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KEY FACTS
Terminology
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Definitions
- Percutaneous transluminal angioplasty (PTA): Inflation of catheter-mounted balloon within narrowed vascular structure to enlarge luminal diameter, improve flow hemodynamics
- Arterial angioplasty: Primary mechanism is controlled fracture of obstructing atherosclerotic plaque
- Desquamation of endothelial cells
- Causes fissures in plaque/intima; stretches media
- Virtually no compression of plaque itself
- Venous angioplasty: PTA of stenotic venous lumen
- Stretches entire vein wall, usually without fissures
- Often requires high-pressure balloon
- Stent associated: PTA often performed in conjunction with stenting
- Predilation PTA of stenosis, allowing stent advancement into position
- Postdeployment PTA, maximally distending & securing stent
- Post angioplasty: In weeks following PTA, reendothelialization of intima occurs; vessel remodels
- Post-PTA restenosis due to prolific neointimal hyperplasia &/or major vascular remodeling (e.g., recoil); largely an inflammatory response
- Arterial angioplasty: Primary mechanism is controlled fracture of obstructing atherosclerotic plaque
- Angioplasty catheter designs
- Over-the-wire (OTW): Central lumen for guidewire access/contrast injection, small parallel lumen within catheter for balloon inflation/deflation
- Traditional angioplasty balloon catheter design
- Guidewire in central lumen improves catheter tracking & pushability
- Contrast can be injected through catheter
- Rapid exchange (monorail): Guidewire passes through balloon, exits catheter proximal to balloon, runs outside catheter shaft
- Increasingly popular angioplasty catheter
- Exchange length guidewires unnecessary
- Balloon typically has lower profile
- Rapid balloon inflation/deflation times
- Often used with guide-catheter/sheath to minimize following disadvantages
- Unable to inject contrast through catheter
- Poorer trackability/pushability than OTW
- Over-the-wire (OTW): Central lumen for guidewire access/contrast injection, small parallel lumen within catheter for balloon inflation/deflation
- Various angioplasty technologies/techniques
- Conventional, a.k.a. plain old balloon angioplasty (POBA): Balloon inflation within narrowed lumen
- Outward force (measured in atmospheres) exerted by balloon against obstructing lesion/stenosis
- Degree of force depends on
- Diameter, compliance (elasticity), inflation pressure, and length of angioplasty balloon
- Severity and morphology of stenosis
- Cutting balloon angioplasty: 3-4 atherotomes (microsurgical blades) fixed longitudinally on surface of noncompliant balloon
- Atherotomes expand radially, delivering longitudinal incisions in plaque & vessel
- Theoretically reduces vessel stretch/injury by scoring plaque vs. uncontrolled disruption
- Randomized trial of 1,385 coronary lesions: No clinical or angiographic difference between cutting & standard PTA at 6-month follow-up
- Some small studies suggest lower restenosis rates
- Generally infrequently used for arterial lesions
- Most frequently used for PTA of venous stenoses
- Atherotomes expand radially, delivering longitudinal incisions in plaque & vessel
- Scoring balloon angioplasty: Balloon surrounded by wire "cage" for focally concentrated dilatation
- AngioSculpt scoring balloon (AngioScore): Semicompliant balloon encircled by 3-4 nitinol spiral struts
- Balloon inflation focuses radial force along edges of struts, scoring plaque circumferentially
- Similar technology to cutting balloon angioplasty; wires rather than blades
- VascuTrak PTA balloon (Bard Peripheral Vascular): 2 flexible longitudinal wires externally parallel semicompliant balloon
- Flexible wires score plaque in tortuous vessels
- 0.014"/0.018" rapid exchange system
- Balloon lengths from 20-300 mm
