Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Up to 30% to 40% of patients with successful coronary angioplasty will develop recurrent narrowing at the site of balloon inflation.
The use of newer devices such as intracoronary stents and atherectomy, as well as newer pharmacologic agents has resulted in higher success rates, reduced complications, and reduced recurrence after percutaneous coronary intervention.
What is balloon angioplasty?
Balloon angioplasty of the coronary artery, or percutaneous transluminal coronary angioplasty (PTCA), was introduced in the late 1970's. PTCA is a non-surgical procedure that relieves narrowing and obstruction of the arteries to the muscle of the heart (coronary arteries). This allows more blood and oxygen to be delivered to the heart muscle. PTCA, is now referred to as percutaneous coronary intervention, or PCI, as this term includes the use of balloons, stents, and atherectomy devices. Percutaneous coronary intervention is accomplished with a small balloon catheter inserted into an artery in the groin or arm, and advanced to the narrowing in the coronary artery. The balloon is then inflated to enlarge the narrowing in the artery. When successful, percutaneous coronary intervention can relieve chest pain of angina, improve the prognosis of individuals with unstable angina, and minimize or stop a heart attack without having the patient undergo open heart coronary artery bypass graft (CABG) surgery.
Coronary Balloon Angioplasty Illustration
In addition to the use of simple balloon angioplasty, the availability of stents, in a wire-mesh design, have expanded the spectrum of people suitable for percutaneous coronary intervention, as well as enhanced the safety and long-term results of the procedure. Since the early 1990's, more and more patients are treated with stents, which are delivered with a percutaneous coronary intervention balloon, but remain in the artery as a "scaffold". This procedure has markedly reduced the numbers of patients needing emergency CABG to below 1%, and particularly with the use of the new "medicated" stents (stents coated with medications that help prevent plaque formation), has reduced the rate of recurrence of the blockage in the coronary artery ("restenosis") to well below 10%. At present, the only patients treated with just balloon angioplasty are those with vessels less than 2mm (the smallest diameter stent), certain types of lesions involving branches of coronary arteries, those with scar tissue in old stents, or those who cannot take the blood thinner medication known asclopidogrel bisulfate (Plavix), which is taken over the long-term following the procedure.
Various "atherectomy" (plaque removal) devices were initially developed as adjuncts to percutaneous coronary intervention. These include the use of the excimer laser for photoablation of plaque, rotational atherectomy (use of a high-speed diamond-encrusted drill) for mechanical ablation of plaque, and directional atherectomy for cutting and removal of plaque. Such devices were initially thought to decrease the incidence of restenosis, but in clinical trials were shown to be of little additional benefit, and now are only used in selective cases as an adjunct to standard percutaneous coronary intervention (percutaneous artery intervention).