Name of the Procedure:

Percutaneous transcatheter placement of intracoronary stent(s) with coronary angioplasty when performed; each additional branch of a major coronary artery

Summary

This procedure involves inserting a stent into a coronary artery to keep it open, often combined with angioplasty (widening the artery). It addresses blockages in additional branches of a major coronary artery beyond the primary location.

Purpose

The procedure aims to treat coronary artery disease by improving blood flow to the heart. It helps relieve chest pain (angina), prevent heart attacks, and improve overall heart function.

Indications

• Symptoms like chest pain, shortness of breath, or heart attack
• Diagnosed coronary artery disease with multiple branch blockages
• Poor blood flow detected via tests such as stress tests or angiograms

Preparation

Patients may need to fast for several hours before the procedure. Medications, particularly blood thinners, may require adjustment. Pre-procedure tests often include blood work, ECG, and a coronary angiogram.

Procedure Description

1. Local Anesthesia: Often administered where the catheter will enter the body, typically in the groin or wrist.
2. Catheter Insertion: A catheter is threaded through the artery to the heart's coronary arteries.
3. Angioplasty: A small balloon on the catheter's tip is inflated to widen the artery.
4. Stent Placement: A metal stent is placed in the artery to keep it open, particularly in additional branches as necessary.
5. Completion: The balloon is deflated and removed, leaving the stent in place.

Duration

The procedure typically takes 1 to 2 hours, but this can vary with the number of branches treated.

Setting

Usually performed in a hospital's catheterization laboratory (cath lab).

Personnel

A cardiologist specializing in interventional procedures, supported by a team of nurses and technicians. An anesthesiologist or nurse anesthetist may be involved if sedation is required.

Risks and Complications

• Common: Bleeding or bruising at the catheter insertion site
• Rare: Blood vessel damage, heart attack, stroke, or allergic reactions to contrast dye
• Stent-related: Blood clots, which can be managed with medications like blood thinners

Benefits

• Immediate improvement in blood flow
• Reduction in chest pain and other symptoms
• Lowered risk of heart attack
• Enhanced quality of life and physical capabilities

Recovery

• Initial Recovery: Monitored in the hospital for several hours or overnight
• Home Care: Instructions may include medication regimen, wound care, activity restrictions, and signs of complications to watch for
• Follow-Up: Typically involves check-ups and potential imaging tests to ensure the stent remains open

Alternatives

• Medication management: antihypertensives, cholesterol-lowering drugs
• Lifestyle changes: diet, exercise, smoking cessation
• Surgical options: Coronary artery bypass grafting (CABG), which is more invasive but may be recommended for extensive blockages

Patient Experience

Patients may feel pressure or mild discomfort during catheter insertion but typically do not feel the stent placement. Post-procedure pain is usually minimal and manageable with over-the-counter pain relievers. Most patients resume normal activities within a week but should avoid heavy lifting or strenuous activity during initial recovery.