Percutaneous Transluminal Coronary Angioplasty
During the Procedure
The procedure takes place inside a Cardiac Catheterization Laboratory that may appear very similar to an operating room. You will be awake during the procedure and you will lie on your back on a movable table that is connected to an x-ray machine called a fluoroscope. You will see large video monitors in the room that the physician will use to see the images of your heart and blood vessels. If you wish to watch the procedure, you may ask that the video screen be turned so that you may view it.
Before the procedure begins, an intravenous (IV) line will be inserted into your arm. This line will be used to administer a sedative that will help you to relax during the procedure. You will also be hooked to a device to measure your heart rate. In addition, you will be given anticoagulant medication to thin your blood and reduce the potential for clots to form. The doctor will decide whether to insert the catheter into a blood vessel in the groin or arm. The selected area will be shaved, cleaned and prepared with an antibacterial solution.
Once the preparations have been completed, the doctor will make a very small incision and insert first a special sheath and then the catheter into your blood vessel. Watching the progress of the catheter on the video monitor, the physician will carefully guide the catheter to areas in and around your heart. There, blood pressure will be monitored and blood samples may be taken. The physician will inject a special dye through the catheter. This dye shows up on the x-ray machine and allows the doctor to watch the dye flow through your arteries and heart and to identify and locate blockages in the arteries. When the dye is injected, you will normally feel warm and flushed for a brief period. You may also experience headache, nausea, or a pounding heart (palpitations). The discomfort will normally stop after a short time. You should tell the doctor about any discomfort, nausea or other symptoms you experience during the procedure.
Once a blockage is located, the cardiologist will evaluate whether or not it is suitable to be treated using PTCA. If it is, then the cardiologist will remove the catheter and insert another specially designed catheter with a deflated balloon located at its tip. The balloon catheter will be guided to the area of the blockage, by watching the image on the video monitor. Once the balloon catheter reaches the point of the blockage, the cardiologist will inflate and deflate the balloon several times to compress the plaque forming the blockage. By compressing this plaque against the artery walls, the artery will be opened. The cardiologist may then decide to place a device called a stent inside the artery at the point of the compressed plaque. A stent is a small mesh device made of metal. Stents are designed to hold the artery open, and research has found that for many patients, the introduction of the stent will reduce the likelihood that the blockage will return.
After the catheter is removed, the doctor will decide whether to temporarily leave the sheath in place inside your blood vessel or to immediately remove it and close the incision at the insertion point. If the sheath is left in place, it is usually removed within a few hours, after the effects of the anticoagulant medication subside. If it is immediately removed, the doctor will use a hemostatic device to close the opening while you are still in the Catheterization Laboratory. After the incision is closed, a bandage will be applied and often a small sandbag will be used to apply pressure to the area. Normally, the entire procedure will take one to two hours to complete