Name of the Procedure:

Percutaneous Transluminal Revascularization of Acute Total/Subtotal Occlusion During Acute Myocardial Infarction, Coronary Artery or Coronary Artery Bypass Graft. Common Names: PTCA, Coronary Angioplasty with Stent, Emergency Angioplasty

Summary

This procedure is a minimally invasive intervention used to open blocked coronary arteries during or immediately after a heart attack. It involves the use of a balloon-tipped catheter to widen the artery and may include the placement of a stent, removal of plaque through atherectomy, and aspiration of blood clots to restore blood flow.

Purpose

Medical Conditions:

• Acute Myocardial Infarction (Heart Attack)
• Complete or Partial Blockage of a Coronary Artery

Goals:

• Restore blood flow to the heart muscle
• Reduce damage to the heart
• Prevent further complications such as heart failure or another heart attack

Indications

• Severe chest pain (angina) not relieved by medication
• Evidence of significant myocardial infarction on an electrocardiogram (ECG)
• Findings of acute total or subtotal artery blockage during imaging tests
• Hemodynamic instability (e.g., low blood pressure, shock)

Preparation

• Fasting for several hours before the procedure
• Adjustment of current medications, particularly blood thinners
• Diagnostic tests such as ECG, blood tests, and imaging studies (e.g., coronary angiography)

Procedure Description

1. Access Point: A small incision is made, typically in the groin or wrist, to access a large artery.
2. Catheter Insertion: A catheter with a small balloon on its tip is threaded through the artery up to the site of blockage.
3. Balloon Inflation: The balloon is inflated to push the plaque against the artery walls, widening the artery.
4. Stent Placement: A metal stent may be placed to keep the artery open.
5. Atherectomy and Thrombus Aspiration: If necessary, specialized tools are used to remove plaque and/or blood clots.
6. Final Imaging: Contrast dye is injected, and X-rays are used to ensure the artery is properly opened.

Equipment:

• Catheters with balloons and stents
• Imaging systems for real-time guidance
• Atherectomy devices if plaque removal is needed

Anesthesia:

• Local anesthesia at the insertion site
• Sedation to help the patient relax

Duration

Typically, the procedure takes about 1-2 hours but may vary depending on the complexity.

Setting

The procedure is performed in a hospital setting, specifically in a cardiac catheterization lab.

Personnel

• Interventional cardiologist
• Nurses specialized in cardiac care
• Radiologic technologists
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Bleeding or infection at the catheter insertion site
• Damage to blood vessels
• Re-occlusion of the artery
• Heart attack or stroke during the procedure
• Rarely, death

Benefits

• Rapidly restores blood flow to the heart
• Reduces heart muscle damage
• Decreases the likelihood of complications and improves survival rates

Recovery

• Monitoring in a hospital for several hours to a few days
• Medications to prevent blood clots
• Limited physical activity for a short period
• Follow-up appointments to check heart function and healing

Alternatives

• Medication management (thrombolytic therapy)
• Coronary artery bypass grafting (CABG)
• Lifestyle modifications and medical therapy for stable cases

Pros and Cons:

• PTCA is less invasive and offers quicker recovery compared to CABG but may not be suitable for all cases depending on the severity of blockages.

Patient Experience

• During the procedure: Sensation of pressure at the insertion site, some discomfort when the balloon is inflated.
• After the procedure: Some soreness at the catheter site, restrictions on heavy lifting and strenuous activities for about a week.
• Pain management: Local anesthetics and prescribed pain relievers as needed.