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Percutaneous Transluminal Coronary Angioplasty (PTCA)

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Percutaneous Transluminal Coronary Angioplasty (PTCA)
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• Introduction

After the diagnostic
coronary angiogram is completed and the doctor has viewed all the pictures, he will make a decision on whether to do a coronary angioplasty or not.

There are several reasons to undergo an angioplasty procedure:  

  •  If chest pain symptoms are not easily controlled with medications.

  •  If symptoms prevent the patient from participating in daily activities.

  •  If the patient is experiencing chest pain at rest.

  •  If chest pain continues after a heart attack an angioplasty will be done to treat the blockage causing the problem.

  
However, not all patients with Coronary Artery Disease need an angioplasty. Some patients with infrequent or rare angina or those whose symptoms are easily controlled with medication can be treated with medication alone and may not require an angioplasty.   


• Procedure

A coronary angioplasty system consists of three basis components:   

  • A guiding catheter that provides stable access to the coronary ostium (opening), and a route for contrast administration, as well as a conduit for the advancement of the dilatation equipment.

 

  • A leading guidewire that can be passed through the guiding catheter, across the target lesion, and well into the distal coronary vasculature to provide a rail over which a series of therapeutic devices can be advanced.


  • A non-elastomeric balloon dilatation filled with liquid contrast medium.

 

  • A guide catheter is introduced via femoral artery approach, retrogradely, over the guidewire through the abdominal aorta and into the ascending aorta.

 

  • The guidewire is removed and the guide catheter is maneuvered until it is sitting at the ostium of the left or right coronary artery, depending on which artery is going to be ballooned or stented.


  • Thereafter once the desired position is attained, an angioplasty guidewire is threaded through guide catheter and into the coronary artery.


  • This wire is maneuvered past the lesion guided by small injections of contrast using a device called the torque device and sits in the coronary distal to the lesion until the procedure is over.


  • Once the size of the lesion is measured by the Radiographer, an appropriate size balloon is used.


  • The balloon is threaded over the guidewire and through the guide catheter.


  • The balloon is then maneuvered to the target lesion and is inflated progressively using an endeflator. The amount of pressure used depends on how the vessel responds to the angioplasty.


  • Once adequate dilatation was deemed to have been achieved, the balloon is removed from the guide catheter and contrast is injected to view the successfulness of the procedure.


 



  • If after the Angioplasty, the artery recoils (narrows) a stent may be inserted, using a similar procedure.


  • The stent is placed across the lesion and is then inflated to nominal pressures (the pressures in which the stent will be deployed).


  • The balloon is then removed with the stent deployed in the coronary artery and the artery reviewed under fluoroscopy using dye.


 


  • When the artery is optimally opened up, the guidewire and guiding catheter is removed.

 

  • Due to blood-thinning medication, given to the patient during the procedure, a sheath may be left in the groin which is removed a few hours later in the ward.

 
Although angioplasty has proven to be relatively safe, it is a surgical procedure that carries a risk for complication. These include:   

  • Bleeding at the site of insertion. This commonly leads to a small bruise in the groin area and, in rare cases, to more serious internal bleeding.


  • Infection at the site of sheath insertion.

 

  • Damage to blood vessels in the groin.

 

  • Allergic reaction to the iodine-based contrast medium.


  • Kidney damage ad/or kidney failure.

 

  • Stroke.


  • Heart Attack.


  • Need for emergency bypass surgery.

 

  • Death.

 

• Post Intervention: Reducing Your Risk

Most Commonly Asked Questions:

1. What happens after the Angioplasty / Stent?  

  • You will be able to get out of bed the day after the procedure. If a stent was used, your treatment will be adjusted during the time it takes for the stent to be fully covered by the arterial wall.

 
2. Am I Definitely cured?  

  • The dilated area can sometimes “restenose” or block up again. This sometimes happens within six (6) months of the procedure. In this case you will be re-admitted and the stenosed area re-dilated. Some cases surgery might be necessary. It is therefore vital that you keep your follow-up appointments with your Cardiologist.

  
3. Can I play Sport?  

  • YES!! But be cautious. Speak to your Cardiologist before you engage in any strenuous activity.

 
4. Can I walk through metal detectors if I have a stent?  

  • YES! The stent is made of non-magnetic metals.

 
5. When can I resume work?  

  • Majority of patients that have these invasive procedures return to work a few days later.

 
6. Can I undergo MRI / CT Scanning?  

  • YES! However be sure to advise the doctor that you have a stent implanted.


7. Can I continue to smoke?  

  • NO!!! Smoking is one of the primary risk factors of Coronary Artery Disease and should be discontinued immediately.

 
8. What if I still get pain?  

  • Immediately inform your Cardiologist.


9. How should modify my diet?


  • Reducing your intake of animal fats (cheese, meat, butter, full cream milk, eggs, etc) and increase your intake of low cholesterol foods (fish, vegetables, etc)

 
10. How long would I be on medication?  

Follow your Cardiologist instructions on medication intake. Be sure to take your medication as prescribed and consult with your doctor if you have any doubts or negative reactions to any new medication prescribed.



 
 
 
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