Name of the Procedure:

Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch (C9602).

Summary

This procedure involves removing plaque from a coronary artery, inserting a drug-eluting stent, and performing angioplasty to widen the artery and improve blood flow to the heart.

Purpose

Medical Conditions Addressed

• Coronary artery disease (CAD)
• Atherosclerosis in a major coronary artery or branch

Goals

• Restore adequate blood flow to the heart
• Reduce symptoms such as chest pain (angina)
• Prevent heart attacks

Indications

Symptoms or Conditions

• Severe chest pain (angina)
• Shortness of breath
• Evidence of reduced blood flow to the heart in diagnostic tests

Patient Criteria

• Cases where medication therapy is insufficient
• Patients with suitable vessel anatomy for stenting
• Patients not high-risk for surgical procedures

Preparation

Pre-Procedure Instructions

• Fasting for 6-8 hours before the procedure
• Adjustment of current medications as directed by a healthcare provider
• Avoiding certain medications, like blood thinners, under medical supervision

Diagnostic Tests

• Electrocardiogram (ECG)
• Cardiac stress test
• Coronary angiography

Procedure Description

1. Local anesthesia is administered to numb the site.
2. A small incision is made, usually in the groin or wrist, to access a blood vessel.
3. A catheter is threaded through the blood vessel to the coronary artery.
4. Atherectomy is performed to remove plaque from the artery.
5. A drug-eluting stent is placed to keep the artery open and release medication to prevent restenosis.
6. Balloon angioplasty is conducted to further widen the artery if needed.
7. Catheter is removed, and the incision site is closed.

Tools

• Catheter
• Atherectomy device
• Drug-eluting stent
• Balloon angioplasty equipment

Anesthesia

• Local anesthesia, sometimes combined with mild sedation

Duration

Typically, the procedure takes about 1-2 hours.

Setting

Usually performed in a hospital’s cardiac catheterization laboratory.

Personnel

• Interventional cardiologist
• Nurses specialized in cardiac care
• Radiologic technologist
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

Common Risks

• Bleeding at the catheter insertion site
• Pain or discomfort

Rare Complications

• Blood clots
• Artery damage
• Infection
• Adverse reaction to contrast dye

Management

• Monitoring and medication for any complications
• Immediate medical intervention if severe complications occur

Benefits

• Successful restoration of blood flow to the heart
• Reduction in symptoms such as chest pain and shortness of breath
• Decreased risk of future heart attacks

Realization Timeline

Benefits are typically realized shortly after the procedure, with improvements seen within days to weeks.

Recovery

Post-Procedure Care

• Monitoring in a recovery area for a few hours
• Pressure applied to the incision site to prevent bleeding
• Instructions for medication and wound care

Recovery Time

• Most patients can return to normal activities within a week.
• Restrictions on heavy lifting and strenuous activities for several days
• Follow-up appointments to monitor recovery

Alternatives

Other Treatments

• Medication management for coronary artery disease
• Coronary artery bypass graft (CABG) surgery

Pros and Cons

• Medication: Non-invasive, but might not be sufficient for severe cases
• CABG: More invasive with a longer recovery time, but may be necessary for complex cases or multiple blocked arteries.

Patient Experience

During the Procedure

• Mild discomfort due to the injection of local anesthesia
• Possible sensations of pressure during catheter insertion

Post-Procedure

• Mild soreness at the incision site
• Instructions for managing pain and ensuring comfort
• Pain management with prescribed medications if needed