93460 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) fo

Name of the Procedure:

Catheter Placement in Coronary Artery(s) for Coronary Angiography with Intraprocedural Injection(s); Right and Left Heart Catheterization Including Intraprocedural Injection(s)

Summary

This procedure involves placing a catheter into the coronary arteries to perform an angiogram, a special type of X-ray that takes pictures of the heart's blood vessels. During this process, both the right and left sides of the heart are examined to check for any blockages or abnormalities. It includes injecting a contrast dye to help visualize the arteries clearly.

Purpose

The procedure addresses conditions related to coronary artery disease, including blockages, narrowing of the arteries, and other abnormalities of the heart. The main goal is to diagnose and assess the severity and location of arterial blockages, providing crucial information for potential treatments such as angioplasty or surgery.

Indications

• Chest pain (angina) suggestive of coronary artery disease
• Abnormal stress test results
• Recent heart attack (myocardial infarction)
• Heart failure of unknown cause
• Congenital heart disease

Preparation

• Fasting for 6-8 hours before the procedure
• Adjustments in medications as advised by the doctor
• Pre-procedure blood tests and electrocardiogram (EKG)

Procedure Description

1. A local anesthetic is applied to the puncture site, usually the groin or wrist.
2. A catheter is threaded through a blood vessel to the heart's coronary arteries.
3. Contrast dye is injected through the catheter to make the coronary arteries visible on X-ray images.
4. Both the right and left sides of the heart are examined.
5. Detailed images are taken under imaging supervision and interpretation.
6. The catheter is removed, and the puncture site is sealed.

Tools and equipment include catheters, contrast dye, X-ray equipment, and imaging devices. The procedure may involve light sedation to keep the patient comfortable.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

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

Personnel

• Interventional cardiologist
• Nurses
• Radiologic technologists
• Anesthesiologist (if deeper sedation is required)

Risks and Complications

• Allergic reaction to contrast dye
• Bleeding or bruising at the puncture site
• Infection
• Blood clots
• Heart attack or stroke (rare)

Benefits

• Accurate diagnosis of coronary artery disease
• Identification of the exact location and severity of blockages
• Essential information for further treatment planning The benefits are usually realized immediately after the procedure, with clear diagnostic results.

Recovery

• Monitoring for a few hours post-procedure in a recovery area
• Instructions to avoid heavy lifting and strenuous activities for a few days
• Keeping the puncture site clean and dry
• Follow-up appointment with the cardiologist

Alternatives

• Non-invasive stress tests
• CT angiography
• Medical management with medications Each alternative has its own pros and cons, such as less invasiveness versus lower accuracy compared to catheter-based angiography.

Patient Experience

During the procedure, patients may feel pressure at the catheter insertion site and a warm sensation when the dye is injected. Pain management includes local anesthetics and possibly mild sedation. Post-procedure, patients might experience mild soreness at the puncture site but should generally feel comfortable after resting.