Balloon dilatation and stent implantation

If the vessels become narrow and the blood flow is blocked

For the heart to fulfil its demanding task it requires a reliable blood supply. The heart muscle is supplied via the coronary arteries (coronaria) with oxygen-rich blood coming from the aorta. In the course of our lifetime we have to reckon with an increasing calcification of the arteries (arteriosclerosis) and a deposition of blood lipids and cell components (plaque) on the previously damaged vascular walls, which leads to angiostenosis. The narrowed areas impair the blood supply of the heart muscle and lead to an oxygen deficiency of the heart, which will cause, for example, the typical symptoms of stenocardia (angina pectoris).

Arteriosclerosis and angiostenosis

There is a threat of heart attack when the narrowing in the coronary vessels grows to a threatening extent and the blood flow in the narrowed area is shut off completely owing to a tiny blood clot (thrombus). Consequently, the part of the heart muscle that is located downstream of the occluded point is no longer being supplied with oxygen and nutrient media. If the occlusion is not re-opened by medical intervention in good time, the heart muscle tissue will inevitably become necrotic. The area involved loses its pumping capability and scars, which will result in a more or less considerable impairment of the heart performance.

Heart attack

Expanding the narrowed vessel sections can ensure proper blood flow

The balloon dilatation technique applied in the coronary vessels, also called "Percutaneous Transluminal Coronary Angioplasty", or short PTCA, is based on the fact that angiostenosis of the coronary vesselsis mostly caused by deformable material (e.g. deposition of blood lipids and cell components). The material hindering the blood flow can be expanded by means of the balloon dilatation.

Above all, balloon dilatation is performed in case of short narrowed areas or obstructions of the coronary vessels. Thanks to the remarkable technological progress in this medical field in recent years it is meanwhile possible to also help patients with several narrowed areas of the different coronary vessels by treating them with a balloon dilatation, which formerly was feasible only with a bypass surgery.

For the widening of a narrowed coronary vessel by means of a small balloon a purpose-build balloon catheter is introduced via a thin guidewire into the artery of the groin or the bend of the elbow. The balloon catheter is advanced along the guide catheter through the vascular system and the left ventricle until it has reached the narrowed areas of the coronary artery.

A few millimetres behind the tip of the balloon catheter there is an inflatable stiff balloon which is inserted into the narrowed area in slackened condition. As soon as the balloon has been placed inside the narrowing, is is unfolded for some seconds by applying high pressure. This serves to deform and squeeze the obstructing tissue cells and deposits. However, the vessel expansion is achieved, not only by a deformation of the deposits causing the narrowing but also by an outward expansion of the entire coronary vessel. The blood flow is thus improved or re-established. The success of this treatment is verified after dilatation by means of a radiographic contrast medium.

Expansion of the narrowed blood vessel by means of a balloon catheter

A vessel support helps to stabilize the widening

Where the balloon dilatation alone possibly fails to achieve sufficient and sustained success, a so-called stent, a vessel support made of a fine stainless steel mesh, is inserted into the narrowed area of the coronary vessel. The stent retains calcium deposits in the coronary vessels, smoothes their interior surfaces and prevents any dangerous lacerations of the vessels' interior walls. This leads to an improved blood flow and prevents a restenosis of the successfully widened coronary vessel.

Vessel support made of stainless steel, the stent

Usually the stent is introduced using a balloon catheter. The not yet unfolded vessel support is advanced to the narrowed section of the coronary vessel, just like for the balloon dilatation. There the stent is unfolded by inflating the balloon and anchored in the interior vessel wall. The proper position of the stent is verified by means of a radiographic contrast medium.

Expansion of the narrowed blood vessel by means of a balloon catheter and a stent

In order to prevent the formation of a blood clot (thrombus) in the treated coronary vessel after a balloon dilatation combined with a stent implantation, the patient needs to take certain anticoagulants. Typically, this is a combination of the so-called platelet aggregation inhibitor ASS and clopidogrel. The duration of the necessary intake of this drug combination depends on the severity level of the disease and the stent applied. ASS needs to be taken as a lifelong medication to ensure a sufficient protection against the formation of blood clots.

Safety thanks to the most advanced medical equipment

A balloon dilatation / stent implantation is usually performed when the patient is in the waking state. The puncture point is locally anaesthetised so that the needle penetrates the groin or the bend of the elbow without inflicting pain. In particular cases the intervention might also be performed under short anaesthesia. Before the examination is commenced, the patient must be covered with a large sterile drape for hygienic reasons. During the examination the patient is monitored by means of the most advanced circulatory and respiratory monitoring equipment. On average, a balloon dilatation / stent implantation in the Schüchtermann-Klinik takes approx. 30 minutes.

Balloon dilatation and stent implantation: safe and successful

In Germany every year a total of over 290,000 balloon dilatations are performed. In 86% of the performed balloon dilatations at least one stent is inserted. If the balloon dilatation / stent implantation is performed early enough and if the heart is not already impaired by a heart attack, the risk of the intervention is very small.

If the heart muscle has not already been damaged by a heart attack in the time before surgery, the physical performancecapacity will be fully restored after a successful intervention. The life expectancy after balloon dilatation / stent implantation will then equal that of a healthy person. The patients will again be able to bear the stresses and strains of their everyday life without feeling heart pain and to continue their life as before.

Balloon dilatation /stent implantation after an acute heart attack as a life-saver

The interventional cardiology in the Schüchtermann-Klinik focuses on the emergency medical aid for patients, who have already suffered an acute heart attack and are therefore threatened by an acute cardiac failure. In close cooperation with the rescue team such high-risk patients are monitored already while being transported to the hospital by means of a special monitoring system which transmits ECG data to our cardiological intensive care unit. The subsequent immediate balloon dilatation and stent implantation will considerably improve the chance of survival for the patient.