Percutaneous Transluminal Coronary Angioplasty (PTCA)
Percutaneous Transluminal Coronary Angioplasty (PTCA) was originally described by Andreas Gruentzig in 1975. He used balloon catheters to dilated narrowed coronary arteries. PTCA success rates and quality of hardware has improved a lot from the days of Gruentzig.
After diagnostic coronary angiographic has localised the lesion, a guide catheter is introduced and the culprit vessel cannulated. Guide catheters have a wider lumen and braided wall to give better support. A guide wire is introduced into the culprit vessel using a manifold and connector. The wire is gently pushed and if necessary rotated with torquer to cross the coronary lesion. Once the floppy tip of the guide wire has crossed the lesion, it is introduced further down the distal vessel. Check injections of contrast through the guide catheter enables visualisation of the coronary tree to show the final position of the guide wire.
Once the guide wire is in position, a balloon catheter is threaded over the guide wire and the balloon is positioned across the lesion. After verifying the position of the balloon across the lesion, it is inflated using an indeflator. The inflation pressure is monitored in the pressure gauge attached to the indeflator. Care is taken to avoid exceeding the rated burst pressure of the balloon. After maintaining the inflation for about 20 seconds, the balloon is deflated and placed on negative pressure. The balloon is gradually withdrawn and check injection of contrast given to visualise the result of balloon angioplasty. In the earlier days, only plain balloon angioplasty was being practiced, while now-a-days, most balloon dilatations are followed by stenting to prevent vessel recoil and abrupt closure. Stenting is also useful in walling off dissections if any, which had occurred during balloon dilatation.