Percutaneous Transluminal Coronary Angioplasty / Stent

Introduction

More premature deaths are caused by coronary artery disease than by any other disease process in North America. Coronary artery disease is the narrowing or obstruction of the vessels that supply blood and oxygen to the heart muscle. This narrowing is caused by fatty deposits (plaque) on the walls of the arteries.

These fatty deposits gradually build up and can cause a marked reduction of blood and oxygen to the heart. If the blood flow is significantly reduced, some form of medical treatment becomes necessary. The picture on the right shows a diseased LAD artery.

One of the most common non-surgical treatment for opening obstructed coronary arteries is Percutanueous Transluminal Coronary Angioplasty (PTCA). The name itself says a lot about the procedure:

Percutaneous means access to the blood vessel is made through the skin

Transluminal means the procedure is performed within the blood vessel

Coronary specifies that the coronary artery is being treated

Angioplasty means "to reshape" the blood vessel (with balloon inflation)

Also referred to as "balloon treatment" because special balloons are used to open up obstructed arteries, illustrated on the left, this procedure sometimes also involves the use of devices known as "stents" to help keep the arteries open.

The illustration on the right shows how a balloon catheter works to open an occluded artery.

Below, on the left, is an illustration of a special catheter being used to install a stent device.   If agreed upon in advance by you and your physician, the diagnostic cardiac catheterization procedure and PTCA are done together. This is an added convenience for you as it shortens your hospital stay by one day.

The picture on the right shows the diseased LAD  pictured above after it has undergone a successful PTCA procedure in which a stent was installed.

Following is a description of the PTCA procedure. We hope to answer some of the questions you might have. However, it is important for you to realize that everyone's situation may be different, and what you actually experience may vary slightly from what you read on the following pages. If you have any questions or doubts, please contact us or your physician.

PTCA/Stent  Procedure

Pre-Admission and Evaluation

You will first undergo a thorough evaluation by your physician. Any questions you still have before your procedure begins can be answered at this time. You may be permitted clear liquids in the morning of the procedure. However, this should be cleared with your physician first. Otherwise, food and beverages may be withheld after midnight. If you are a diabetic, you will be given special instructions. Your groin area will be washed and shaved in preparation for the PTCA/Stent.

Angioplasty Procedure

If family or friends are with you, they will wait in the waiting room near the catheterization laboratory. The length of the procedure depends on the complexity of each individual's situation, but in general, the duration is between 1 and 2 hours.

An intravenous line will be started in your arm this morning. You will receive various medications in the angioplasty laboratory though this line. To help you relax, you will be given medication prior to leaving for the lab. You will remain awake, but slightly drowsy.

You will be placed on an x-ray table upon your arrival in the lab. It is the same type of room in which you had your cardiac catheterization. All personnel in the lab will be wearing surgical attire. You will be covered by sterile sheets, and so will some of the equipment. Your groin (arm) will be cleansed with an antiseptic (might be cold) and then numbed with an anesthetic. You will feel the sting of the needle, but then your groin (arm) will feel quite numb. Heart monitoring equipment will be placed on your arms and legs, and you may be given oxygen to breathe. You will be given certain medications through the intravenous line, and periodically medication will be given to relax you and decrease any restlessness. Remember, you must still be able to talk and follow directions.

The NIR stent shown in the delivery state (above) and in the expanded installed state (below).

The angioplasty catheter (balloon-tipped) is inserted at the numb area, and advanced to your heart, using x-ray to guide it. When the balloon is inflated at the point of the blockage, you may feel chest pressure, or discomfort, and this is normal.  It will subside when the balloon is deflated. You may also feel your heart thump or skip, feel flushed, or have a headache. All these sensations are normal. You will be asked at times to hold your breath for a few seconds. You may also be asked to cough. Try your best to cough forcefully, as you are instructed.

After the procedure, you will be moved to a recovery area for a short time, and then taken to your room where your heart can be monitored. Nurses will closely monitor your vital signs and general well being. They will also frequently check the groin area and dressing. A small, flexible catheter is routinely left in the groin for 4-6 hours unless a percutaneous suture is used to close the hole. You will be required to remain in bed and keep your leg immobilized.

You will be able to eat as soon as you wish after the procedure.

Recuperation

The catheter will be removed and firm pressure applied for about 20 minutes. Then a pressure bandage is applied and a small sandbag placed over it. This is to assure proper healing of the artery.   Pain medication is available to you every few hours after the procedure. Please let your nurse know of any pain or discomfort you may feel at any time. The rest of the day is basically for rest, recuperation, and a gradual return to your activities.

Discharge

Your doctor will see you the morning of discharge. Your doctor's nurse will go over medications, activities, and follow-up care. You will receive prescriptions for medicines you will need, and will usually undergo a low-level stress test very shortly after your discharge.

POSSIBLE COMPLICATIONS AND RISK

No invasive procedure occurs without a certain amount of potential risk and complications. You are followed closely by your doctor and nurses, precisely for the reason that if any of these complications arise, corrective action can be taken immediately. The incidence of complications is low, but nonetheless, you need to be aware what they can be:

1. Severe bruising/bleeding into the groin area of the procedure leg.

2. Changes in your heart rhythm.

3. Allergic reaction to the dye or to other medications used.

4. A tear in the lining of the artery which is being dilated.

5. Possibility of a heart attack during or following inflation of the balloon. (you are given strong blood thinners to minimize this risk.)

6. Possibility of a blood clot in the artery in which the catheter is inserted. (If this occurs, surgical removal may be required.)

Follow-up Care

Periodic follow-up with your personal physician is quite important. It is important for you to realize that by angioplasty (PTCA), your immediate problem has been taken care of, but it does not cure coronary artery disease. In some patients, re-narrowing of the artery may occur. If this happens, your original symptoms will return, or your stress test will be abnormal.

If you have chest discomfort, stop your activity, sit or lie down, and take nitroglycerine, as instructed. If the chest discomfort does not go away after 3 nitrolycerin tablets in a 15 minute period, DO NOT DELAY SEEKING MEDICAL ATTENTION.  Either call your doctor, or go to an emergency room.