Complex Coronary Interventions
Coronary Angiography, Angioplasty, and Coronary Artery Stents
Coronary angiography involves taking pictures of the arteries of the heart utilizing catheters placed into the heart and injecting contrast while utilizing real-time x-ray. If blockages are present in the arteries, angioplasty combined with stent placement can be performed to treat these blockages. Angioplasty is a medical procedure used to dilate the narrowed arteries supplying blood to the heart. This is accomplished by inflating a small balloon inside the artery to dilate the vessels and increase the blood flow to the heart. During angioplasty, stents are placed in the coronary artery to widen the passage of the blood vessels and improve the blood supply to the heart, while ensuring they remain open.
Procedure
Angiography and angioplasty is performed by a specialist in the cardiac catheterization laboratory of the hospital under local anesthesia and IV sedation. You will be made to lie comfortably on your back on an X-ray table. The area of catheter insertion, either the groin or arm, is shaved, disinfected and a local anesthesia is injected to numb the area. A small tube called a sheath is then inserted into an artery in the groin. A flexible tube called a catheter is passed through this sheath into the vessel and will be advanced under the guidance of X-ray images to reach the coronary arteries. A special dye is injected through the catheter into the artery followed by X-ray pictures that will be taken to assess the extent of blockages.
If no significant blockages exist, the catheters are removed. However if a significant blockage does exist and can be easily treated with angioplasty and stent placement our physician will insert a guide wire through the catheter advancing it across the blockage. A catheter with a deflated balloon at its end is then threaded over the guide wire into the blockage. The balloon is inflated to push the plaque against the artery walls which opens up the blocked artery and increases blood flow to the heart. Then a stent made up of wire mesh is placed within the artery to help keep the artery open. After confirming that the artery is successfully dilated with the mesh in place, the balloon is deflated and the guide wire as well the catheter is withdrawn. The stent remains in place within the artery. Pressure will be applied to the insertion site for 15 minutes followed by a tight pressure bandage to prevent bleeding.
Pre- procedure instructions
- Inform your doctor if you take any blood thinners, and obtain instructions on how to take them prior to the angiogram.
- In most instances you should continue any platelet medications (Aspirin, Plavix, Brilinta, etc)
- Often times medications for diabetes will need to be held prior to the procedure, check with your physician prior to the procedure for details.
- Take other prescribed medication before the test, with a sip of water.
- Do not eat or drink anything for at least 6 hours before the procedure.
- Avoid alcoholic drinks at least a few days before the procedure.
- Dentures should be removed.
Post-procedure instructions
The procedure may take about 1-2 hours. It is unsafe to drive after the procedure, so the patient should arrange for a companion to drive them home. Occasionally it is possible you will need to be monitored overnight in the hospital.
Risks
As with any medical procedures, angioplasty is also associated with certain potential risks. Most patients do not have complications after angioplasty; however, some complications can occur and may include:
- Bleeding from the insertion site
- Irregular heart beat
- Chest pain
- Blood vessel damage from the catheter requiring an operation for repair
- Kidney damage from dye used with angiogram
- Restenosis- Usually occurs within 6 months. Restenosis is the re-accumulation of plaque or scar tissue causing narrowing or blockage of the coronary artery
- Blood clot formation
- Dislocation of stent
- Stroke
