Angioplasty & Stenting
In 1977 the first balloon angioplasty of the heart artery was performed in Zurich, Switzerland by Dr. Andreas Gruentzig. Percutaneous transluminal angioplasty (PTA), is a minimally-invasive procedure performed under local anesthesia, to improve blood flow which has been reduced due to a blockage in the artery. A balloon catheter is temporarily inserted, usually into the groin or wrist, and advanced over a wire under X-ray to the site of blockage. The balloon is then inflated to compress the plaque comprised of fat, calcium, cholesterol deposits and fibrous tissue. This results in remodeling of the artery (Angioplasty) and a larger arterial opening to allow enhanced blood flow.
At times, the artery may develop re-closure or dissection (tear) which then is promptly treated with a stent acting as a vascular scaffold.
Coronary percutaneous transluminal angioplasty (PTA) or coronary angioplasty, is a minimally-invasive procedure done under local anesthesia, to improve blood flow to the heart muscle which has been reduced due to a blockage in the artery. A balloon catheter is temporarily inserted into the groin or wrist and advanced using fluoroscopy to the site of the blockage. The balloon is then inflated to compress fat and cholesterol deposits within the blockage, improving blood flow.
Dr. Lew was one of 12 PAMI-No SOS investigators in North America who performed successful cardiac angioplasty and stents in patients presenting with an acute heart attack to a hospital without open heart facilities. The positive result of this landmark study is one of the reasons why an acute cardiac angioplasty is permitted in other hospitals without surgical facilities in the United States.
Stenting (Medicated and Non-Medicated)
In 1986, Puel and Sigwart deployed the first coronary stent to act as a scaffold but it was not until 1994 when the Johnson and Johnson Palmaz-Schatz stent was approved by the United States FDA for deployment in humans.
Subsequent studies have shown that stenting as compared to balloon angioplasty alone is associated with 50% reduction of arterial (vessel) reclosure or blockage.
Stenting is a procedure in which your cardiologist inserts a slender, metal-mesh tube, called a stent, which expands inside your artery to increase blood flow in areas blocked by plaque. Stents are most commonly placed in the heart, lower extremity, and carotid arteries but can be placed in almost any artery in the body when necessary. In atherosclerosis or hardening of the arteries, plaque builds up in the walls of your arteries as you age. Cholesterol, calcium, and fibrous tissue make up the plaque. As more plaque accumulates, your arteries can narrow and stiffen. Eventually, enough plaque may build up to reduce blood flow through your arteries, or cause blood clots or pieces of plaque to break free and to block the arteries in the heart, brain, kidneys, legs, etc. When this occurs, a heart attack, stroke or other potentially life-threatening event may occur. The stent is a tiny, coiled wire or mesh that is permanently placed at the angioplasty site acting as a scaffold to maintain the new opening. For coronary patients, this is often done after a recent heart attack, for stable or unstable angina. It can also be used during an acute heart attack to quickly open blockages and reduce damage to the heart muscle.
Dr. Lew was the first physician in Lake county to successfully perform the carotid stenting procedure with distal embolic protection (DEP).
Peripheral Angioplasty is also a minimally-invasive procedure which is performed using a catheter which is temporarily inserted to open narrowed arteries of the legs, arms, aorta, and its branches. Blockages to the arteries of the legs can cause pain and cramps when walking, a condition known as claudication. Stents may be inserted to maintain healthy blood flow which if left untreated may result in gangrene and infection, which may lead to amputation.
Like the coronary arteries (the blood vessels of the heart), the carotid arteries (the blood vessels to the brain), can be blocked by fat and cholesterol deposits, called plaque. Over time, the build-up narrows the artery, decreases blood flow to the brain and can lead to a stroke, also known as a brain attack.
Carotid stenting is an exciting procedure that may eliminate the need in many individuals for traditional surgery to treat carotid artery blockage. Dr. Lew has been a pioneer and has been the local principal investigator for multiple carotid stenting trials, including the prestigious National Institute of Health sponsored CREST trial.
Blockages of arteries to the kidneys can lead to high blood pressure and renal insufficiency. The procedure for performing renal angioplasty and stenting is similar to other peripheral angioplasties and can help to lower blood pressure caused by these blockages.