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Percutaneous transluminal coronary angioplasty (PTCA) is a procedure done under local anesthesia and designed to dilate (widen or expand) narrowed coronary arteries.

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Choosing Angioplasty (PTCA) or Coronary Artery Bypass Surgery (CABG)

People whose angina has not been relieved by medications are candidates for PTCA. The ideal candidate has only one narrowed artery, although many persons with several areas of narrowing can undergo PTCA.

The decision to recommend PTCA rather than bypass surgery is based on the location, number and severity of blockages, as well as the overall function of the heart. However, the procedure does not cure the underlying disease. In fact, the procedure may have to be repeated to reopen the same or another artery that becomes blocked. Compared to CABG, PTCA generally costs less and involves a shorter period of hospitalization.

If you have mild angina or recovered from a heart attack with no continuing symptoms, you are probably best treated by medication or other means, rather than by a bypass or another operation. Your doctor may recommend CABG in appropriate situations, such as:

  • a blocked left main coronary artery

  • disease in multiple vessels and poor function of the left ventricle (the main pump of the heart)

  • debilitating angina - For these persons, a bypass procedure is of clear value in most cases and life is clearly prolonged.

Several randomized trials have shown that during follow-up periods of several years, the infarction (heart attack) and mortality rates of CABG and PTCA are comparable. An exception may be patients with diabetes who have better outcomes with CABG than PTCA.

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You will receive local anesthesia. Your doctor then inserts a thin plastic tube (a catheter) into an artery in your arm or leg. The doctor then guides the catheter to the aorta (the large artery that conducts blood from the heart to the rest of the body). From there, it passes into the coronary arteries. As the doctor guides the catheter to the coronary arteries, the procedure is monitored by a special x-ray camera (called a fluoroscope).

Once the catheter is passed into the narrowed coronary artery, a smaller catheter (with a balloon on the tip) is passed through the first catheter. You can think of this as one "pipe" passing through another. As the second catheter is passed through the first, the balloon remains deflated. Once the balloon tip reaches the narrowed part of the coronary artery, it is inflated.

When the balloon is inflated, it compresses the plaque and enlarges the diameter of the opening within the blood vessel. The balloon is then deflated and the catheters are withdrawn, the result being the blood vessel is dilated and blood can flow more easily through the (formerly narrowed) part of the coronary artery.

Before your doctor considers PTCA, you will undergo a variety of tests, including a cardiac catheterization. During this catheterization, a special dye will be injected into your coronary arteries and x-ray pictures will be taken to see where coronary artery disease is present. This procedure is called "coronary arteriography."

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Questions to Ask Your Doctor

How many angioplasties have you performed?

What percentage of your patients have a heart attack, die or suffer a complication during the procedure requiring surgery?

Will there be surgical backup in case of an emergency?

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