Name of the Procedure:

• Common Name(s): Coronary Atherectomy with Drug-Eluting Stent
• Medical Term: Percutaneous Transluminal Coronary Atherectomy, with Drug-Eluting Intracoronary Stent, with Coronary Angioplasty when Performed (HCPCS Code C9603)

Summary

This medical procedure involves the removal of plaque from a coronary artery (atherectomy) and the insertion of a drug-eluting stent to keep the artery open. It's often performed alongside an angioplasty, a process that uses a balloon catheter to widen the artery.

Purpose

The procedure is primarily used to address narrowed or blocked coronary arteries, which can cause chest pain (angina) and other symptoms of coronary artery disease (CAD). The main goals are to improve blood flow to the heart, alleviate symptoms, prevent heart attacks, and improve overall heart function.

Indications

• Chronic or unstable angina (chest pain)
• Acute coronary syndromes including heart attack
• Significant narrowing or blockage of a major coronary artery
• Inadequate response to other treatments such as medication or lifestyle changes
• Patients who are not good candidates for coronary artery bypass surgery (CABG)

Preparation

• Follow fasting instructions (usually no food or drink 6-8 hours before the procedure)
• Adjust or stop certain medications (e.g., blood thinners), as directed by your doctor
• Pre-procedure diagnostic tests like blood tests, electrocardiogram (EKG), and imaging studies such as coronary angiography

Procedure Description

1. Anesthesia: Local anesthesia and possibly mild sedation are administered.
2. Access: A catheter is inserted into the groin or wrist artery.
3. Atherectomy: A specialized device is maneuvered up to the coronary artery to remove the plaque.
4. Angioplasty: A balloon catheter is inflated to widen the artery.
5. Stent Placement: A drug-eluting stent is inserted to keep the artery open and release medication to prevent re-narrowing.
6. Completion: The catheter is removed, and the insertion site is closed and bandaged.

Tools and Equipment:

• Catheters, balloons, and atherectomy devices
• Drug-eluting stents

Duration

The procedure typically takes around 1-3 hours, depending on complexity.

Setting

Usually performed in a hospital's cardiac catheterization lab.

Personnel

• Interventional Cardiologist
• Nurses specializing in cardiac care
• Anesthesiologist or nurse anesthetist, if sedation is used
• Radiologic technologists

Risks and Complications

Common risks include:

• Bleeding at the catheter insertion site
• Blood vessel damage
• Allergic reactions to contrast dye
• Re-narrowing of the artery (restenosis)

Rare but serious complications:

• Heart attack
• Stroke
• Perforation of the artery
• Death

Benefits

• Improved blood flow to the heart
• Relief from chest pain and other symptoms of CAD
• Reduced risk of heart attacks
• Quick recovery time compared to traditional surgery

Recovery

• Monitoring in the hospital for a few hours to a day
• Instructions to avoid strenuous activities for a few days
• Medication to prevent blood clots and manage pain
• Follow-up appointments to monitor recovery and heart health

Alternatives

• Medication management including antiplatelets, statins, and anti-anginal drugs
• Coronary artery bypass graft surgery (CABG)
• Lifestyle modifications like diet, exercise, and smoking cessation

Pros and Cons:

• Medication: Non-invasive, but may not be as effective for severe blockages.
• CABG: More invasive, longer recovery but may be better for multiple blockages.
• Lifestyle Changes: Essential but may not be sufficient alone.

Patient Experience

During the procedure, patients might feel pressure at the catheter site but should experience little to no pain due to anesthesia. Post-procedure, some bruising or soreness at the catheter insertion site can be expected. Pain management and comfort measures are provided to minimize discomfort. Most patients are able to resume normal activities within a few days, although heavy lifting and intense physical activities should be avoided as directed by their healthcare provider.