Percutaneous transluminal coronary angioplasty

Percutaneous transluminal coronary angioplasty . It is done to open blocked coronary arteries due to disease of the coronary artery (CAD) and to restore arterial blood flow to the tissue heart without resorting to surgery to open heart. A special catheter (long, hollow tube) is inserted into the coronary artery for treatment. This catheter has a tiny balloon on the tip. The balloon is inflated after the catheter has been placed into the narrowed area of ​​the coronary artery. As the balloon inflates, the fatty tissue in the artery is compressed and a larger opening is formed inside the artery to improve blood flow. The use of fluoroscopy (a special type of X-ray, similar to an X-ray “film”) helps the doctor locate blockages in the coronary arteries as the contrast dye moves through the arteries. During PTCA, a technique called intravascular ultrasound (IVUS) can be used. in which a computer and a transducer that emits ultrasonic sound waves are used to generate images of the blood vessels. The use of IVUS provides direct visualization and measurement of the interior of the blood vessels and can help the physician select the appropriate size of balloons and / or stents to ensure that the stent, if necessary, opens correctly. , or to evaluate the use of other angioplasty instruments. A technique called Fractional Flow Reserve (FFR) assessment is often used during catheterization to help determine the meaning of moderate coronary narrowing. The technique consists of placing a transduction pressure cable through the narrowing, and after a brief infusion of medication, measuring the variation in pressure in the coronary artery. This can help the doctor decide if PTCA or stent placement is appropriate.

Summary

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  • 1 What is stent placement?
  • 2 Coronary artery disease
  • 3 Angina
  • 4 Heart attack
  • 5 Reasons to perform the procedure
    • 1 Risks of the procedure
    • 2 Before the procedure
    • 3 After the procedure
      • 3.1 In the hospital
      • 3.2 In your home
    • 6 Sources

What is the placement of a stent?

In recent years, many refinements have been developed in the PTCA procedure. A common procedure used in PTCA is the placement of stents. A stent is a very small, expandable metal device that is inserted into the recently opened area of ​​the artery to prevent the artery from re-narrowing (narrowing) or occluding (closing).

Stent placement

Newer stents (Drug Stents, or DES) are coated with a drug that prevents scar tissue from forming within the stent. These pharmacological stents release the drug into the same blood vessel. This medication inhibits the overgrowth of tissue that can occur within the stent. The effect of this medicine is to prevent stenosis of the recently treated blood vessel with stents. If scar tissue forms within the stent, radiation therapy (called brachytherapy) can be used to clear the scar area and open the vessel completely. Other related procedures that can be used to evaluate the heartinclude: resting or exertion electrocardiogram (ECG), Holter monitor, averaged signal ECG, cardiac catheterization, chest radiographs, chest computed tomography (CT), echocardiography, electrophysiological studies, nuclear magnetic resonance imaging (MRI) of the heart, scans myocardial perfusion, radionuclide angiography, and ultrafast computed tomography. Please see these procedures for additional information. An additional technique is rotational atherectomy. This is sometimes used to aid stent placement when the plate hardens and is calcified.

Coronary artery disease

Coronary artery disease (CAD) is the narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle) due to an accumulation of fatty materials on the walls of the arteries. Such accumulation causes the interior of the arteries to narrow and become irregular, limiting the supply of oxygen- rich blood to the heart muscle .

Coronary artery disease

To better understand how coronary artery disease affects the heart, an analysis of the anatomy and basic functions of the heart is presented below. The heartit’s basically a bomb. The heart is made up of specialized muscle tissue called the myocardium. The main function of the heart is to pump blood throughout the body, so that tissues can receive oxygen and nutrients, and so that waste substances are eliminated. Like any pump, the heart requires fuel to function. The myocardium requires oxygen and nutrients, like any other body tissue. However, the blood that passes through the heart chambers only does so on its way through the body: this blood does not supply oxygen or nutrients to the myocardium. The myocardium receives oxygen and nutrients from the coronary arteries, which are outside the heart.

