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What are interventional procedures?
Interventional procedures are nonsurgical procedures used to treat blocked
coronary arteries and increase blood flow to the heart. (Figure
1 below)
After an interventional
procedure, the coronary artery is opened, increasing
blood flow to the
heart.
Interventional procedures are performed in the cardiac catheterization
laboratory by a specialized cardiologist and a cardiovascular team of nurses and
technicians.
Cardiac catheterization procedure
First, the patient receives medication for relaxation. The doctor then numbs
the area where the procedure will be performed. A sheath (thin, plastic tube) is
inserted into an artery in the groin or sometimes the arm. A long, slender tube
called a catheter is inserted through the sheath and guided through the blood
vessel to the arteries surrounding the heart.
A diagnostic procedure called coronary angiography is performed next. During
angiography, a small amount of contrast material is injected through the
catheter and is photographed as it moves through the heart’s chambers, valves
and major vessels. From the digital photographs of the contrast material, the
doctors can tell whether the coronary arteries are narrowed and/or whether the
heart valves are working correctly.
Interventional
procedures
An interventional procedure starts out in the same way as a diagnostic
cardiac catheterization. Once the blocked artery is identified with the
catheterization, the doctor performs the interventional procedure. There are
several interventional procedures that may be used to open the artery.
Balloon angioplasty (Percutaneous Transluminal Coronary Angioplasty or
PTCA), (Figure 2 to the right): A small balloon at
the tip of the catheter is inflated to compress the fatty matter into the artery
wall and stretch the artery open to increase blood flow to the heart.
Stent (Figure
3 to the left): A stent is a small, metal mesh tube that acts as a
scaffold to provide support inside the coronary artery. A balloon catheter,
placed over a guide wire, is used to insert the stent into the narrowed coronary
artery. Once in place, the balloon is inflated and the stent expands to the size
of the artery and holds it open. The balloon is deflated and removed, and the
stent stays in place permanently. Over a several-week period, the artery heals
around the stent. Stents are commonly placed during interventional procedures
such as angioplasty or atherectomy to help keep the coronary artery open.
Drug-eluting stents (introduced in 1993) contain medicine and are designed to
reduce the risk of reblockage (restenosis). Your interventionalist will decide
if a drug-eluting stent is appropriate for your type of blockage.
Atherectomy (Directional Coronary Atherectomy or DCA): A catheter, with a
hollow cylinder on the tip, and an open window on one side and a balloon on the
other is inserted into the narrowed artery. The balloon is inflated, pushing the
window against the fatty matter. A blade (cutter) within the cylinder rotates
and shaves off any fat that protruded into the window.
The shavings are caught in a chamber within the catheter and removed. (Figure
4 to the right)
Rotoblation (Percutaneous Transluminal Rotational Atherectomy or PCRA): A
special catheter, with an acorn-shaped, diamond-coated tip, is guided to the
point of narrowing in the coronary artery. The tip spins around at a high speed
and grinds away the plaque on your artery walls. This process is repeated as
needed to improve blood flow. The microscopic particles are washed safely away
in your blood stream and filtered out by your liver and spleen. (Figure
5 to the left)
Cutting balloon: The cutting balloon catheter has a special balloon tip
with small blades. When the balloon is inflated, the blades are activated. The
small blades score the plaque, then, the balloon compresses the fatty matter
into the artery wall. (Figure 6 to the right)
How long will the procedure last?
Most interventional procedures last 1 Ѕ to 2 Ѕ hours, but the preparation
and recovery time add several hours. Please plan to stay in the hospital all day
for the procedure and most likely remain in the hospital overnight.
If you need to have an interventional procedure, your doctor or nurse will
give you more information about what to expect before, during and after the
procedure.
What happens after the procedure?
You may be required to lay flat immediately after the procedure. You may
receive medication to reduce discomfort.
Before you go home, your doctor will discuss the results of the procedure
with you and your family.
You will be given instructions about your medications, diet, activity, and
when to call your doctor.
You may be given a prescription for nitroglycerin after the procedure. Follow
your doctor’s instructions about how and when to take this medication.
You will need to take it easy for a few days after the procedure. You may
climb stairs, but use a slower pace. Do not strain during bowel movements.
Gradually increase your activities until you reach your normal activity level
by the end of the week.
What is restenosis?
Restenosis is a blockage in the treated coronary artery. It usually occurs
in the first six months after treatment. On average, one in about four to five
blockages return to the coronary artery after treatment. Restenosis is caused by
the accumulation of scar tissue at the treatment site. It is quite rare for
restenosis to cause serious problems, such as a heart attack.
If you have angina similar to what you experienced before the procedure, it
may be a sign that the coronary artery is renarrowing, or that you have new
blockages. Symptoms may include chest discomfort, excessive shortness of breath,
dizziness, irregular heartbeats, or being unable to do your normal activities
without becoming overtired. Call your doctor as soon as symptoms occur.
Do interventional procedures cure coronary artery disease?
For most people, interventional procedures increase blood flow to the heart,
diminish chest pain and decrease the risk of a heart attack.
Although interventional procedures open up blocked arteries, they do not cure
coronary artery disease. You will still need to focus on reducing your
risk factors and making certain lifestyle changes to prevent future disease
development or progression.
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