Percutaneous Transluminal Angioplasty (PTA)

Healthcare Professionals

Patient Preparation and Peripheral Artery Angioplasty Procedure
While clinical pathways for peripheral vascular interventions vary from hospital to hospital, the following procedural steps are considered typical to a peripheral PTA procedure and frequently performed. The patient is kept NPO after midnight prior to the procedure and a peripheral I.V. is inserted. Once the patient has arrived in the interventional radiology suite (or in some cases, the cardiac catheterization laboratory, special procedures suite, or operating room), the groin entry site is shaved and scrubbed. The patient is hooked up to hemodynamic monitoring equipment and is monitored throughout the procedure.

A local anesthetic is administered to the prepped area and the patient may be given a mild sedative to assist in relaxation.

After the local anesthetic is administered, a small incision is made to assist in the insertion of a long, thin sheath. A guiding catheter is then passed through the sheath to the narrowed artery. The physician monitors the insertion of the catheter under fluoroscopy. An injection through the catheter of contrast dye/medium allows the physician visualization of the peripheral arteries.

Once the catheter is engaged in the ostium of the artery where the lesion is located, a guide wire is threaded through the guide catheter. The guide wire is then manipulated under fluoroscopy, beyond the lesion to a distal location within the artery. With the guide wire in place, a balloon catheter is inserted over the guide wire and advanced to the lesion site.

The balloon is dilated within the artery at the lesion site, causing a compression of the arterial plaque against the inner lining of the arterial wall. Subsequent balloon dilatation may be used if the physician decides to increase the atmospheres (ATM) of pressure or duration of time that the balloon is applied to the lesion.

Upon examination of the pre and post PTA images, the physician may decide to follow the PTA procedure with the implantation of a stent at the site of the lesion. He or she may also consider using an adjunctive imaging device such as intravascular ultrasound (IVUS). This provides the physician with a cross-sectional and longitudinal image of the vessel and morphology of the plaque. IVUS allows for measurement of the artery and the plaque burden, which assists the physician with accurate sizing of the stent to be used.

Boston Scientific’s Sterling™ PTA Balloon Dilatation Catheter with its breakthrough 4F profile meets the challenges of carotid, renal and lower extremity anatomy. The Sterling PTA Balloon Dilatation Catheter is indicated for PTA in the peripheral vasculature, including iliac, femoral, ilio-femoral, popliteal and renal arteries, and for the treatment of obstructive lesions of native or synthetic arteriovenous dialysis fistulae. This device is also indicated for post-dilatation of balloon expandable and self-expanding stents in the peripheral vasculature.