The History of Angioplasty - an introduction

Unfortunately most of us have a loved one affected by heart disease. According to the Irish Heart Foundation approximately 10,000 people die each year from cardiovascular disease. This includes coronary heart disease, stroke and other circulatory diseases. It is the most common cause of death in Ireland, accounting for 36% of all deaths. The largest number, 22%, of these deaths relate to coronary heart disease . Also, 22% of premature deaths (defined as death before the age of 65) are from cardiovascular disease.

It was once a male disease, or predominately so, but not any more. I recently had a meeting with one of Germany's top Cardiologists. During the meeting one of his staff brought in a file for his signature. He reviewed the file, signed it, looked at me and said "There's equality for you, a 40 year old woman with two blocked arteries, you wouldn't have seen that ten years ago". Just what I wanted to hear as I stressed about clinical trial design!

So, angioplasty, what is it and why is it important?

The heart is a vital organ which pumps blood to the entire body allowing for the circulation of oxygen and nutrients and the removal of waste. Its a muscular organ which requires a good blood flow of its own. Heart disease generally involves the narrowing or blockage of the arteries supplying blood to the heart, thus preventing it from working effectively. This can lead to fatigue, shortness of breath and pain, among other symptoms.

Previously these blockages were treated by by-pass surgery. This is a complex operation where vein graphs are taken from another part of the body, typically the leg, and are used to 'by-pass' the blockages in the heart.

What angioplasty does is remove the blockage with only a tiny incision, normally in the groin, which allows most patients to go home the same day! A massive difference in both risk and recovery time.

A balloon catheter is inserted into an artery in the groin, the femoral artery and travels to the heart and into the diseased vessel. Once positioned across the blockage the balloon is inflated, opening the vessel to its original size. Several vessels can be treated during the procedure.

The cardiologist views the images using x-ray and radiopaque dyes. The catheters and guidewires used also have radiopaque markers at know positions to assist in the positioning of the instruments in the coronary arteries.

The image below shows a diseased artery as seen by a cardiologist. You can see the blockage mid way down the image on the left.

This second image is the aerty following treatment, with full blood flow restored.