Having coronary artery disease means the inside
of one or more of the arteries leading to your heart are partially
or totally blocked with fatty deposits (or plaque). When arteries
become narrowed or blocked, less blood is carried to your heart.
This blockage can cause chest pain (angina) or a heart attack
(myocardial infarction) — both are events where immediate
medical care are necessary.
If you've had one or more of these symptoms,
your physician may prescribe a variety of diagnostic tests —
which may include a cardiac catheterization, where x-ray dye is
injected into your body and travels through your arteries to determine
the location of your blockage. At this point, your physician may
discuss with you the extent of your arterial disease and the best
treatment for your situation.
Occasionally, an ultrasound is used to determine
which method of treatment is necessary. During this procedure,
an ultrasound catheter (small tube) is placed in the artery, and
measurements are taken of the size of the opening and the vessel
wall. This information will help your physician determine your
best course of treatment.
Your Treatment
Depending on several factors, including the extent and location of your arterial blockage, your physician may choose from a range of Percutaneous Coronary Interventions (PCI) as the best course of treatment. (Percutaneous means the procedure is done through a hole in the skin. Coronary means the artery being treated is on the heart. An intervention is a procedure that fixes a problem.) These treatments include balloon angioplasty, stent implant, and atherectomy among others. Because the preparation, procedure and aftercare are similar for all these procedures, we will discuss the first two in this section.
Preparation
Before you go for your procedure, your physician may order a series of tests that may include blood tests, a chest x-ray, and electrocardiogram (ECG). If you're taking any blood thinners, be sure to notify your physician before you go for your angioplasty. Do not stop taking aspirin unless told to do so.
If you're an outpatient, your physician may advise you when and where to report and will discuss the procedure, its purpose, benefits, and potential risks. This is a good time to ask questions or voice any concerns you may have. Although complications occur infrequently, a very small percentage of people having a PCI require coronary artery bypass graft surgery. Therefore, you'll be asked to sign a consent form that includes consent for surgery should it become necessary.
To prepare for your procedure, you should:
• get a good night's sleep the night
before your procedure.
• report for registration one-two
hours before your procedure is to begin.
• don't eat or drink anything, except
for sips of water with your medications, after midnight the
night before your procedure.
(Note: if you have been scheduled in the
afternoon, please ask your physician what you may have to eat
or drink in the morning.)
• remove all polish from your finger
and toe nails.
When you arrive, you'll be asked to put on
a hospital gown. You may wear your wedding ring, watch, and glasses
during the procedure, if you desire. You'll be asked to empty
your bladder ahead of time so you will be comfortable during the
procedure.
Before the procedure, an intravenous (IV)
catheter will be started in your hand or arm and you will be given
some medication to help you relax. You'll then be taken to the
cardiac catheterization lab and moved onto a special x-ray table
where small, sticky pads with wires will be placed on your skin
to monitor your heart rhythm.
The area where the catheter (soft, hollow
tube) is inserted — usually the groin, but sometimes
the arm — will be shaved and cleansed to prevent infection.
You'll be comfortable, covered with sterile sheets. Then, using
a needle, the physician will numb the area that has been cleansed.
The medicine may sting slightly before it takes effect.
PTCA (Balloon Angioplasty)
PTCA is the technique used to open the narrowing in your coronary artery by inflating a tiny balloon at the point where your artery is blocked. Commonly called angioplasty, PTCA stands for percutaneous transluminal coronary angioplasty. (Percutaneous means the procedure is done through a hole in the skin. Transluminal means the physician performs the procedure inside the artery. Coronary means the artery being treated is on the heart. Angioplasty is a technique in which a balloon is inflated to open the narrowed artery.)
PTCA (Balloon Angioplasty)
Procedure
The physician or cath lab staff will be
explaining each step of the procedure to you as it happens.
You may be awake throughout the procedure and be asked to help
your care team by taking several deep breaths or coughing when
asked. The physician will begin by making a small hole in the
skin and placing a small sheath (flexible plastic tube) in the
opening. A catheter is then guided through the sheath and into
your artery. The physician will inject your arteries with dye
to look at the narrowing(s), monitoring this movement on a nearby
television screen.
