Name of the Procedure:

Percutaneous Transluminal Coronary Thrombectomy – Mechanical Also known as: Mechanical Thrombectomy, Coronary Mechanical Thrombectomy

Summary

In simple terms, this procedure involves removing a blood clot from the coronary arteries using a special device inserted through a blood vessel. It is performed alongside another primary procedure, such as angioplasty.

Purpose

This procedure is designed to treat obstructive clots in the coronary arteries, which can lead to heart attack. The goal is to restore proper blood flow to the heart muscle and prevent further damage.

Indications

• Acute coronary syndromes, such as a heart attack
• Evidence of a large thrombus (blood clot) in the coronary artery during angiography
• Patients exhibiting symptoms like severe chest pain, shortness of breath, or ECG changes indicative of a clot

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Blood tests, ECG, and imaging studies like echocardiography or angiography will be performed.
• Medications such as anticoagulants or antiplatelet agents might be adjusted.

Procedure Description

1. The patient is sedated, and local anesthesia is applied to the insertion site (usually the groin or wrist).
2. A catheter is inserted through the blood vessel and guided to the coronary arteries.
3. Mechanical devices, such as aspiration catheters or thrombectomy devices, are used to physically remove the clot.
4. Simultaneously or afterward, another primary procedure like angioplasty may be conducted to open the artery further.
5. The catheter and devices are then removed, and pressure is applied to the insertion site to prevent bleeding.

Duration

Typically, 1 to 2 hours, depending on the complexity and the additional primary procedure being performed.

Setting

This procedure is usually performed in a hospital's cardiac catheterization laboratory.

Personnel

• Interventional Cardiologist
• Cardiac Catheterization Laboratory Nurses
• Radiologic Technologist
• Anesthesiologist or Nurse Anesthetist (if sedation beyond local anesthesia is required)

Risks and Complications

Common risks:

• Bleeding or bruising at the insertion site
• Minor discomfort

Rare but serious complications:

• Damage to the blood vessel
• Dislodgment of the clot causing stroke or other embolic events
• Arrhythmias
• Myocardial infarction (heart attack)
• Infection

Benefits

• Rapid restoration of blood flow to the heart
• Reduced risk of heart muscle damage
• Improved survival and heart function post-heart attack

Recovery

• Patients may need to lie flat for a few hours post-procedure.
• Monitoring in a cardiac care unit for a day or two.
• Gradual resumption of normal activities within a week.
• Follow-up appointments for cardiac assessment and medication management.

Alternatives

• Pharmacologic thrombolysis (using clot-busting medications)
• Open-heart surgery (in extreme cases)
• Stenting alone without thrombectomy

Pros and cons:

• Medication is less invasive but may not be effective for large clots.
• Surgery is more invasive with a longer recovery but may be necessary in severe cases.

Patient Experience

During the procedure:

• Mild discomfort at the insertion site.
• Sensations of pressure or movement within the chest as the catheter is guided.

After the procedure:

• Soreness at the insertion site
• Possible mild chest discomfort
• Pain management provided through medications.

Overall, patients should expect a notable improvement in symptoms shortly after the procedure, with a majority experiencing relief from chest pain and better heart function.