Name of the Procedure:

Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel.

Summary

This procedure involves using advanced imaging techniques, such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT), to visualize the inside of coronary vessels or grafts. It helps doctors assess the condition of the blood vessels supplying the heart and guide interventions if necessary.

Purpose

The procedure is mainly used to diagnose and treat coronary artery disease. It provides high-resolution images of the coronary arteries or grafts, allowing for the detection of blockages, plaque buildup, or other abnormalities. The goal is to provide precise information that helps in planning appropriate treatments or interventions.

Indications

• Symptoms of angina (chest pain)
• Abnormal stress test results
• Unexplained shortness of breath
• High-risk patients with known coronary artery disease
• Assessment of stented vessels or grafts post-surgery

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Adjustments to certain medications (especially blood thinners) may be needed.
• Pre-procedure diagnostic tests such as blood tests, electrocardiograms (ECG), or earlier imaging results may be reviewed.

Procedure Description

1. The patient is taken to a cardiac catheterization lab.
2. A local anesthetic is applied to numb the insertion site, typically the groin or wrist.
3. A catheter with an IVUS or OCT probe is inserted into a blood vessel and guided to the coronary arteries.
4. Once in place, the imaging probe is activated to capture detailed images of the vessel walls.
5. The images are analyzed in real-time, and a report is generated.
6. If needed, therapeutic interventions (e.g., stent placement) may be performed based on the findings.
   • The procedure uses specialized IVUS or OCT imaging equipment.
   • Sedation may be administered in some cases for patient comfort.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the complexity and whether any interventions are needed.

Setting

This procedure is usually performed in a hospital or outpatient cardiac catheterization lab.

Personnel

• Interventional cardiologist
• Nursing staff
• Radiologic technologist
• Anesthesiologist (if sedation is required)

Risks and Complications

• Bleeding or infection at the catheter insertion site
• Allergic reactions to contrast dye (if used)
• Blood vessel damage
• Arrhythmias (irregular heartbeats)
• Rarely, heart attack or stroke

Benefits

• Provides precise, high-resolution images of coronary vessels or grafts
• Helps in accurate diagnosis and planning of appropriate treatments
• Can lead to better management of coronary artery disease and improved outcomes

Recovery

• Patients are observed for a few hours after the procedure for any complications.
• Instructions typically include keeping the insertion site clean and dry.
• Avoid strenuous activities for a day or two.
• Follow-up appointments for review and further management.

Alternatives

• Non-invasive imaging options such as coronary CT angiography (CTA) or magnetic resonance angiography (MRA)
• Traditional coronary angiography
• Pros: Non-invasive alternatives may have fewer risks.
• Cons: They may not provide as detailed images as IVUS or OCT.

Patient Experience

• During the procedure, patients might feel some pressure at the insertion site but should not feel pain due to local anesthesia.
• Some patients may experience mild sedation, making them relaxed and drowsy.
• Post-procedure, minor discomfort at the insertion site and feelings of tiredness may occur.
• Pain management includes over-the-counter pain relievers if needed.