Angina

When the heart tissue does not receive an adequate amount of blood, it cannot function as well. If myocardial blood supply decreases for a time, a condition called ischemia can occur. Ischemia can reduce the heart’s pumping ability, because the heart muscle is weakened by lack of food and oxygen. Unfortunately, you may not have symptoms of initial coronary artery disease, however, the disease will continue to progress until there is sufficient arterial blockage to cause angina (chest pain or discomfort from coronary artery disease). Angina sensations include chest or arm pain, chest pressure, fatigue, indigestion, heartburn, and shortness of breath.

Heart attack

If the coronary artery is completely closed by a blood clot, myocardial infarction (heart attack) can occur. The blood clot can form when a plaque ruptures (a build-up of fatty tissue within the artery walls). If blood flow cannot be restored quickly to a particular area of ​​the affected heart muscle, the tissue dies.

Reasons to perform the procedure

Percutaneous transluminal coronary angioplasty is performed to restore blood flow to the coronary artery, when the stenosed artery is in a location that can be reached by this means. Not all coronary artery disease can be treated with percutaneous transluminal coronary angioplasty. Your doctor will determine the best treatment for coronary artery disease based on your personal circumstances. Your doctor may recommend percutaneous transluminal coronary angioplasty for other reasons.

Risks of the procedure

Possible risks associated with percutaneous transluminal coronary angioplasty, atherectomy, and / or stents may include, but are not limited to, the following:

  • Bleeding from the catheter insertion site (usually in the groin, although the arm may also be used in certain circumstances)
  • Blood clot or injury to the blood vessel at the insertion site
  • Blood clot inside the vessel treated with percutaneous transluminal coronary angioplasty or stent
  • Infection at the catheter insertion site
  • Cardiac dysrhythmias / arrhythmias (abnormal heart rhythm)
  • Myocardial infarction
  • Chest pain or discomfort
  • Rupture of the coronary artery, requiring open heart surgery

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your radiation exposure history, such as previous scans and other types of radiological scans, so that you can inform your doctor. The risks associated with radiation exposure may be related to the cumulative number of exams and / or X-ray treatments over a long period of time. If you are pregnant or suspect that you are pregnant, you should inform your doctor due to the risk of injuring the fetus with percutaneous transluminal coronary angioplasty. Exposure to radiation during pregnancy can cause birth defects. If you are breastfeeding or breastfeeding, You must inform the doctor. There is a risk of having an allergic reaction to the dye. Patients with allergies or sensitivity to certain medications, contrast dye,Iodine or shellfish should inform your doctor. Also, patients with kidney failure or other kidney problems should inform their doctor. For some patients, lying down without moving on the table during the procedure may cause some discomfort or pain. There may be other risks depending on your specific health condition. Remember to consult all your doubts with your doctor before the procedure.

Before the procedure

  • Your doctor will explain the procedure to you and offer you an opportunity to ask any questions you have about it.
  • You will be asked to sign a consent form authorizing the testing. Read the form carefully, and ask if there is anything unclear to you.
  • Tell your doctor if you have ever had a reaction to any contrast dye, or if you are allergic to iodine or shellfish.
  • Tell your doctor if you are sensitive or allergic to any medications, latex, tape, and anesthetic agents (local and general).
  • You must fast for a certain period before the procedure. Your doctor will advise you how long you will need to fast, either for a few hours or overnight.
  • If you are pregnant or suspect you may be pregnant, you should tell your doctor.
  • Tell your doctor if you have any piercing in the chest and / or abdomen.
  • Tell your doctor about all medications (prescription and over-the-counter) and herbal supplements you are taking.
  • Tell your doctor if you have a history of bleeding disorders or if you are taking anticoagulant medications (blood thinners), aspirin, or other medications that affect blood clotting. You may need to stop taking some of these medications before the procedure.
  • Your doctor may request a blood test before the procedure to determine how long it takes for the blood to clot. Other blood tests may also be done.
  • If you have a pacemaker, tell your doctor.
  • You may be given a sedative before the procedure to help you relax.
  • Depending on your clinical condition, the doctor may request another specific preparation.

