Name of the Procedure:

Percutaneous Transluminal Revascularization of Chronic Total Occlusion (also known as: PCI for CTO, Coronary Angioplasty with Stent, Atherectomy)

Summary

Percutaneous Transluminal Revascularization is a minimally invasive procedure to open up blocked coronary arteries that have been completely obstructed for a long time. The procedure can involve using stents, atherectomy (removal of plaque), and/or angioplasty (balloon dilatation) to restore blood flow to the heart.

Purpose

This procedure treats chronic total occlusions (CTOs) in the coronary arteries, coronary artery branches, or coronary artery bypass grafts. The primary goal is to improve blood flow, reduce chest pain (angina), and enhance overall heart function, reducing the risk of a heart attack.

Indications

• Severe chest pain (angina) not relieved by medication
• Evidence of significant myocardial ischemia (reduced blood flow to the heart)
• Positive stress tests indicating heart disease
• Symptoms affecting quality of life despite optimal medical therapy
• High risk of heart attack due to blocked arteries

Preparation

• Fasting for 6-8 hours before the procedure
• Adjusting medications as directed by your physician (e.g., stopping blood thinners)
• Pre-procedure blood tests, ECG, and potentially a coronary angiography
• Discussing allergies, especially to contrast dye or medications

Procedure Description

1. The patient is usually given a local anesthetic with mild sedation.
2. An access site, typically in the groin or wrist, is numbed and a catheter is inserted.
3. A contrast dye is injected to visualize the blockage using X-ray imaging.
4. A guidewire is navigated through the occlusion.
5. Depending on the blockage, a balloon catheter is inflated to open the artery and/or a stent is placed to keep the artery open.
6. Atherectomy may be utilized to remove hard plaque before or after balloon angioplasty.
7. The catheter is then removed, and the access site is closed.

Duration

The procedure typically takes between 2 to 3 hours but may vary depending on the complexity of the occlusion.

Setting

This procedure is performed in a hospital's catheterization laboratory (cath lab).

Personnel

• Interventional Cardiologist
• Cath Lab Technicians
• Nurses
• Anesthesiologist (if deeper sedation or general anesthesia is needed)

Risks and Complications

• Common: Bleeding at the catheter insertion site, bruising, and hematoma
• Less common:
  • Blood vessel damage
  • Blood clots
  • Infection
  • Allergic reaction to contrast dye
  • Arrhythmias
• Rare but serious:
  • Heart attack
  • Stroke
  • Death

Benefits

• Relief from chest pain
• Improved exercise capacity and quality of life
• Reduced risk of heart attack
• Restoration of normal blood flow to the heart
• Immediate benefits are often noticed, with optimal results seen in days to weeks

Recovery

• Monitoring in a recovery unit for several hours post-procedure
• Possible overnight hospital stay for observation
• Instructions to avoid heavy lifting and strenuous activities for a few days
• Follow-up appointments for assessment and medication adjustments
• Potential for dual antiplatelet therapy (aspirin and another antiplatelet agent) for a specified period

Alternatives

• Medical management with medications (e.g., beta-blockers, nitrates, calcium channel blockers)
• Coronary artery bypass graft (CABG) surgery
• Lifestyle modifications (diet, exercise)
• Risks and benefits of alternatives compared to the described procedure vary and should be discussed with a healthcare provider.

Patient Experience

• During the procedure: You may feel pressure at the insertion site and a flushing sensation from the contrast dye, but pain is generally minimal.
• After the procedure: Mild soreness at the catheter site, potential bruising; pain management includes over-the-counter pain relievers.
• Most patients can resume normal activities within a week, with specific restrictions advised by the doctor.