 500 times normal blood pressure (6 to 20 atmospheres).
E ) A stent may or may not also be placed.
F ) At the conclusion of the procedure, the balloons, wires and catheters are removed and the vessel puncture site is treated either with direct pressure or avascular closure device.
11 The first coronary angioplasty with a drug delivery stents system was perfomed by Luis de la Fuente, at de Instituto Argentino de Diagnóstico y Tratamiento, since Buenos Aires in 1999.
ROLE / RATIONALE
1 Early detection can reduce morbidity due to cardiovascular disease
2 Has a survival advantage of 30 yrs as strokes may occur at any age , risk doubles in each decade of life starting at age 55
3 In hypertensives as there is increase incidence of carotid disease
4 In smokers and hyperlipidemic patients over 60 yrs of age
5 In identifying carotid bruits especially in diabetics ( type 2 ) as there is increased risk of stroke in 2 years
6 There is level 1 evidence of its use
7 It is done to avoid risk of CVA or stroke during major operations or planning prior to major operations as prophylactically especially in immediate post op phase
8 It prevents from TIA prophylactically
9 To identify patients with severe atherosclerosis
TRIALS THAT ARE USED TILL NOW
1 ACST - Asymptomatic cardiac surgery trials - I and II
2 SAPPHIRE TRIAL
RISKS AND COMPLICATIONS
1 Embolization , or the launching of debris into the bloodstream
2 Arterial rupture from over-inflation of a balloon catheter or the use of an inappropriately large or stiff balloon, or the presence of a calcified target vessel.
3 Hematoma or pseudoaneurysm formation at the access site
4 Radiation Injuries Radiation induced injuries (burns) from the X-Rays used
5 Angioplasty may also provide a less durable treatment for atherosclerosis, and be more prone to restenosis, relative to vascular bypass or coronary artery bypass grafting.