Your physician will thread the balloon catheter
through the guiding catheter until the balloon reaches the middle
of the narrowed artery. You won't feel the catheter move inside
you because there are no nerve endings inside your arteries.
When it is in the right position, the balloon will be inflated
and deflated several times to open the narrowing and decrease
the plaque. At this point, you may feel tightness or chest discomfort
that may feel similar to the symptoms you've been experiencing.
These feelings should go away when the balloon is deflated.
Your input is an important part of successful treatment, so
be sure to tell your care team exactly how you feel throughout
this procedure.
After the artery is dilated, the catheter
will be removed and your physician will take additional pictures
to determine the improvement. When your angioplasty is finished,
the sheath will be left in your groin for a period of time.
Stent
A coronary stent is a tiny, stainless steel mesh tube that acts as a scaffold against the artery wall and is mounted on a balloon catheter similar to that used for angioplasty. A stent, once it is positioned and left in the narrowed artery, will not rust or move. Your physician may decide to implant more than one stent to adequately cover the blocked area. Most of the newer-generation stents have a drug coating on their surface that is designed to decrease the likelihood that the blockage will return.
Stent Procedure
You'll go through the same preparations
as those for angioplasty. Your physician introduces the catheter
through the groin and maneuvers it into the blockage site where
the balloon has been inflated. Then the stent is expanded, pressing
against the inner wall of the artery. The balloon is deflated
and removed, while the stent remains in place, holding the blood
vessel open and improving the flow of blood. You won't feel
the stent in your artery, and it should immediately relieve
symptoms of chest pain or angina.
Within several weeks after the stent has
been implanted, your body will grow a natural covering over
the device that keeps it securely in place. After the stent
implantation you will be treated with medications — such
as aspirin or other anti-platelet medications — to help
prevent blood clots from sticking to the metal surface of the
stent. Be sure not to miss any doses, and continue to take all
of your medications until your physician tells you to stop.
Atherectomy
Atherectomy is the procedure for removing
the plaque material in an artery. Your physician may choose this
procedure to make sure you have a satisfactory opening for blood
flow. An atherectomy is done with a small rotating cutting utensil
that cuts out or grinds down the plaque.
Your Recovery
After your procedure, you'll be taken to a
hospital room for recovery. You'll have an IV
and a heart monitor, and your nurse will check your blood pressure
periodically. If you experience any
chest discomfort, weakness or dizziness, be sure to tell the nurse
immediately. You will need to lie flat and still in bed for several
hours. Depending on the extent of your angioplasty and your physician's
orders, you may be required to lie flat for a long period of time
(up to 14 hours).
The dye used during the procedure will make
you want to urinate (pass water) often. It's important to drink
extra fluids to help your kidneys get rid of this dye. If you
have trouble passing your water while
lying flat, a catheter may be inserted into your bladder to assist
you.
When the sheath in your groin is removed,
pressure will be applied to your groin for 15 to 30 minutes. Afterwards,
a small dressing and sandbag will be applied. It's important to
notify the nurse if you feel any warmth or wetness at the dressing
site, or if you notice any bleeding. Apply firm pressure to the
dressing with your hands as you call the nurse. You will be required
to lie flat for additional hours after the sheath is removed.
While you're recovering, you'll be allowed
to eat, drink, and visit with your family. It's best to eat lightly
to prevent discomfort from a full stomach while lying flat and
to minimize any nausea (feeling sick to your stomach).
When you're told it's all right to get out
of bed, you should get up slowly and with help, as you may feel
a little weak. You could be discharged from the hospital as early
as 24 hours after your procedure and should arrange for someone
to take you home.
Your Good Health
Percutaneous Coronary Interventions (PCI), whether a Balloon Angioplasty, Stent Implant, or Atherectomy, do not always provide a permanent cure. In some patients the artery may re-narrow (restenosis) and could require additional treatment, such as another PCI or surgery. However, you can help prevent this by following your physician's recommendations regarding diet, exercise, smoking cessation, and medications. And if at any time you develop chest discomfort or side effects from any of your medications, immediately contact your physician. It's also very important to keep any follow-up appointments that have been scheduled for you.
As always, if you have any questions about your health, be sure to ask your physician.
If you are a Munson Healthcare patient and have a compliment,
concern, or complaint, please contact one of our Patient
Liaisons.
