Balloon angioplasty, also known as percutaneous transluminal coronary angioplasty (PTCA), is a widely used catheter-based technique for opening blocked arteries and treating coronary artery disease. The first balloon angioplasty was performed in 1977 by the Swiss physician Andreas Gruentzig. About 664,000 PTCA procedures were performed in the United States in 2004 (the last year for which figures are available), according to the American Heart Association.

Balloon angioplasty opens arteries that have been narrowed due to plaque buildup (atherosclerosis) along the artery walls. To restore normal blood flow, a balloon-tipped catheter is guided into one of the clogged arteries, and the balloon is rapidly inflated. This action helps blood flow more freely through the vessel in one or more of the following ways:

• Pushes the plaque back against the artery wall.
• Creates small cracks or fissures called plaque fractures within the brittle, fatty deposit.
• Stretches the artery.

A successful intervention will result in a wider artery with an improved blood flow. It will not result in a completely “clean” artery, but the plaque will be pushed aside or cracked in such a way that blood can pass through the vessel more freely. This often helps reduce chest pain (angina) associated with coronary artery disease.

In most angioplasty procedures, a stent is placed in the blocked artery. A stent is a small metal mesh tube that is implanted in the arteries to help keep the blood vessel open. Stents may be coated with drugs that help keep the artery open. Advances in stent technology have greatly increased the success rate of balloon angioplasty, making it a more attractive option for many patients. Other procedures may include atherectomy (excision of plaque material).

Balloon angioplasty may also be used as a treatment for a heart attack in some hospitals and emergency care facilities. The American College of Cardiology and the American Heart Association guidelines maintain that angioplasty and clot-buster medications are equally effective in certain settings. The guidelines note that angioplasty is the treatment of choice only when patients are treated within two to six hours of the onset of their symptoms in facilities where surgical backup is available.

Compared to surgical interventions (e.g., bypass surgery), balloon angioplasty is a relatively low-risk and low-cost procedure. Studies have shown that patients who undergo balloon angioplasty recover much more quickly than patients who undergo bypass surgery. In most cases, a patient may return to normal activities within a few days of angioplasty, whereas full recovery from surgery often takes months.

Because bypass surgery and angioplasty treat the same condition (e.g., coronary artery disease), there is always the question of which patients are suitable for which procedure. In general, many cardiologists will recommend balloon angioplasty with stenting in most patients in whom it is possible before referring the patient for open-heart surgery.

A form of balloon angioplasty called peripheral percutaneous transluminal angioplasty may be used to treat clogged arteries in areas of the body other than the heart. These areas include the following vessels:

• Cerebral (brain)
• Carotid (neck)
• Renal (kidney)
• Visceral (abdominal)
• Iliac (hip)
• Femoropopliteal (thigh)
• Infrapopliteal (knee)