Percutaneous Transluminal Coronary Angioplasty / Stent

One of the most common non-surgical treatment for opening  obstructed coronary arteries is Percutaneous Transluminal Coronary  Angioplasty (PTCA). The name itself says a lot about the procedure:

Percutaneous means access to the blood vessel is made through the skin

Transluminal means the procedure is performed within the blood vessel

Coronary specifies that the coronary artery is being treated

Angioplasty means "to reshape" the blood  vessel (with balloon inflation) Also referred to as "balloon treatment" because special balloons are  used to open up obstructed arteries, illustrated on the left,  this procedure sometimes also involves the use of devices known  as "stents" to help keep the arteries open.

The illustration on the right shows how a balloon catheter works to open  an occluded artery.

Below, on the left, is an illustration of a special catheter  being used to install a stent device. 

Stent Compressed

Stent expanded

  The picture on the  right shows the diseased LAD  pictured above after it has  undergone a successful PTCA procedure in which a stent was installed.  

Preparation

You will be given instructions.

Food and beverages may be withheld after midnight. If you are a diabetic, you will be given special instructions.  Your groin area will be washed and shaved in preparation for  the PTCA/Stent.

Angioplasty Procedure

An intravenous line will be started in your arm this morning.  You will receive various medications in the angioplasty laboratory  though this line. To help you relax, you will be given medication  prior to leaving for the lab. You will remain awake, but slightly  drowsy.

You will be placed on an x-ray table upon your arrival in  the lab. It is the same type of room in which you had your cardiac catheterization. All personnel in the lab will be wearing surgical  attire. You will be covered by sterile sheets, and so will some  of the equipment. Your groin (arm) will be cleansed with an antiseptic  (might be cold) and then numbed with an anesthetic. You will  feel the sting of the needle, but then your groin (arm) will  feel quite numb. Heart monitoring equipment will be placed on  your arms and legs, and you may be given oxygen to breathe. You  will be given certain medications through the intravenous line,  and periodically medication will be given to relax you and decrease  any restlessness. Remember, you must still be able to talk and  follow directions.  

The angioplasty catheter (balloon-tipped) is inserted at the  numb area, and advanced to your heart, using x-ray to guide it.  When the balloon is inflated at the point of the blockage, you  may feel chest pressure, or discomfort, and this is normal.  It  will subside when the balloon is deflated. You may also feel  your heart thump or skip, feel flushed, or have a headache. All  these sensations are normal. You will  be asked at times to hold your breath for a few seconds. You  may also be asked to cough.

After the procedure, you will be moved to a recovery area  for a short time, and then taken to your room where your heart  can be monitored. Nurses will closely monitor your vital signs  and general well being. They will also frequently check the groin  area and dressing. A small, flexible catheter is routinely left  in the groin for 4-6 hours unless a percutaneous suture is used to close the  hole. You will be required to remain in bed and keep  your leg immobilized.

You will be able to eat as soon as you wish after the procedure.

 Recuperation

The catheter or sheath will be removed approximately 4-6 hours after the procedure is over. This waiting period is crucial as the physician uses blood-thinning agents to implant the stent, thus the sheaths cannot be removed until the blood thinning reverted back to normal and firm pressure applied for about 20 minutes. Then a pressure bandage is applied and a small sandbag placed over it. This is to assure proper healing of the  artery.   Pain medication is available to you every few  hours after the procedure. Please let your nurse know of any  pain or discomfort you may feel at any time. The rest of the  day is basically for rest, recuperation, and a gradual return  to your activities.

Here are some Helpful Sites

http://www.heartsite.com/html/ptca.html

http://www.heartsite.com/html/stent.html

http://www.heartsite.com/html/drug_stent.html