Name of the Procedure:

Percutaneous Transluminal Coronary Atherectomy with Intracoronary Stent and Coronary Angioplasty; each additional branch of a major coronary artery

Summary:

This procedure involves cleaning out plaque from the arteries feeding the heart, placing a stent to keep the artery open, and widening the artery through angioplasty. This description specifically applies to performing these actions on additional branches of a major coronary artery beyond the primary site.

Purpose:

This procedure is used to treat coronary artery disease, where plaque buildup narrows or blocks the coronary arteries. The goal is to restore normal blood flow to prevent heart attacks and relieve symptoms like chest pain (angina).

Indications:

• Symptoms of chest pain (angina) or shortness of breath
• Evidence of significant coronary artery disease on diagnostic tests
• Failure of medical therapy to control symptoms
• Myocardial infarction (heart attack)

Preparation:

• The patient may be instructed to fast for 6-8 hours before the procedure.
• Adjustments may be needed for medications, particularly blood thinners and diabetes medications.
• Pre-procedural diagnostic tests such as ECG, blood tests, and coronary angiography may be required.

Procedure Description:

1. The patient is given local anesthesia at the insertion site and possibly mild sedation.
2. A catheter is inserted through an artery in the groin or wrist and guided to the heart.
3. Contrast dye is injected, allowing X-ray imaging of the coronary arteries.
4. An atherectomy device is used to remove plaque from the arterial walls.
5. A balloon catheter inflates to widen the artery (angioplasty).
6. A stent is deployed to keep the artery open.
7. Steps 3-6 are repeated for each additional branch of a major coronary artery needing treatment.

Duration:

The procedure typically takes 1-3 hours, depending on the number of arteries treated.

Setting:

Performed in a hospital's catheterization lab, which is equipped with specialized imaging equipment.

Personnel:

• Interventional cardiologist
• Medical assistants or nurses
• Radiologic technologists
• Anesthesiologists if sedation beyond local anesthesia is required

Risks and Complications:

• Bleeding or infection at the catheter insertion site
• Allergic reaction to contrast dye
• Blood vessel damage
• Heart attack or stroke
• Re-narrowing of the artery (restenosis)
• Blood clots

Benefits:

• Improved blood flow to the heart muscle
• Relief from symptoms like chest pain and shortness of breath
• Reduced risk of heart attack
• Potentially improved quality of life

Recovery:

• Patients typically stay in the hospital for 1-2 days
• Instructions may include avoiding strenuous activities for a week
• Follow-up appointments to monitor heart health and medication adjustments
• Patients may be prescribed antiplatelet medications to prevent blood clots

Alternatives:

• Medication management (e.g., beta-blockers, nitrates, cholesterol-lowering drugs)
• Lifestyle changes (diet, exercise, smoking cessation)
• Coronary artery bypass graft (CABG) surgery
  • Pros: CABG may be more effective for complex cases
  • Cons: CABG is more invasive with longer recovery times

Patient Experience:

• During the procedure: Minimal discomfort due to local anesthesia, possible mild sedation to relax.
• Post-procedure: Some soreness at the catheter site, typically manageable with over-the-counter pain relief.
• Over time: Gradual improvement in symptoms and overall quality of life, assuming adherence to recommended lifestyle and medication regimens.