During the procedure

Normally, a percutaneous transluminal coronary angioplasty follows this process:

  1. You will be asked to remove any jewelry or other objects that may interfere with the procedure. If you wear dentures or hearing aids, you can leave them on.
  2. You will be asked to remove your clothes and you will be given a gown to put on.
  3. You will be asked to empty your bladder before the procedure.
  4. If there is a lot of hair in the catheter insertion area, it can be trimmed.
  5. An intravenous (IV) line will be placed in your hand or arm before the procedure to inject medications or intravenous fluids if needed.
  6. You will lie on your back on the procedure table.
  7. It will be connected to an electrocardiogram (ECG) monitor that records the electrical activity of the heart and monitors it during the procedure through small adhesive electrodes. During the procedure, vital signs (heart rate, blood pressure, respiratory rate, and oxygenation level) will be monitored.
  8. There will be several monitoring screens in the room, showing vital signs, images of the catheter moving through the body to the heart, and the structures of the heart when the dye is injected.
  9. You will be given a sedative through the IV before you start the procedure to help you calm down. However, you will probably stay awake during the procedure.
  10. Your pulses will be monitored and marked under the insert to verify limb circulation below the site after the procedure.
  11. A local anesthetic will be injected into the skin at the insertion site. You may feel itchy for a few seconds after the local anesthetic is injected.
  12. Once the local anesthetic has taken effect, a sheath, or introducer, will be inserted into the blood vessel. This is a plastic tube through which the catheter will be inserted into the blood vessel to advance it to the heart. If the arm is used, a small incision (cut) may be made to expose the blood vessel to insert the sheath.
  13. The angioplasty catheter will be inserted through the sheath into the blood vessel. The doctor will pass the catheter through the aorta to the heart. Fluoroscopy will be used to help pass the catheter to the heart.
  14. The catheter will be passed through the coronary arteries. Once the catheter is in place, a contrast dye will be injected into the coronary arteries to view the narrowed areas. You may experience some effects when the contrast dye is injected into the IV line. These effects include a hot feeling, a salty or metallic taste in the mouth, and / or a slight headache. These effects usually last a few moments.
  15. You should inform your doctor if you experience any difficulty breathing, sweating, numbness, nausea and / or vomiting, chills, itching, or palpitations.
  16. After the contrast dye is injected, a series of rapid and sequential radiographic images of the heart and coronary arteries will be taken. At this time, you may be instructed to inhale deeply and hold your breath for a few seconds.
  17. When the doctor locates the narrowed artery, the catheter will pass to that location and the balloon will be inflated to open the artery. You may experience some chest pain or discomfort at this time, as a result of the inflated balloon is temporarily blocking blood flow. All chest pain or discomfort should disappear when the balloon is deflated. However, if you notice any ongoing discomfort or pain, such as chest, neck, jaw, back, or arm pain, shortness of breath, or difficulty in breathing, notify your doctor immediately.
  18. The doctor may inflate and deflate the balloon several times. At that time, a decision can be made to insert a stent to maintain the opening of the artery. In some cases, the stent can be inserted into the artery before the balloon is inflated. As the balloon is inflated, the artery will open and the stent will fully expand.
  19. The doctor will take measurements after the artery has been opened. Once it is determined that the artery is sufficiently open, the angioplasty catheter will be removed.
  20. The insertion site can be closed with a closure device that uses collagen to seal the artery opening, using sutures, or by applying manual pressure to the area to prevent the blood vessel from bleeding. The doctor will determine the appropriate method for your condition.
  21. If a closure device is used, a sterile dressing will be applied in place. If manual pressure is used, the doctor (or an assistant) will maintain the pressure at the insertion site so that a clot forms. When the bleeding has stopped, a very tight bandage will be put in place. A sandbag or other weight may be placed on the bandage to put more pressure on the spot, especially if it is in the groin.
  22. Your doctor may decide not to remove the sheath, or introducer, from the insertion site for approximately four to six hours, in order to allow the effects of the anticoagulant medication given during the procedure to wear off. You should remain lying down during this time. If you start to feel uncomfortable in that position, the nurse can give you medications to eliminate discomfort.
  23. They will help you get from the table to a stretcher so they can take you to the recovery area. NOTE: If the insertion was made in the groin, you will not be allowed to bend your leg for several hours. To help you remember to keep your leg straight, they can cover your knee with a sheet, with the edges tucked under the mattress on either side of the bed, to make a kind of loose hold.

