Coronary Angioplasty: Balloon Dilatation/Stent Insertion
Coronary Angioplasty
Treatment
This is a minimally invasive procedure that is used to treat narrowing and blockages of the coronary arteries. It is the ideal and emergent treatment when having a heart attack.
How is Coronary Angioplasty performed?
This is a minimally invasive procedure, meaning that it is performed via a small and easy puncture of an artery, preferably the wrist artery (radial artery). In some cases, if this is not possible, the groin artery will be the alternative access blood vessel (femoral artery).
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A short tube is placed inside the artery and through this short tube we advance longer catheters and very fine wires all the way to the heart. This is not painful because the inner layer of the arterial wall does not have any sensory receptors. Contrast is then injected into the arteries of the heart to visualize them under Xray control.
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Once the blockage has been identified, an even finer wire is being threaded exactly to this location and over this wire we advance balloons and stents into the right place.
Balloons are dilating the area while being inflated expand and open up the narrowing, the stents placed over a balloon are being inflated in a similar way, but once they expand and the balloon is deflated the expanded stent remains in place and keeps the artery open.
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The stent is usually a metal alloy that is coated with a special drug that reduces its chance of re-narrowing.
At the end of the procedure all tubes and wires are removed from the body; however if a stent has been implanted this will remain in the artery for life.
The procedure generally takes 40-60 minutes but may be longer, if additional tests are performed at the same time or if multiple balloons and stents have to be deployed like in a complex lesion involving side branches.
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Risks Involved
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Our ability to use imaging guidance and cutting-edge technology minimizes patient risk. Prior to your procedure, you will discuss your individual potential risks with your doctor.
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Conditions to let us know about
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As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
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Preparing for your procedure
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You must be fasting at least 6 hours prior to the procedure.
Please discuss with your doctor what medications you are taking on a regular basis. Some, like blood thinning medications and diabetes medications, may need to be paused some days prior.
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Insurance coverage
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Coronary angioplasty/Stents are covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
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Recovering from your procedure
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You will not receive general anesthesia during your procedure; however, sometimes light sedation may be necessary to make you feel more comfortable. You will stay in the monitored observational area for at least 8 hours after the intervention to monitor for bleeding from the vascular access site and for possible arrhythmias.
Then you will be transferred to the regular room until you are ready for discharge. You will be given written post procedure discharge instructions that will advise you about return to normal physical activity.
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Fractional Flow Reserve (FFR)
This additional test may be necessary to measure the exact significance of a narrowing of the artery. It is a pressure wire assessment (fractional flow reserve/ instant wave-free ratio), meaning that a special wire capable of measuring intraarterial pressures, will be advanced over the narrowing and the pressure gradient over the narrowing will indicate the need for a balloon dilatation intervention or a Stent insertion.
This technique is fairly new and an important tool in situations when standard evaluation of the vascular blockages may not seem sufficient.
There are no specific, additional risks involved.
Treatment
Chronic Total Occlusion (CTO) of a Coronary Vessel
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When vessels calcify slowly over time, they will eventually occlude completely but on some occasions, collateral additional vessels have created weak, but life sustaining bypasses to other normal arteries. Reopening of these chronic occlusions may be necessary to improve heart function and are a highly specialized area of coronary interventions.
At CardioCare we are proud to offer CTO-interventions to our patients.
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What is the Chronic Total Occlusion intervention and how is it done?
The CTO procedure is a coronary angioplasty procedure, however, more complex and more complicated.
The severe stenosis is often accessed from both ends, making two arterial accesses necessary, one in each arm wrist.
Due to the complexity of this interventions, it may take 1-3 hours, which is significantly longer than a standard angioplasty.
Why would you need a CTO procedure?
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When a chronic total occlusion has been identified and active heart tissue has been preserved through collateral vessel formation. The procedure will improve the activity of this tissue area, which is still alive despite the total blockage. More often however, we see non-active “dead” tissue behind a complete blockage. In these cases there is no need to reopen the occlusion.
Quite often, successful revascularisation has improved cardiac function and quality of patient’s life tremendously and often has prevented patients from needing bypass surgery.
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Risks involved
​
Our ability to use imaging guidance and cutting-edge technology minimizes patient risk. Prior to your procedure, you will discuss your individual potential risks with your doctor.
​
Conditions to let us know about
​
As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
​
Preparing for your procedure
​
You must be fasting at least 6 hours prior to the procedure.
Please discuss with your doctor what medications you are taking on a regular basis. Some, like blood thinning medications and diabetes medications, may need to be paused some days prior.
​
Insurance coverage
​
CTO procedures are covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
​
Recovering from your procedure
​
You will not receive general anesthesia during your procedure; however, sometimes light sedation may be necessary to make you feel more comfortable. You will stay in the monitored observational area for at least 8 hours, preferably over night, after the intervention, then you will be transferred to the regular room until you are ready for discharge.
You will be given written post procedure discharge instructions that will advise you about return to normal physical activity.
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