Hardening of the Arteries (cont.)
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Balloon angioplasty: In this procedure, a balloon-tipped catheter is used to open blocked or narrowed arteries. The catheter (thin tube) is inserted into the body through a blood vessel in the groin region and pushed all the way up and into the blocked artery. When the narrowed part of the artery is reached, the balloon is inflated to press the plaque against the arterial wall so that the lumen of the affected artery increases in diameter, therefore improving blood flow through the previously blocked artery. The problem is that the balloon damages the wall temporarily, creating a stimulus to the inner lining or endothelium to proliferate, and restenose the artery with fibrous tissue.
Stenting: Frequently following angioplasty, a metal tube called a stent is placed in the artery to keep the lumen open after a successful dilatation. The stent acts as a scaffold, supporting the arterial walls, preventing collapse or recoil, and seals over injured areas of the endothelium. Some stents are coated with special drugs that help prevent proliferation of the endothelium, and reblockage of the affected artery. After stenting, the patient is asked to take drugs to prevent clotting of the metal surface.
If lifestyle changes and medications are not helpful in alleviating symptoms of atherosclerosis, and/or angioplasty with stenting has already been performed and is not technically feasible again, surgical bypass procedures may be indicated.
Bypass surgery: This surgery uses arteries or veins from other areas in the body to bypass the blocked arteries and improve blood flow to the downstream artery. When the surgery is performed on the coronary arteries, it is called coronary artery bypass surgery. Carotid artery endarterectomy rotorooter the plaque on the inside of the artery so more easy flow of blood to the brain is accomplished. Bypass surgery of the leg arteries frequently uses specially designed tubes (grafts) from cloth, Dacron, or plastic to perform bypass.
Shabir Bhimji, MD
Shehnaz Shaikh, MD
Alan D Forker, MD
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Atherosclerosis is a disease of large and medium-sized muscular arteries and is characterized by endothelial dysfunction, vascular inflammation, and the buildup of lipids, cholesterol, calcium, and cellular debris within the intima of the vessel wall.