- AngioSculpt scoring balloon (AngioScore): Semicompliant balloon encircled by 3-4 nitinol spiral struts
- Cryoplasty: Combines angioplasty with cold energy to treat obstructive atherosclerotic plaque
- PolarCath peripheral dilation catheter (Boston Scientific)
- Liquid nitrous oxide used to inflate balloon while lowering its surface temperature to -10°C
- Theoretically causes altered plaque response, decreased elastic recoil, cellular apoptosis
- Recent trials indicate cryoplasty does not offer outcomes superior to balloon angioplasty
- Unfavorable cost-benefit
- Possibly higher restenosis rates
- Drug-eluting balloon angioplasty: Balloon coated with medication (e.g., paclitaxel)
- Delivers antiproliferative drug to vessel surface
- Local drug application to vessel surface to prevent restenosis without placing stent
- High drug concentration reduces neointimal proliferation even with short time exposure
- Investigational device with ongoing trials
- Delivers antiproliferative drug to vessel surface
- Conventional, a.k.a. plain old balloon angioplasty (POBA): Balloon inflation within narrowed lumen
- Percutaneous transluminal angioplasty (PTA): Inflation of catheter-mounted balloon within narrowed vascular structure to enlarge luminal diameter, improve flow hemodynamics
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Expected Outcomes
Selected References
- Naghi J et al: New developments in the clinical use of drug-coated balloon catheters in peripheral arterial disease. Med Devices (Auckl). 9:161-74, 2016
- Diehm NA et al: Drug eluting balloons. Tech Vasc Interv Radiol. 13(1):59-63, 2010
- Banerjee S et al: Atheroemboli during peripheral arterial interventions. J Invasive Cardiol. 21(12):632-3, 2009
- Bosiers M et al: Use of the AngioSculpt scoring balloon for infrapopliteal lesions in patients with critical limb ischemia: 1-year outcome. Vascular. 17(1):29-35, 2009
- Conrad MF et al: Infrapopliteal balloon angioplasty for the treatment of chronic occlusive disease. J Vasc Surg. 50(4):799-805, 2009
- Das TS et al: Primary cryoplasty therapy provides durable support for limb salvage in critical limb ischemia patients with infrapopliteal lesions: 12-month follow-up results from the BTK Chill Trial. J Endovasc Ther. 16(2 Suppl 2):II19-30, 2009
- Laird JR et al: The role for cryoplasty in the treatment of infrainguinal artery disease: case studies. J Endovasc Ther. 16(2 Suppl 2):II116-28, 2009
- Shammas NW: Restenosis after lower extremity interventions: current status and future directions. J Endovasc Ther. 16 Suppl 1:I170-82, 2009
- Siablis D: Atheroembolization and peripheral vascular interventions: the evidence is mounting. J Endovasc Ther. 16(2):203-5, 2009
- Wilson AM et al: Randomized controlled trial of aspirin and clopidogrel versus aspirin and placebo on markers of smooth muscle proliferation before and after peripheral angioplasty. J Vasc Surg. 50(4):861-9, 2009
- Bosiers M et al: Present and future of endovascular SFA treatment: stents, stent-grafts, drug coated balloons and drug coated stents. J Cardiovasc Surg (Torino). 49(2):159-65, 2008
- Fonseca A et al: Intravascular ultrasound assessment of the novel AngioSculpt scoring balloon catheter for the treatment of complex coronary lesions. J Invasive Cardiol. 20(1):21-7, 2008
- Werk M et al: Inhibition of restenosis in femoropopliteal arteries: paclitaxel-coated versus uncoated balloon: femoral paclitaxel randomized pilot trial. Circulation. 2008 Sep 23;118(13):1358-65. Epub 2008 Sep 8. Erratum in: Circulation. 118(16):e670, 2008
- Scheinert D et al: Results of the multicenter first-in-man study of a novel scoring balloon catheter for the treatment of infra-popliteal peripheral arterial disease. Catheter Cardiovasc Interv. 70(7):1034-9, 2007
- Laird JR et al: Cryoplasty for the treatment of femoropopliteal arterial disease: extended follow-up results. J Endovasc Ther. 13 Suppl 2:II52-9, 2006
