What is the role of balloon catheters in percutaneous coronary intervention (PCI)?

Updated: Nov 27, 2019
  • Author: George A Stouffer, III, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

The original description of angioplasty by Dotter and Judkins described enlargement of the vessel lumen through a mechanism of atheromatous plaque compression. This mechanism is also partially responsible for luminal enlargement with balloon angioplasty.

In addition, however, the increase in luminal diameter after balloon angioplasty also results from stretching of the vessel wall by the balloon. Balloon inflation actually results in overstretching of the vessel wall and partial disruption of not only the intimal plaque but also the media and adventitia, resulting in enlargement of the lumen and the outer diameter of the vessel.

Axial redistribution of plaque material also contributes to improvements in lumen diameter. Atherectomy devices and, subsequently, intracoronary stents were developed, in part, to decrease the early and late loss in luminal diameter observed with conventional balloon angioplasty.

Several different balloon catheter designs have existed (eg, over-the-wire, monorail, and fixed wire) and have used balloon materials with different compliance characteristics that allow varying degrees of expansion with increasing pressure. Irrespective of the balloon design, a steerable guide wire precedes the balloon into the artery and permits navigation through a considerable portion of the coronary tree.

The development of bending capability, allowing easy advancement through tortuous vascular segments (trackability), as well as increased shaft stiffness (pushability), allowing the catheter to be forced through stenotic lesions, has significantly increased the versatility of balloon catheters. Another evolving feature of catheter design has been a reduction in the diameter of the deflated balloon, allowing easier passage through very stenotic lesions.

Improvements in catheter design have been partially responsible for the improved success rates of PCI. The balloon catheter also serves as an adjunctive device for many other interventional therapies, including atherectomy and coronary stenting.


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