Coronary Angioplasty - Stents
Percutaneous Coronary Angioplasty (PTCA):
The Angioplasty procedure follows the Cardiac catheterization we discussed before.
During cardiac catheterization, your physician will insert a long, thin tube into a blood vessel in your groin or arm. The tube will be gently directed to the heart and to the origin of the coronary arteries. A contrast agent (dye) is then injected into the coronary artery while the X-ray pictures are taken. The contrast agent in the coronary arteries is seen by the X-rays as a thick white line. A disruption of the white line may suggest an area of plaque build-up inside the wall of the artery, or a blood clot in the artery.
If the plaque build up> 50% your doctor could consider balloon PTCA or stent placement to improve clinical outcome and prognosis based on clinical judgment and every patient problem.
The Interventional Cardiologist then start a special blood thinner and then insert a special wire into blocked area and advance a balloon on top of it to dilate the area. Then in most of the time advance a stainless steel mesh called stent to maintain a good results and minimize the collapse of the plaque again. This is what we call PTCA / Stent procedure. All PTCA and stent procedure patients have to take blood thinner for a long time, currently the recommendation about a year.
The preparation and follow up for PTCA / Stent is similar to the heart catheterization, except in most of cases patient spend the night in the hospital for safety reasons.
IF YOU CAN”T TAKE BLOOD THINNER FOR LONG TIME YOU SHOULD INFORM YOUR DOCTOR AND DISCUSS BEFORE YOUR PROCEDURE TO AVOID COMPLICATION AND MISUNDERSTANDING
• You may be asked to come before your procedure for pre-testing.
• Do not eat after midnight prior to the day of your procedure, or at least six hours before, you should not to eat or drink anything, except enough water to take your medications.
• Arrive at the hospital or out-patient department at least 60 minutes prior to your scheduled procedure.
• Blood work
• Electrocardiogram (ECG or EKG)
• Chest X-ray. Only if the physician require for specific reasons.
• You should inform the physician and staff about any allergy to medication or contrast (Dye).
Catheterization / PTCA / Stent:
On your arrival at the Cath Lab, you will be asked to move onto an X-ray table and you will see a lot of equipment around you. Nurses and technicians will prepare you for the procedure by placing ECG electrodes on your chest, cleansing either your groin area or your arm with antiseptic solution, clipping the hair in that area, and covering you with sterile towels and sheets.
When your doctor arrives, he will inject your groin or arm with a numbing medication known as Lidocaine. After this medication has taken effect, your doctor will make a small puncture at the groin (traditionally called the Femoral Approach) or the arm (a newer method called the Trans-radial Approach) where the catheter will be inserted into your artery.
The physician will watch the movement of the catheter by X-ray. You may feel some pressure at the site of the insertion, but not feel the catheter inside your body. Once the catheter has been guided to your heart, the contrast agent is administered into the blood vessels.
There may be several injections of the contrast agent, and the catheter may be moved around during the procedure. This is necessary to get different views of your heart and coronary arteries. A flushed feeling may occur, possibly all over your body, while taking the picture of your heart muscle. This will last only for about 15 to 20 seconds. This is a normal reaction to the contrast agent and is not a cause for concern.
During the catheterization procedure, you may be asked to breathe deeply and cough. The entire time in the cath lab will probably be about 1 hour. Be sure to let your physician know if at any time you feel dizziness, nausea, tingling, numbness or chest discomfort.
Once the catheterization is completed, the catheter could be exchanged to a bigger one to proceed with the angioplasty / stent. Then after the dilation of the lesion and deploying the stent, the catheter is removed two hours later or a closure device may be placed in the blood vessel if conditions are suitable. This allows early mobility. Some institution still use firm pressure, applied to the incision in your groin for approximately 20 minutes to stop bleeding. A dressing will be put over the incision.
Post-Catheterization / PTCA - Stent:
After the catheterization using the femoral approach, you will be returned to a recovery area or your room. You may have to lie flat in bed for 1 to 6 hours, (duration depending on whether a closure device was used), to allow the puncture site to heal.
You will be allowed to resume eating and drinking.
Your blood pressure and pulse, as well as the puncture site, will be checked periodically.
Your physician will discuss your findings with you and your family.
The oral blood thinner will be discussed with you and your family and about the important not to stop it unless your cardiologist is informed, because the risk of shutting down your stent is very high if you do so abruptly.
Outpatient cases usually will be discharged with 2 hours post closure devise or small catheter use, or 6-8 hours after large catheters use.
When the dressing is removed, you will notice a small bruise at the catheter insertion site, about the size of a quarter. You also may feel a hard lump there. The bruise may become slightly larger and darker the first few days you are home. The bruise and the lump are the result of the blood vessels normal healing process, and in one to two weeks, will completely disappear. If you are uncomfortable about the size or appearance of the bruise, or are experiencing discomfort, please call our office.