Editing Angioplasty (section)

== Uses and indications ==

=== Coronary angioplasty ===
{{Further|Percutaneous coronary intervention}}
[[File:Ha1.jpg|thumb|A [[coronary angiogram]] (an X-ray with radio-opaque contrast in the coronary arteries) that shows the left [[coronary circulation]]. The distal [[left main coronary artery]] (LMCA) is in the left upper quadrant of the image. Its main branches (also visible) are the [[left circumflex artery]] (LCX), which courses top-to-bottom initially and then toward the centre-bottom, and the [[left anterior descending]] (LAD) artery, which courses from left-to-right on the image and then courses down the middle of the image to project underneath the distal LCX. The LAD, as is usual, has two large diagonal branches, which arise at the centre-top of the image and course toward the centre-right of the image.]]

A coronary angioplasty is a therapeutic procedure to treat the [[stenotic]] (narrowed) [[coronary artery|coronary arteries]] of the [[heart]] found in [[coronary heart disease]].<ref name="Chhabra_2019" /> These stenotic segments of the coronary arteries arise due to the buildup of [[cholesterol]]-laden [[Atheroma|plaque]]s that form in a condition known as [[atherosclerosis]].<ref>{{Cite web|url=https://www.nhlbi.nih.gov/health-topics/atherosclerosis|title=Atheroscleoris|website=NHLBI|access-date=January 22, 2020|archive-date=October 5, 2017|archive-url=https://web.archive.org/web/20171005113430/https://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/atrisk|url-status=live}}</ref>  A [[percutaneous coronary intervention]], or coronary angioplasty with stenting, is a non-surgical procedure used to improve the blood flow to the heart.<ref name="Chhabra_2019" />

Coronary angioplasty is indicated for coronary artery diseases such as [[unstable angina]], [[NSTEMI]], [[STEMI]] and spontaneous coronary artery perforation.<ref name="Chhabra_2019">{{cite book | vauthors = Chhabra L, Zain MA, Siddiqui WJ | chapter = Angioplasty|date=2019| chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK499894/| title =StatPearls|publisher=StatPearls Publishing|pmid=29763069|access-date=2020-01-20 |archive-date=October 24, 2022|archive-url=https://web.archive.org/web/20221024092217/https://www.ncbi.nlm.nih.gov/books/NBK499894/|url-status=live}}</ref> Percutaneous coronary intervention for stable coronary disease has been shown to significantly relieve symptoms such as [[angina]], or chest pain, thereby improving functional limitations and quality of life.<ref>{{cite journal | vauthors = Arnold SV | title = Current Indications for Stenting: Symptoms or Survival <sup>CME</sup> | journal = Methodist DeBakey Cardiovascular Journal | volume = 14 | issue = 1 | pages = 7–13 | date = 2018 | pmid = 29623167 | pmc = 5880567 | doi = 10.14797/mdcj-14-1-7 }}</ref>

=== Peripheral angioplasty ===

Peripheral angioplasty refers to the use of a balloon to open a blood vessel outside the coronary arteries.  It is most commonly done to treat [[atherosclerosis|atherosclerotic]] narrowings of the abdomen, leg and [[renal]] arteries caused by [[peripheral artery disease]]. Often, peripheral angioplasty is used in conjunction with guide wire, peripheral [[Stent#peripheral artery stent|stenting]] and an [[atherectomy]].<ref>{{cite journal | vauthors = Abdullah O, Omran J, Enezate T, Mahmud E, Shammas N, Mustapha J, Saab F, Abu-Fadel M, Ghadban R, Alpert M, Al-Dadah A | title = Percutaneous angioplasty versus atherectomy for treatment of symptomatic infra-popliteal arterial disease | journal = Cardiovascular Revascularization Medicine | volume = 19 | issue = 4 | pages = 423–428 | date = June 2018 | pmid = 29269152 | doi = 10.1016/j.carrev.2017.09.014 | s2cid = 36093380 }}</ref>

===Chronic limb-threatening ischemia===

Angioplasty can be used to treat advanced [[peripheral artery disease]] to relieve the [[claudication]], or leg pain, that is classically associated with the condition.<ref>{{Citation| vauthors = Topfer LA, Spry C |title=New Technologies for the Treatment of Peripheral Artery Disease|date=2016|url=http://www.ncbi.nlm.nih.gov/books/NBK519606/|work=CADTH Issues in Emerging Health Technologies|publisher=Canadian Agency for Drugs and Technologies in Health|pmid=30148583|access-date=2020-01-30|archive-date=June 18, 2022|archive-url=https://web.archive.org/web/20220618161812/https://www.ncbi.nlm.nih.gov/books/NBK519606/|url-status=live}}</ref>

The bypass versus angioplasty in a study of severe ischemia of the leg investigated infrainguinal [[vascular bypass|bypass surgery]] first compared to angioplasty first in select patients with severe lower limb ischemia who were candidates for either procedure. In this study, angioplasty was associated with less short term morbidity compared with bypass surgery; however, long term outcomes favor bypass surgery.<ref>{{cite journal | vauthors = Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, Fowkes FG, Gillepsie I, Ruckley CV, Raab G, Storkey H | title = Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial | journal = Lancet | volume = 366 | issue = 9501 | pages = 1925–1934 | date = December 2005 | pmid = 16325694 | doi = 10.1016/S0140-6736(05)67704-5 | s2cid = 54229954 }}</ref>

