Editing Angioplasty (section)

== Technique ==

[[File:Balloon-Tipped Catheter.png|thumb|Balloon-tipped catheter.]]

[[File:Angioplasty - Balloon Inflated with Stent.png|thumb|Balloon inflated with stent]]

[[File:Balloon-catherter.png|right|thumb|Diagram of a balloon catheter]]

Access to the vascular system is typically gained [[percutaneous]]ly (through the skin, without a large surgical incision). An [[introducer sheath]] is inserted into the blood vessel via the [[Seldinger technique]].<ref>{{cite journal | vauthors = Thaut L, Weymouth W, Hunsaker B, Reschke D | title = Evaluation of Central Venous Access with Accelerated Seldinger Technique Versus Modified Seldinger Technique | journal = The Journal of Emergency Medicine | volume = 56 | issue = 1 | pages = 23–28 | date = January 2019 | pmid = 30503723 | doi = 10.1016/j.jemermed.2018.10.021 | s2cid = 54484203 }}</ref> [[Fluoroscopy|Fluoroscopic guidance]] uses magnetic resonance or X-ray fluoroscopy and [[radiopaque]] [[contrast dye]] to guide angled wires and [[catheter]]s to the region of the body to be treated in real time.<ref>{{cite journal | vauthors = Saeed M, Hetts SW, English J, Wilson M | title = MR fluoroscopy in vascular and cardiac interventions (review) | journal = The International Journal of Cardiovascular Imaging | volume = 28 | issue = 1 | pages = 117–137 | date = January 2012 | pmid = 21359519 | pmc = 3275732 | doi = 10.1007/s10554-010-9774-1 }}</ref> Tapered guidewire is chosen for small occlusion, followed by intermediate type guidewires for tortuous arteries and difficulty passing through extremely narrow channels, and stiff wires for hard, dense, and blunt occlusions.<ref name="pmid27316507">{{cite journal | vauthors = Dash D | title = Guidewire crossing techniques in coronary chronic total occlusion intervention: A to Z | journal = Indian Heart Journal | volume = 68 | issue = 3 | pages = 410–420 | date = 2016 | pmid = 27316507 | pmc = 4912030 | doi = 10.1016/j.ihj.2016.02.019 }}</ref>

To treat a narrowing in a blood vessel, a wire is passed through the [[stenosis]] in the vessel and a [[Balloon catheter|balloon on a catheter]] is passed over the wire and into the desired position.<ref>{{Cite journal| vauthors = Ali R, Greenbaum AB, Kugelmass AD |date=2012-01-14|title=A Review of Available Angioplasty Guiding Catheters, Wires and Balloons - Making the Right Choice|url=https://www.icrjournal.com/articles/angioplasty-guiding-catheters|journal=Journal - A Review of Available Angioplasty Guiding Catheters, Wires and Balloons - Making the Right Choice|language=en-gb|access-date=January 22, 2020|archive-date=January 25, 2020|archive-url=https://web.archive.org/web/20200125171042/https://www.icrjournal.com/articles/angioplasty-guiding-catheters|url-status=live}}</ref> 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), with most coronary angioplasties requiring less than 10 atmospheres.<ref>{{cite journal | vauthors = Kahn JK, Rutherford BD, McConahay DR, Hartzler GO | title = Inflation pressure requirements during coronary angioplasty | journal = Catheterization and Cardiovascular Diagnosis | volume = 21 | issue = 3 | pages = 144–147 | date = November 1990 | pmid = 2225048 | doi = 10.1002/ccd.1810210304 }}</ref> A [[stent]] may or may not also be placed.

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 a [[vascular closure device]].<ref>{{cite journal | vauthors = McTaggart RA, Raghavan D, Haas RA, Jayaraman MV | title = StarClose vascular closure device: safety and efficacy of deployment and reaccess in a neurointerventional radiology service | journal = AJNR. American Journal of Neuroradiology | volume = 31 | issue = 6 | pages = 1148–1150 | date = June 2010 | pmid = 20093310 | pmc = 7963929 | doi = 10.3174/ajnr.A2001 | doi-access = free }}</ref>

Transradial artery access and transfemoral artery access are two techniques for percutaneous coronary intervention.<ref name="Mason_2018">{{cite journal | vauthors = Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, Drachman DE, Valle JA, Rhodes D, Gilchrist IC | title = An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association | journal = Circulation. Cardiovascular Interventions | volume = 11 | issue = 9 | pages = e000035 | date = September 2018 | pmid = 30354598 | doi = 10.1161/HCV.0000000000000035 | s2cid = 53031413 | doi-access = free }}</ref> Transradial artery access is the technique of choice for management of acute coronary syndrome as it has significantly lower incidence of bleeding and vascular complications compared with the transfemoral artery approach.<ref name="Mason_2018" /> It also has a mortality benefit for high risk patients with acute coronary syndrome and who are at high risk of bleeding.<ref name="Mason_2018" /> Transradial artery access was also found to yield improved quality of life, as well as decreased healthcare costs and resources.<ref name="Mason_2018" />