Cardiac Catheterization & Stent Placement

Coronary angioplasty of a tight stenosis followed by a stent placement

Percutaneous Transluminal Coronary Angioplasty (image above), known as PTCA, is the procedure that uses a balloon to open a blocked artery. After a thin wire is passed across a blockage, a balloon-tipped catheter is inflated, flattening the plaque against the artery. Blood thinners are given during the procedure, and the tiny tubes inserted in the groins, called sheaths, may not be removed for several hours until the blood thinners lose their effect. Because there is a small risk of needing emergency surgery for failed angioplasty, the procedure is performed at the hospital on an inpatient basis.

Unfortunately, the angioplasty technique is plagued with up to a forty percent (40%) recurrence of the blockage, often within the first six months. This recurrence is known as restenosis. Coronary stents are small metallic scaffolds, often balloon -mounted, that are permanently placed across a blockage. Stents are known to reduce restenosis to less than twenty percent (20%) in many cases.

 

Rotablator® burr reducing coronary plaque.

Rotational Atherectomy (image above), or Rotablator®, is often done in conjunction with PTCA and stenting. A small high-speed drill is passed over a wire to pulverize plaques into microscopic particles. Rotablator® is particularly useful for small, diffusely diseased arteries, and arteries with heavy calcium deposits. Directional Atherectomy, called DCA, uses a small cutting blade to shave plaque into a chamber. The debris is then removed from the body. Large, bulky blockages respond well to DCA.

Intravascular Ultrasound, or ICUS, is essentially an echocardiogram performed on a catheter placed within the artery. It gives information on vessel size, plaque composition and percent stenosis. Intravascular ultrasound is used to ensure the proper seating of stents against the arterial wall.

Peripheral angioplasty, called PTA, is the balloon technique applied to the peripheral arteries. Peripheral stents are placed in selective locations. Renal artery angioplasty and stenting are used for treating blockages of the kidney arteries. This may help preserve kidney function or decrease the high blood pressure caused by these blockages.

Patient Preparation:
 

• No food or drink at least four (4) hours before the procedure.
• Take your medications with sips of water unless otherwise instructed.