Based on this study, the ACCF/AHA{{clarify|Alphabet soup|date=January 2025}} guidelines recommend balloon angioplasty only for patients with a life expectancy of 2 years or less or those who do not have an [[Vascular bypass|autogenous vein]] available. For patients with a life expectancy greater than 2 of years life, or who have an autogenous vein, a bypass surgery could be performed first.<ref>{{cite journal | vauthors = Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, Golzarian J, Gornik HL, Halperin JL, Jaff MR, Moneta GL, Olin JW, Stanley JC, White CJ, White JV, Zierler RE | title = 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline) | collaboration = A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines | journal = Journal of the American College of Cardiology | volume = 58 | issue = 19 | pages = 2020–2045 | date = November 2011 | pmid = 21963765 | pmc = 4714326 | doi = 10.1016/j.jacc.2011.08.023 }}</ref>

=== Renal artery angioplasty ===
[[Renal artery stenosis]] is associated with [[hypertension]] and loss of [[renal failure|renal function]].<ref>{{cite journal | vauthors = Raman G, Adam GP, Halladay CW, Langberg VN, Azodo IA, Balk EM | title = Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: An Updated Systematic Review | journal = Annals of Internal Medicine | volume = 165 | issue = 9 | pages = 635–649 | date = November 2016 | pmid = 27536808 | doi = 10.7326/M16-1053 | doi-access = free }}</ref> Atherosclerotic obstruction of the [[renal artery]] can be treated with angioplasty with or without [[stent]]ing of the renal artery.<ref name="van den Berg_2012" /> There is a weak recommendation for renal artery angioplasty in patients with renal artery stenosis and flash edema or congestive heart failure.<ref name="van den Berg_2012">{{cite journal | vauthors = van den Berg DT, Deinum J, Postma CT, van der Wilt GJ, Riksen NP | title = The efficacy of renal angioplasty in patients with renal artery stenosis and flash oedema or congestive heart failure: a systematic review | journal = European Journal of Heart Failure | volume = 14 | issue = 7 | pages = 773–781 | date = July 2012 | pmid = 22455866 | doi = 10.1093/eurjhf/hfs037 | doi-access = free }}</ref>

=== Carotid angioplasty ===
{{Main|Carotid artery stenting}}

[[Carotid artery stenosis]] can be treated with angioplasty and [[carotid stenting]] for patients at high risk for undergoing [[carotid endarterectomy]].<ref>{{cite journal | vauthors = Ahn SH, Prince EA, Dubel GJ | title = Carotid artery stenting: review of technique and update of recent literature | journal = Seminars in Interventional Radiology | volume = 30 | issue = 3 | pages = 288–296 | date = September 2013 | pmid = 24436551 | pmc = 3773038 | doi = 10.1055/s-0033-1353482 }}</ref>  Although carotid endarterectomy is typically preferred over carotid artery stenting, stenting is indicated in select patients with radiation-induced stenosis or a carotid lesion not suitable for surgery.<ref>{{cite journal | vauthors = Giannopoulos S, Texakalidis P, Jonnalagadda AK, Karasavvidis T, Giannopoulos S, Kokkinidis DG | title = Revascularization of radiation-induced carotid artery stenosis with carotid endarterectomy vs. carotid artery stenting: A systematic review and meta-analysis | journal = Cardiovascular Revascularization Medicine | volume = 19 | issue = 5 Pt B | pages = 638–644 | date = July 2018 | pmid = 29422277 | doi = 10.1016/j.carrev.2018.01.014 | s2cid = 46801250 }}</ref>

=== Venous angioplasty ===

Angioplasty is used to treat venous stenosis affecting [[Hemodialysis|dialysis]] access, with drug-coated balloon angioplasty proving to have better 6 month and 12 month patency than conventional balloon angioplasty.<ref>{{cite journal | vauthors = Yan Wee IJ, Yap HY, Hsien Ts'ung LT, Lee Qingwei S, Tan CS, Tang TY, Chong TT | title = A systematic review and meta-analysis of drug-coated balloon versus conventional balloon angioplasty for dialysis access stenosis | journal = Journal of Vascular Surgery | volume = 70 | issue = 3 | pages = 970–979.e3 | date = September 2019 | pmid = 31445651 | doi = 10.1016/j.jvs.2019.01.082 | doi-access = free }}</ref> Angioplasty is occasionally used to treat residual [[subclavian vein]] stenosis following [[Decompression (surgery)|decompression surgery]] for [[thoracic outlet syndrome]].<ref>{{cite journal | vauthors = Schneider DB, Dimuzio PJ, Martin ND, Gordon RL, Wilson MW, Laberge JM, Kerlan RK, Eichler CM, Messina LM | title = Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty | journal = Journal of Vascular Surgery | volume = 40 | issue = 4 | pages = 599–603 | date = October 2004 | pmid = 15472583 | doi = 10.1016/j.jvs.2004.07.028 | doi-access = free }}</ref> There is a weak recommendation for deep venous stenting to treat obstructive chronic venous disease.<ref>{{cite journal | vauthors = Seager MJ, Busuttil A, Dharmarajah B, Davies AH | title = Editor's Choice-- A Systematic Review of Endovenous Stenting in Chronic Venous Disease Secondary to Iliac Vein Obstruction | journal = European Journal of Vascular and Endovascular Surgery | volume = 51 | issue = 1 | pages = 100–120 | date = January 2016 | pmid = 26464055 | doi = 10.1016/j.ejvs.2015.09.002 | doi-access = free }}</ref>