Interventional Stenting

Angioplasty with or without vascular stenting is commonly used to treat conditions that involve a narrowing or blockage of arteries or veins throughout the body, including:

• Narrowing of large arteries including the aorta and its branches due to atherosclerosis. 
• Venous narrowing involving the central veins in the chest, abdomen or pelvis. In some cases, stenting of the narrowed vein also is needed.
• Narrowing in dialysis fistula or grafts. When there is decreased flow in the graft or fistula making it inadequate for dialysis, angioplasty is generally the first line of treatment. Stenting or stent grafting may also be needed in some cases.
• Renal vascular hypertension: high blood pressure caused by a narrowing of the kidney arteries. Angioplasty with stenting is a commonly used method to open one or both of the arteries that supply blood to the kidneys. Treating renal arterial narrowing also is performed in some patients to protect or improve the kidney function.
• Carotid artery stenosis: a narrowing of the neck arteries supplying blood to the brain.
• Peripheral artery disease (PAD)
  • Peripheral artery disease (PAD): Atherosclerosis, or narrowing or blockage of arteries due to the buildup of fatty deposits, affecting the arteries that supply blood to the legs and feet.
• Coronary artery disease (CAD)
  • Coronary artery disease (CAD): Narrowing and hardening of the arteries that supply blood to the heart due to the buildup of plaque in the artery wall. CAD is the most common type of heart disease. The reduced blood flow to the heart can cause angina (chest pain) and heart attack and can contribute to heart failure and arrhythmias.

This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted.

A very small skin incision is made at the site, and a sheath is inserted into the artery or vein. Guided by X-rays, a catheter is inserted through the skin and maneuvered through the vessel to the site of the blockage. Once the catheter is in place, contrast material will be injected into the artery and an angiogram (imaging) will be taken of the blocked artery to help identify the site of the blockage.

A guide wire then will be moved to the site, followed by the balloon-tipped catheter. Once it reaches the blockage, the balloon will be inflated for a short period of time. The same site may be repeatedly treated, or the balloon may be moved to other sites.

Additional X-rays will be taken to determine how much the blood flow has improved. When your physician is satisfied with blood flow, the balloon catheter, guide wire and catheter will be removed.

Many angioplasty procedures also include the placement of a stent, a small, flexible tube made of plastic or wire mesh to support the damaged artery walls. Stents can be self-expandable or balloon expandable. Balloon expandable stents typically are placed over a balloon-tipped catheter so that when the balloon is expanded, it pushes the stent in place against the artery wall. When the balloon is deflated and removed, the stent remains permanently in place, acting like a scaffold for the artery. Self-expandable stents are easy to deploy but may require additional angioplasty with a balloon to obtain satisfactory opening of the diseased vessel.

Drug-coated stents, also called drug-eluting stents, are covered with a medication that is slowly released to help keep the blood vessel from re-narrowing, a condition called restenosis.

At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin will be covered with a dressing – no sutures are needed.

The length of the procedure varies depending on the time spent evaluating the vascular system prior to any therapy, as well as the complexity of the treatment.