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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

C oronary 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.

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 or sheath will be removed approximately 4-6 hours after theprocedure is over. This waiting period is crucial as the physician uses blood-thinning agents to implant the stent, thus the sheaths cannot be removed until the blood thinning reverted back to normal and firm presssure 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 contrast or 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 or stent implantation.. (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 (Restenosis) of the artery may occur over the ensuing 3-6 months. If this happens, your original symptoms may 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.