Angioplasty vs. Stenting are terms often used together, but they refer to different aspects of vascular intervention:
Angioplasty:
Definition: Angioplasty is a procedure where a balloon-tipped catheter is used to dilate or open up a narrowed or blocked artery. The balloon is inflated at the site of the blockage to compress the plaque against the artery wall, thereby improving blood flow.
Technique:
A catheter with a deflated balloon at its tip is threaded into the artery via a small incision, typically in the groin or arm.
Once positioned at the blockage, the balloon is inflated, pushing the plaque outward and expanding the artery.
After dilation, the balloon is deflated and removed.
Indications:
Used for coronary artery disease, peripheral artery disease, renal artery stenosis, and other vascular issues where there's a significant blockage.
Advantages:
Minimally invasive with quick recovery time.
Can be performed without general anesthesia.
Limitations:
There's a risk of the artery narrowing again (restenosis) after the procedure without additional intervention like stenting.
Stenting:
Definition: Stenting involves placing a small, expandable metal mesh tube (stent) inside the artery to keep it open after angioplasty.
Technique:
After or during angioplasty, a stent is mounted on the balloon catheter.
The balloon expands the stent at the site of the lesion, and the stent remains in place to maintain the artery's openness after the balloon is deflated and removed.
Types of Stents:
Bare-Metal Stents (BMS): Simple metal mesh.
Drug-Eluting Stents (DES): Coated with drugs to prevent restenosis.
Bioabsorbable Stents: Dissolve over time, aiming to leave behind a naturally healed vessel.
Covered Stents/Stent-Grafts: Used for aneurysms or to seal off vessel wall defects.
Indications:
Often used when there's a high risk of restenosis post-angioplasty, or when initial angioplasty alone isn't sufficient to maintain vessel patency.
Applicable in both coronary and peripheral vasculature.
Advantages:
Helps maintain long-term vessel patency, reducing the likelihood of restenosis compared to angioplasty alone.
Provides structural support to the artery after dilation.
Limitations:
Requires long-term medication (like dual antiplatelet therapy) to prevent stent thrombosis, particularly with DES.
Stent placement can lead to complications like thrombosis, restenosis of the stent, or vessel injury.
Comparison:
Immediate Outcome: Both procedures aim to improve blood flow, but stenting generally offers a more durable patency because it provides a physical structure to keep the artery open.
Restenosis: Angioplasty alone has a higher rate of restenosis compared to stenting, especially with DES.
Procedure Complexity: Stenting adds complexity and cost to angioplasty but is often justified by better long-term outcomes.
Risk of Complications: Stenting introduces additional risks like stent thrombosis, which isn't a concern with angioplasty alone, although both share risks like dissection or embolization.
Drug Therapy: Patients with stents, particularly DES, typically need to take antiplatelet drugs longer than those who only underwent angioplasty.
Vessel Suitability: Not all lesions or patients are suitable for stenting due to vessel size, lesion characteristics, or patient factors.
In practice, angioplasty and stenting are often combined in a single procedure known as Percutaneous Coronary Intervention (PCI). The decision between angioplasty alone or with stenting is made based on multiple factors including the patient's overall health, the nature of the blockage, and the likelihood of restenosis. Stenting has become the standard of care for many vascular interventions due to its efficacy in maintaining vessel patency, but angioplasty might be preferred in certain situations where stenting isn't necessary or advisable.