Ground-breaking heart attack treatment celebrates 50th birthday, and countless lives saved
“If a plumber can do it with pipes, we can do it with blood vessels.” That’s the simple starting point for an idea that opened the door to half a decade of successful surgeries for an estimated 60 million survivors of heart attack and other artery blockages.
The principle is straightforward: to unblock a blood vessel, a surgeon inserts a catheter which in many cases is basically a long deflated balloon (not surprisingly called a balloon catheter). The balloon is then inflated to expand the blood vessel. Just as a plumber unblocks a pipe, a surgeon clears the path for blood to restore healthy blood flow throughout the circulatory system.
Angioplasty is most commonly used to treat narrowings and blockages of the coronary arteries and the arteries which supply blood to the legs. However, angioplasty can also be used to treat the carotid (neck) arteries to prevent strokes and the arteries which supply the kidneys and intestines. Similar procedures are used to help patients with kidney dialysis, severe trauma and those undergoing cancer therapy.
It was Dr. Charles Dotter who pioneered the procedure and was the first to use it in 1964 when he opened up a clogged leg artery in an 82-year-old woman with leg pain and an infected foot. Surgeons had told the patient that amputation was the only option. After the procedure, performed in the US state of Oregon, she walked out of the hospital on both legs and was independently mobile for the remaining two and a half years of her life. This was the first successful case of what is technically called “percutaneous transluminal angioplasty”.
Vintage medtech: this is “Dottering”
The technique paved the way for the many minimally invasive surgery techniques that open blocked vessels through the body, often eliminating the need for painful, risky open surgery. Dotter’s method of using catheters to open blood vessels caught on first in Europe where it was termed “Dottering.” Within a decade’s time American doctors were dottering too.
Today, the possibilities of minimally invasive interventional medicine have grown substantially and over 75,000 coronary angioplasties are carried out annually on heart patients in the UK alone (according to the UK National Health Service). “Many angioplasty procedures are performed as day case procedures and the patients can leave hospital within a few hours of their treatment,” says Dr. Duncan Ettles, President of the British Society of Interventional Radiology. “In most cases, it avoids general anaesthesia and in-hospital care. Patients can usually return to work and normal activities within 48 hours and complications are very uncommon.
High success rate, but repeat blockages possible
Angioplasty itself as well as the myriad related techniques have proved extremely successful, but they’re not always permanent answers to the problem at hand. “The problem”, says Dr Ettles, “is that narrowings in blood vessels tend to come back and so the patient may get a recurrence of their symptoms. This is rarely a problem because a repeat angioplasty can be performed, but in the small blood vessels of the leg and in certain patients, such as diabetics, long term outcomes are less good.”
In some cases, drug treatment or even exercise can be used to treat the symptoms which patients experience due to the effects of narrowed or blocked arteries. Dr Ettles says that in the case of angina, a medical approach to treatment usually often involves smoking cessation, weight loss and control of blood lipids. “It’s not possible to treat all arterial disease by angioplasty and in a relatively small proportion of patients , bypass surgery will be required, even though this may carry higher risks.”
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