Name of the Procedure:

Percutaneous Transcatheter Placement of Drug-Eluting Intracoronary Stent(s) with Coronary Angioplasty

• Common Name(s): Stenting with Angioplasty

• Technical Terms: Percutaneous Transcatheter Placement, Drug-Eluting Stent, Intracoronary, Coronary Angioplasty

  Summary

  This procedure involves placing a drug-eluting stent in a coronary artery using a catheter. The stent helps to keep the artery open and release medication to prevent blockage. The angioplasty part involves inflating a tiny balloon inside the artery to widen it before the stent is placed. This entry specifically describes the procedure for each additional branch of a major coronary artery.

Purpose

• Medical Conditions: Coronary artery disease (CAD), arterial blockages, myocardial ischemia.
• Goals: To restore and maintain adequate blood flow through the coronary arteries, reduce symptoms like chest pain, and prevent heart attacks.

Indications

• Presence of significant coronary artery stenosis (narrowing).
• Symptoms of chest pain (angina) not alleviated by medication.

• Patients with a history of heart attack needing intervention in multiple branches of a major coronary artery.

  Preparation

• Pre-procedure Instructions: Patients typically must fast for several hours before the procedure. Medication adjustments may be necessary, particularly blood thinners.
• Diagnostics Tests: Pre-procedure diagnostics could include blood tests, electrocardiogram (ECG), and coronary angiography to assess artery condition.

Procedure Description

1. The patient is sedated, and local anesthesia is applied to the insertion site.
2. A catheter is inserted through a small incision, usually in the groin or wrist, and guided to the coronary artery using imaging techniques.
3. A small balloon (angioplasty) is inflated to widen the artery.
4. The drug-eluting stent is placed in the artery to keep it open and release medication to prevent restenosis.
5. The catheter and other instruments are removed, and the incision site is closed.

• Tools and Equipment: Catheter, balloon, drug-eluting stent, fluoroscopy imaging.
• Anesthesia: Local anesthesia with sedation.

Duration

Typically, the procedure takes about 1 to 2 hours, but this can vary based on the complexity and number of arteries treated.

Setting

• Usually performed in a hospital’s cardiac catheterization laboratory.

Personnel

• Cardiologist (Interventional Cardiologist)
• Nurses
• Radiology Technicians
• Anesthesiologist or Nurse Anesthetist (for sedation management)

Risks and Complications

• Common Risks: Bleeding at the insertion site, bruising, allergic reactions to contrast dye.
• Rare Risks: Blood clots, heart attack, artery damage, kidney damage from contrast dye, stroke.
• Management: Immediate medical intervention for complications; medications like antiplatelet agents to reduce blood clot risk.

Benefits

• Improved blood flow to the heart muscle.
• Relief from symptoms like chest pain.
• Reduced risk of future heart attacks.
• Benefits may be realized immediately following the procedure with further improvement over the next few weeks.

Recovery

• Post-procedure Care: Monitoring in a recovery area for several hours; instructions on medication, activity restriction, and diet.
• Recovery Time: Usually a few days to a week; patients can often resume normal activities within a week but should avoid strenuous activities as advised.
• Follow-up: Regular check-ups, possibly including additional imaging or stress tests.

Alternatives

• Medication: Management with drugs like nitrates, beta-blockers, or antiplatelet agents.
• Coronary Artery Bypass Surgery (CABG): A more invasive option that may be suitable for some patients.
• Pros and Cons: Medication might not be sufficient for severe blockages; CABG involves longer recovery but may be necessary for extensive disease.

Patient Experience

• During the procedure, patients are generally awake but sedated and may feel pressure or mild discomfort.
• After the procedure, patients might experience soreness at the insertion site and general fatigue.
• Pain management includes prescribed medications, and comfort measures include rest and limited physical activity post-procedure.