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References
Tables
Tables
KEY FACTS
Terminology
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Definitions
- Percutaneous transluminal angioplasty (PTA): Inflation of catheter-mounted balloon within narrowed vascular structure to enlarge luminal diameter, improve flow hemodynamics
- Arterial angioplasty: Primary mechanism is controlled fracture of obstructing atherosclerotic plaque
- Desquamation of endothelial cells
- Causes fissures in plaque/intima; stretches media
- Virtually no compression of plaque itself
- Venous angioplasty: PTA of stenotic venous lumen
- Stretches entire vein wall, usually without fissures
- Often requires high-pressure balloon
- Stent associated: PTA often performed in conjunction with stenting
- Predilation PTA of stenosis, allowing stent advancement into position
- Postdeployment PTA, maximally distending & securing stent
- Post angioplasty: In weeks following PTA, reendothelialization of intima occurs; vessel remodels
- Post-PTA restenosis due to prolific neointimal hyperplasia &/or major vascular remodeling (e.g., recoil); largely an inflammatory response
- Arterial angioplasty: Primary mechanism is controlled fracture of obstructing atherosclerotic plaque
- Angioplasty catheter designs
- Over-the-wire (OTW): Central lumen for guidewire access/contrast injection, small parallel lumen within catheter for balloon inflation/deflation
- Traditional angioplasty balloon catheter design
- Guidewire in central lumen improves catheter tracking & pushability
- Contrast can be injected through catheter
- Rapid exchange (monorail): Guidewire passes through balloon, exits catheter proximal to balloon, runs outside catheter shaft
- Increasingly popular angioplasty catheter
- Exchange length guidewires unnecessary
- Balloon typically has lower profile
- Rapid balloon inflation/deflation times
- Often used with guide-catheter/sheath to minimize following disadvantages
- Unable to inject contrast through catheter
- Poorer trackability/pushability than OTW
- Over-the-wire (OTW): Central lumen for guidewire access/contrast injection, small parallel lumen within catheter for balloon inflation/deflation
- Various angioplasty technologies/techniques
- Conventional, a.k.a. plain old balloon angioplasty (POBA): Balloon inflation within narrowed lumen
- Outward force (measured in atmospheres) exerted by balloon against obstructing lesion/stenosis
- Degree of force depends on
- Diameter, compliance (elasticity), inflation pressure, and length of angioplasty balloon
- Severity and morphology of stenosis
- Cutting balloon angioplasty: 3-4 atherotomes (microsurgical blades) fixed longitudinally on surface of noncompliant balloon
- Atherotomes expand radially, delivering longitudinal incisions in plaque & vessel
- Theoretically reduces vessel stretch/injury by scoring plaque vs. uncontrolled disruption
- Randomized trial of 1,385 coronary lesions: No clinical or angiographic difference between cutting & standard PTA at 6-month follow-up
- Some small studies suggest lower restenosis rates
- Generally infrequently used for arterial lesions
- Most frequently used for PTA of venous stenoses
- Atherotomes expand radially, delivering longitudinal incisions in plaque & vessel
- Scoring balloon angioplasty: Balloon surrounded by wire "cage" for focally concentrated dilatation
- AngioSculpt scoring balloon (AngioScore): Semicompliant balloon encircled by 3-4 nitinol spiral struts
- Balloon inflation focuses radial force along edges of struts, scoring plaque circumferentially
- Similar technology to cutting balloon angioplasty; wires rather than blades
- VascuTrak PTA balloon (Bard Peripheral Vascular): 2 flexible longitudinal wires externally parallel semicompliant balloon
- Flexible wires score plaque in tortuous vessels
- 0.014"/0.018" rapid exchange system
- Balloon lengths from 20-300 mm
