Percutaneous transluminal coronary angioplasty is also known as P.T.C.A., coronary artery balloon dilation or balloon angioplasty. It is an established and effective therapy for some patients with coronary artery disease.

ACC / AHA Guidelines

A joint American College of Cardiology / American Heart Association report strongly recommends that angioplasty should be limited to those institutions that have an experienced cardiovascular surgical team available as backup for all balloon procedures. There is no exception to this requirement.

Angioplasty may be used to dilate (widen) narrowed arteries. A catheter with a deflated balloon on its tip is passed into the narrowed part of the artery. Then the balloon is inflated, and the narrowed area widened. It is a less traumatic and less expensive alternative to bypass surgery for some patients with coronary artery disease. However, in 25 to 30 percent of patients, the dilated segment of the artery re-narrows within six months after the procedure. They may require either repeat PTCA or coronary artery bypass surgery.

Complications from angioplasty can occur in some patients. However, major complications are unusual. From 1 to 3 percent of patients need emergency coronary bypass surgery when the procedure fails to open the artery.

A joint American College of Cardiology / American Heart Association task force has established PTCA guidelines.

The ACC / AHA guidelines set limits on:

• which patients should receive the procedure.
  
• which institutions should perform it.
  

• patient selection.
  
• proper facilities.
  
• professional qualifications for practicing the procedure.

• greater-than-20-percent increase in the diameter of the narrowed vessel.
  
• the final diameter of the blockage less than 50 percent.
  
• without the procedure causing death, acute heart attack or the need for emergency bypass surgery.

In addition to the lack of a cardiac surgical program within a medical institution, the guidelines cite specific cases in which angioplasty should not be performed. They are:

• patients with no significant obstructing blockage in a vessel.
  
• those with severe diffuse disease in multiple vessels, where bypass surgery would provide a more complete opening of the blood vessels.
  
• patients who have more than 50 percent blockage in the left main coronary artery, which is not protected by a fully open bypass graft to other arteries on the left side of the heart.