If the insertion site was in the arm, it will be kept elevated on pillows and upright, placing it in a cuff (plastic arm board designed to immobilize the elbow joint). In addition, a plastic band (which works like a belt around the waist) can be attached around the arm and near the insertion site. The band will loosen at certain intervals and then remove it at the appropriate time, as directed by your doctor.

After the procedure

At the hospital

After the procedure, they may transfer you to the recovery room, where you will be kept under observation, or you may be taken back to the hospital room. You will lie in bed for several hours after the procedure. A nurse will monitor vital signs, insertion site, and circulation / tenderness in the affected leg or arm. You should tell the nurse right away if you feel chest pain or tightness, or any other pain, and also any feeling of heat, bleeding, or pain at the insertion site in your leg or arm. Rest can vary from two to six hours, depending on your specific situation. If your doctor fitted you with a closure device, you may need less time to rest. In some cases, the sheath or introducer may remain in place at the insertion. If so, the rest period will last until the sheath is removed. After the pod is removed, they can give you a light meal. You may feel the need to urinate frequently, due to the effects of contrast dye and increased fluids. You should use a flat or potty while you are at rest, so as not to bend your affected leg or arm. After the specified rest period ends, you can get up. The nurse will help you the first time you get up and will check your blood pressure while lying in bed, sitting and standing. You should move slowly when getting out of bed, to avoid dizziness due to the prolonged period of rest. You may be given medicine for pain or discomfort related to the insertion site or as a result of lying down and not moving for a long period of time. They will recommend that you drink water and other liquids to help remove the dye from your body. You can resume your usual diet after the procedure, unless your doctor decides otherwise. You will most likely spend the night in the hospital after the procedure. Depending on your condition and the results of your procedure, you may be admitted for longer. You will receive detailed instructions on your discharge and recovery period. They will recommend that you drink water and other liquids to help remove the dye from your body. You can resume your usual diet after the procedure, unless your doctor decides otherwise. You will most likely spend the night in the hospital after the procedure. Depending on your condition and the results of your procedure, you may be admitted longer. You will receive detailed instructions on your discharge and recovery period. They will recommend that you drink water and other liquids to help remove the dye from your body. You can resume your usual diet after the procedure, unless your doctor decides otherwise. You will most likely spend the night in the hospital after the procedure. Depending on your condition and the results of your procedure, you may be admitted longer. You will receive detailed instructions on your discharge and recovery period.

At home

Once at home, you should look at the insertion site for bleeding, unusual pain, swelling, or any abnormal changes in color or temperature at or near the insertion site. It is normal to have a small bruise. If you notice a constant or abundant amount of blood in place, which you cannot contain with a small bandage, notify your doctor. If your doctor used a closure device at the insertion site, he or she will be given specific information about the type of closure device that was used and how you should care for the insertion site. You will have a small lump or lump under your skin at the insertion site. It is normal for this to happen. The knot will gradually disappear in a few weeks. It will be important to keep the insertion site clean and dry. The doctor will give you precise instructions on how to bathe. You may be advised not to do any strenuous activity. Your doctor will tell you when you can return to work and resume normal activities.

Notify the physician of any of the following tables:

  • fever and / or chills
  • increased pain, redness, swelling, bleeding, or other discharge from the insertion site
  • feeling cold, numb and / or tingling, or other changes in the affected limb
  • chest pain / pressure, nausea and / or vomiting, heavy sweating, dizziness and / or fainting

Your doctor may provide additional or alternative instructions after the procedure, depending on your specific situation.

 

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