- AngioSculpt scoring balloon (AngioScore): Semicompliant balloon encircled by 3-4 nitinol spiral struts
- Cryoplasty: Combines angioplasty with cold energy to treat obstructive atherosclerotic plaque
- PolarCath peripheral dilation catheter (Boston Scientific)
- Liquid nitrous oxide used to inflate balloon while lowering its surface temperature to -10°C
- Theoretically causes altered plaque response, decreased elastic recoil, cellular apoptosis
- Recent trials indicate cryoplasty does not offer outcomes superior to balloon angioplasty
- Unfavorable cost-benefit
- Possibly higher restenosis rates
- Drug-eluting balloon angioplasty: Balloon coated with medication (e.g., paclitaxel)
- Delivers antiproliferative drug to vessel surface
- Local drug application to vessel surface to prevent restenosis without placing stent
- High drug concentration reduces neointimal proliferation even with short time exposure
- Investigational device with ongoing trials
- Delivers antiproliferative drug to vessel surface
- Conventional, a.k.a. plain old balloon angioplasty (POBA): Balloon inflation within narrowed lumen
- Percutaneous transluminal angioplasty (PTA): Inflation of catheter-mounted balloon within narrowed vascular structure to enlarge luminal diameter, improve flow hemodynamics
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Expected Outcomes
Selected References
- Naghi J et al: New developments in the clinical use of drug-coated balloon catheters in peripheral arterial disease. Med Devices (Auckl). 9:161-74, 2016
- Diehm NA et al: Drug eluting balloons. Tech Vasc Interv Radiol. 13(1):59-63, 2010
- Banerjee S et al: Atheroemboli during peripheral arterial interventions. J Invasive Cardiol. 21(12):632-3, 2009
- Bosiers M et al: Use of the AngioSculpt scoring balloon for infrapopliteal lesions in patients with critical limb ischemia: 1-year outcome. Vascular. 17(1):29-35, 2009
- Conrad MF et al: Infrapopliteal balloon angioplasty for the treatment of chronic occlusive disease. J Vasc Surg. 50(4):799-805, 2009
- Das TS et al: Primary cryoplasty therapy provides durable support for limb salvage in critical limb ischemia patients with infrapopliteal lesions: 12-month follow-up results from the BTK Chill Trial. J Endovasc Ther. 16(2 Suppl 2):II19-30, 2009
- Laird JR et al: The role for cryoplasty in the treatment of infrainguinal artery disease: case studies. J Endovasc Ther. 16(2 Suppl 2):II116-28, 2009
- Shammas NW: Restenosis after lower extremity interventions: current status and future directions. J Endovasc Ther. 16 Suppl 1:I170-82, 2009
- Siablis D: Atheroembolization and peripheral vascular interventions: the evidence is mounting. J Endovasc Ther. 16(2):203-5, 2009
- Wilson AM et al: Randomized controlled trial of aspirin and clopidogrel versus aspirin and placebo on markers of smooth muscle proliferation before and after peripheral angioplasty. J Vasc Surg. 50(4):861-9, 2009
- Bosiers M et al: Present and future of endovascular SFA treatment: stents, stent-grafts, drug coated balloons and drug coated stents. J Cardiovasc Surg (Torino). 49(2):159-65, 2008
- Fonseca A et al: Intravascular ultrasound assessment of the novel AngioSculpt scoring balloon catheter for the treatment of complex coronary lesions. J Invasive Cardiol. 20(1):21-7, 2008
- Werk M et al: Inhibition of restenosis in femoropopliteal arteries: paclitaxel-coated versus uncoated balloon: femoral paclitaxel randomized pilot trial. Circulation. 2008 Sep 23;118(13):1358-65. Epub 2008 Sep 8. Erratum in: Circulation. 118(16):e670, 2008
- Scheinert D et al: Results of the multicenter first-in-man study of a novel scoring balloon catheter for the treatment of infra-popliteal peripheral arterial disease. Catheter Cardiovasc Interv. 70(7):1034-9, 2007
- Laird JR et al: Cryoplasty for the treatment of femoropopliteal arterial disease: extended follow-up results. J Endovasc Ther. 13 Suppl 2:II52-9, 2006
