Name of the Procedure:

Percutaneous Transluminal Revascularization of Chronic Total Occlusion, Coronary Artery, Coronary Artery Branch, or Coronary Artery Bypass Graft, with Drug-Eluting Intracoronary Stent, Atherectomy, and Angioplasty (C9608).

Summary

This procedure involves reopening a completely blocked coronary artery using a combination of a drug-eluting stent, atherectomy, and angioplasty to improve blood flow to the heart. It is typically done percutaneously, meaning through the skin, using specialized tools.

Purpose

• Medical Conditions: It addresses chronic total occlusion (CTO) of coronary arteries, which are long-term blockages.
• Goals: To restore proper blood flow to the heart muscle, reduce chest pain (angina), and improve overall heart function.

Indications

• Symptoms like severe chest pain (angina) not relieved by other treatments.
• Patients with significant blockages in coronary arteries identified through imaging and diagnostic tests.
• Individuals who are not candidates for coronary artery bypass surgery (CABG).

Preparation

• Instructions: Patients may need to fast for 6-8 hours before the procedure.
• Medications: Adjustments to current medications, including stopping anti-coagulants as advised.
• Diagnostic Tests: Pre-procedure imaging such as coronary angiography, blood tests, and heart function assessments.

Procedure Description

1. Anesthesia: Typically performed under local anesthesia with sedation.
2. Access: A small incision is made in the groin or wrist to access the femoral or radial artery.
3. Guide Wire: A guide wire is threaded through the blockage in the coronary artery.
4. Atherectomy: Specialized tools are used to remove plaque from the artery.
5. Angioplasty: A balloon catheter is inflated to widen the artery.
6. Stent Placement: A drug-eluting stent is placed to keep the artery open and release medication to prevent re-narrowing.

Duration

The procedure usually takes between 2 to 3 hours, depending on the complexity of the blockage.

Setting

Performed in a hospital's cardiac catheterization lab.

Personnel

• Interventional Cardiologist
• Cardiac Nurses
• Anesthesiologist (if deeper sedation is needed)
• Radiologic Technologist

Risks and Complications

• Common risks: Bleeding at the insertion site, blood vessel damage, allergic reactions to contrast dye.
• Rare risks: Heart attack, stroke, blood clot formation, kidney damage, or artery re-closure (restenosis).

Benefits

• Relief from chest pain (angina).
• Improved blood flow to the heart muscle.
• Enhanced quality of life and physical activity capacity.
• Benefits can often be realized immediately or within a few days after the procedure.

Recovery

• Post-Procedure Care: Patients may need to lie flat for a few hours post-procedure, and the insertion site will be monitored.
• Home Care: Instructions on site care, medication regimen, and activity restrictions.
• Follow-up: Typically involves a follow-up visit with the cardiologist within a few weeks.

Alternatives

• Medical Management: Medications like beta-blockers, nitrates, and calcium channel blockers.
• Surgery: Coronary Artery Bypass Grafting (CABG).
• Pros and Cons: CABG has a longer recovery period but might be more suitable for multiple blockages; medical management may not be effective for all patients.

Patient Experience

• During Procedure: Patients may feel mild discomfort or pressure but pain is usually managed well.
• After Procedure: Some bruising at the insertion site, minor discomfort, and a gradual return to normal activities.
• Pain Management: Local anesthesia and sedation during the procedure, with over-the-counter pain relievers as needed post-procedure.