Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch
CPT4 code
Name of the Procedure:
Percutaneous Transluminal Coronary Atherectomy with Coronary Angioplasty; Single Major Coronary Artery or Branch (PTCA)
Summary
This procedure involves using a catheter to remove plaque from the inside of a coronary artery (atherectomy) and then expanding the artery with a small balloon (angioplasty) to restore blood flow. It is a minimally invasive method used to treat coronary artery disease.
Purpose
The procedure addresses coronary artery disease, where plaque builds up in the coronary arteries, leading to reduced blood flow to the heart. The goals are to restore normal blood flow, reduce symptoms such as chest pain (angina), and prevent heart attacks.
Indications
- Persistent chest pain (angina) despite medication
- Significant narrowing of a major coronary artery
- Patients at high risk for heart attack
- Poor response to other treatments for coronary artery disease
Preparation
- Fasting 6-8 hours before the procedure
- Blood tests and possibly imaging tests like an EKG or coronary angiogram
- Adjustments or discontinuation of certain medications as advised by the doctor
Procedure Description
- A local anesthetic is applied to the groin area.
- A small incision is made, and a catheter is inserted into the femoral artery.
- The catheter is guided to the coronary artery using X-ray imaging.
- An atherectomy device is used to remove plaque from the artery.
- A small balloon catheter is then inflated at the site of the blockage to widen the artery.
- Often, a stent is placed to keep the artery open.
- The catheter and other tools are withdrawn, and the incision site is closed.
Tools: Catheter, atherectomy device, balloon catheter, stent, X-ray imaging equipment. Anesthesia: Local anesthesia with possible sedation.
Duration
Typically takes 1 to 2 hours.
Setting
Performed in a hospital, specifically in a cardiac catheterization lab.
Personnel
- Cardiologist or interventional cardiologist
- Cardiac nurses
- Radiologic technologist
- Occasionally an anesthesiologist for sedation
Risks and Complications
- Bleeding at the catheter insertion site
- Blood vessel damage
- Heart attack or stroke
- Arrhythmias (irregular heartbeats)
- Re-narrowing of the artery (restenosis)
Benefits
- Relief from chest pain and other symptoms
- Improved blood flow to the heart
- Reduced risk of heart attack
- Quick recovery time compared to open-heart surgery
Recovery
- Lie flat for several hours post-procedure
- Monitoring in the hospital for a day
- Avoid strenuous activities for a week
- Follow-up appointments to assess recovery and the success of the procedure
Alternatives
- Medication management (beta-blockers, nitrates, etc.)
- Lifestyle changes (diet, exercise)
- Other invasive procedures like coronary artery bypass grafting (CABG)
- Each alternative has its own set of risks, benefits, and suitability depending on the patient's condition.
Patient Experience
During the procedure, patients might feel pressure or discomfort at the catheter insertion site. Post-procedure, they may experience some bruising or soreness. Pain is typically managed with medication, and most patients can return to normal activities within a week.