Name of the Procedure:

Percutaneous Transluminal Revascularization of Chronic Total Occlusion, Coronary Artery, Coronary Artery Branch, or Coronary Artery Bypass Graft (Single Vessel)

• Common Name: Percutaneous Coronary Intervention (PCI) for Chronic Total Occlusion (CTO)
• Technical/Medical Terms: Intracoronary Stent Placement, Atherectomy, Angioplasty

Summary

Percutaneous Transluminal Revascularization is a minimally invasive procedure used to open blocked coronary arteries, branches, or bypass grafts that have become completely obstructed. It involves the use of intracoronary stents, atherectomy, and angioplasty to restore blood flow to a single affected vessel.

Purpose

• Medical Condition Addressed: Chronic total occlusion (CTO) of coronary artery, coronary artery branch, or coronary artery bypass graft.
• Goals/Expected Outcomes: Restore blood flow to improve oxygen delivery to heart muscle, alleviate symptoms (e.g., chest pain), improve heart function, and reduce the risk of heart attacks.

Indications

• Severe chest pain (angina) not responsive to medication.
• Significant blockage (100% occlusion) of one of the coronary arteries, branches, or bypass grafts.
• Reduced heart function due to blocked arteries.

Preparation

• Pre-procedure Instructions: Fasting for 6-8 hours before the procedure. Adjustments to medications, especially blood thinners, as directed by the doctor.
• Diagnostic Tests: Electrocardiogram (ECG), stress test, echocardiogram, coronary angiography.

Procedure Description

1. Access and Sedation: The patient is typically sedated and local anesthesia is applied.
2. Catheter Insertion: A catheter is inserted through a small incision in the groin or wrist and guided to the blocked coronary artery.
3. Imaging: Contrast dye is injected to visualize the blockage using X-ray imaging (angiography).
4. Revascularization: Depending on the blockage, the following may be performed:
   • Angioplasty: A balloon is inflated to widen the artery.
   • Stenting: A stent is placed to keep the artery open.
   • Atherectomy: Specialized tools are used to remove plaque buildup.
5. Completion: Once the blockage is addressed, the catheter is removed, and the incision site is bandaged.

Duration

The entire procedure typically takes between 1 to 3 hours.

Setting

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

Personnel

• Interventional Cardiologist
• Cardiac Nurse
• Radiologic Technologist
• Anesthesiologist (if general anesthesia is required)

Risks and Complications

• Common Risks: Bleeding at the catheter insertion site, allergic reaction to contrast dye, arrhythmias.
• Rare Risks: Heart attack, stroke, arterial damage, kidney damage from contrast dye, need for emergency coronary artery bypass surgery.

Benefits

• Relief from angina symptoms.
• Improved blood flow to the heart muscle.
• Reduced risk of heart attack.
• Improved overall cardiac function.
• Benefits typically realized immediately to within a few days post-procedure.

Recovery

• Post-procedure Care: Monitoring in a recovery area, medications to prevent blood clots, instructions about physical activity and diet.
• Expected Recovery Time: Most patients can return to normal activities within a week, with some restrictions on heavy lifting and strenuous activity. Follow-up appointments to monitor heart health.

Alternatives

• Medications: For managing symptoms but might not be as effective in fully restoring blood flow.
• Coronary Artery Bypass Grafting (CABG): Surgical option for severe cases; more invasive with a longer recovery period.
• Pros and Cons: PCI is less invasive with quicker recovery but may need to be repeated. CABG is more invasive but often more durable.

Patient Experience

• During Procedure: Mild discomfort or pressure at the incision site, occasional sensation of dye, generally well-tolerated due to sedation.
• After Procedure: Some soreness at the insertion site, potential for mild bruising, fatigue. Pain management and comfort measures include prescribed medications and instructions on how to care for the insertion site at home.