Name of the Procedure:

Percutaneous Transluminal Revascularization of or Through Coronary Artery Bypass Graft (C9604)
Common name(s): Angioplasty with Stent Placement, Atherectomy
Technical or medical terms: Percutaneous Coronary Intervention (PCI) through Coronary Artery Bypass Graft (CABG)

Summary

Percutaneous Transluminal Revascularization is a minimally invasive procedure used to open up blocked or narrowed coronary artery bypass grafts. The procedure may include the placement of drug-eluting stents, removal of plaque through atherectomy, and angioplasty to improve blood flow. It often includes distal protection to prevent debris from causing further blockage.

Purpose

This procedure is used to treat blockages or narrowing in grafted arteries that supply blood to the heart, typically following a coronary artery bypass. The goals are to restore proper blood flow to the heart's muscle tissue, relieve symptoms like chest pain (angina), and reduce the risk of heart attack.

Indications

• Persistent chest pain (angina) despite medication
• Evidence of significant blood flow restriction in grafted arteries from diagnostic tests
• Acute coronary syndrome or heart attack
• Poor results from non-invasive stress tests

Preparation

• Fasting for at least 6-8 hours prior to the procedure
• Stopping certain medications as instructed, such as blood thinners
• Blood tests, electrocardiogram (EKG), and possibly a stress test to assess heart function

Procedure Description

1. Anesthesia: Local anesthesia is administered at the insertion site (usually the groin or wrist), and sedation may be provided for comfort.
2. Catheter Insertion: A small incision is made, and a catheter is threaded through a blood vessel to the coronary artery bypass graft.
3. Imaging: Contrast dye and X-ray imaging (angiography) guide the procedure.
4. Stent Placement: A balloon catheter is used to inflate the narrowed area, and a drug-eluting stent is placed to keep it open.
5. Atherectomy (if needed): Special tools may be used to remove plaque buildup.
6. Distal Protection: Devices may be used to capture and remove debris.
7. Final Imaging: Post-procedure angiography ensures proper placement and blood flow.

Duration

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

Setting

The procedure is usually performed in a hospital's catheterization laboratory (cath lab).

Personnel

• Interventional Cardiologist (lead)
• Cardiac Nurse
• Radiology Technician
• Anesthesiologist or Nurse Anesthetist

Risks and Complications

• Bleeding or bruising at the insertion site
• Infection
• Blood clots or embolism
• Restenosis (re-narrowing of the artery)
• Heart attack or stroke
• Kidney damage from contrast dye
• Allergic reactions to medications or dye

Benefits

• Improved blood flow to the heart
• Relief from chest pain and other symptoms
• Reduced risk of heart attack
• Improves overall heart function and patient quality of life

Recovery

• Monitoring in a recovery area for several hours
• Dressings over the insertion site
• Instructions on activity restrictions and wound care
• Typically, return to normal activities within a few days to a week
• Follow-up appointments to monitor heart health and stent function

Alternatives

• Medication Management: Drugs such as nitrates, beta-blockers, or calcium channel blockers
• Lifestyle Modifications: Diet changes, exercise, and smoking cessation
• Other Surgical Options: Repeat coronary artery bypass graft (CABG)
• Pros and Cons: PCI is less invasive with quicker recovery compared to repeat CABG, but may require further interventions. Medication management is non-invasive but may not be as effective in severe cases.

Patient Experience

During the procedure, the patient may feel pressure at the insertion site and warmth from the contrast dye. Post-procedure, there might be soreness at the incision site and fatigue. Pain management includes medications and comfort measures like applying ice packs. Patients often experience significant symptom relief soon after the procedure.