Coronary Angioplasty and Stenting

The heart is supplied by three major coronary arteries and their branches. Atherosclerosis produces areas of blockage within a coronary artery. When the blockages are large enough, they reduce blood supply to heart muscle and produce angina (chest pain). Patients with serious disease can be treated with either open heart surgery or a “needle hole” or “percutaneous” (through the skin) procedure that is performed in the cardiac cath laboratory.

What is Coronary Angioplasty?

what-is-coronary-angioplasty

Angioplasty is a technique used to dilate an area of blockage with the help of a catheter that has a balloon at its tip. The balloon is placed within a blood vessel (transluminal = in the channel or lumen of a blood vessel) via a technique called PTCA or Percutaneous Transluminal Coronary Angioplasty. PCI refers to Percutaneous Coronary Intervention where a stent is placed.

Angioplasty physically opens the blockages and relieves chest pain. Since it is much less invasive than surgery it can be repeated more often should the patient develop disease in the same, or another, artery in the future.

How is PTCA and Stenting performed?

During Cardiac Catheterization (cath), a catheter or thin hollow flexible tube is inserted into the artery of the groin or the wrist. Under x-ray visualization, the tip of the catheter is guided to the heart. A movie (angio) of the heart and blood vessels is obtained while “dye” or contrast material is injected.

Once blockages are identified, a deflated balloon is positioned over it and then inflated to compress the blockage. A stent is then placed to ensure good results.

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The patient remains awake throughout the procedure and mild sedation is used to ensure relaxation and comfort.

Wrist versus Groin Approach. What is the difference?

This procedure can be performed either via the femoral artery in the groin or via the radial artery in the wrist.

wrist-versus-groin

The groin approach is the traditional approach practiced by 90% of cardiologists. The femoral artery is large, so bruising and bleeding may occur. Risk of serious bleeding may occur in one in 100 patients undergoing the procedure. Patient is only allowed to sit up or walk after approximately 6 hours.

The wrist approach is used in less than 1% of cases worldwide. In our clinic, Dr Lim Ing Haan performs most of the angioplasty via the wrist approach. If performed via the wrist, patient can sit up immediately and can be allowed to walk immediately. Most importantly, there is NO RISK of serious bleeding complications.

What can you expect during the procedure?

It can take an hour or longer to perform the entire case. The duration is dependent upon the technical difficulty of the case and the number of balloon catheters that have to be employed.

It is performed under light sedation and local anaesthesia.

If performed via the groin, you must lie flat for 4-6 hours and a compression bandage is placed overnight. If performed via the wrist, you can sit up immediately. A compression bandage is placed for 4 hours.

Heart Stents

heart-stentsHeart stents can be coated with drugs to prevent new blockages after implantation and to ensure good long term results. They are superior to bare stents in reducing repeat procedures and offers a viable alternative to Bypass Surgery in patients with multiple blockages.

 

Rotational Atherectomy and Rotablation

When blockages are rock hard or calcified, Rotablation or drilling using a burr rotating at 180 000 rotations per minute can be used to create a track so that stents can be placed. Rotablation is a high risk procedure that is only attempted by cardiologists accreditated in cardiac intervention.

rotational-atherectomy