Catheter Interventions to Coronary Artery Disease

PTCA - Percutaneous Transluminal Coronary Angioplasty
DCA - Directional Coronary Atherectomy
Stent
It has been determined by previous cardiac catheterization that you have a narrowing in one or more of your coronary arteries that supply your heart muscle with blood. Percutaneous transluminal coronary angioplasty (PTCA), directional coronary atherectomy (DCA), or stent insertion has been recommended.

Angioplasty is a method of treating the localized coronary artery narrowing by dilating the blockage using a special double lumen balloon catheter.

Atherectomy is a method of treating the localized coronary artery narrowing by shaving or cutting out the blockage.

Coronary stent insertion is an intervention that is used in association with balloon angioplasty to open up a blocked coronary artery.

Sometimes, a blockage is found during the initial angiogram of the heart that can be helped by angioplasty, atherectomy or stent insertion. The doctor will continue immediately into the procedure provided your prior consent has been granted and the surgical team is available for standby. These procedures can be performed electively or on an emergency basis. If the procedure is successful, open heart surgery may not be necessary.

Before Procedure: PTCA and DCA
When admitted into the hospital, you will be placed in a hospital room where preparation for the procedure will take place. Preparation for these interventions is the same as prior to cardiac catheterization except for a few details that will be listed below.

Prior to the angioplasty, atherectomy, or stent insertion, the nurse will obtain consents from you which will include: cardiac catheterization, percutaneous transluminal coronary angioplasty and/or directional coronary atherectomy, possible stent and one for emergent coronary artery bypass procedure. This last consent may sound frightening to you, nevertheless the consent is necessary. The hospital requires the open heart surgeons be on standby due to a less than 2% chance of complications during the procedure. The coronary artery could tear, collapse, spasm or clots could form that could shut down the blood flow to that area of heart muscle. If any of these events occur and all techniques have been exhausted by your doctor to salvage blood flow in that artery, emergent bypass surgery is eminent.

Post Procedure: PTCA and DCA
After the procedure, you will return to your room and be placed in bed. An anticoagulant (blood thinner) called Heparin may or may not be started after the procedure through your IV. Heparin is given to maintain the patency of the artery by preventing blood clots from forming inside the artery just opened.

An introducer or sheath may be left in the artery of your groin for emergency access up to 24 hours. This is done as a precautionary measure should your artery close or if you need to return to the cath lab for further pictures of your artery. You will be required to remain at bedrest with the affected site straight while this introducer or sheath is in place, and for 4 to 8 hours after the sheath is removed. Total time of bedrest can be up to 24 hours. The Heparin drip through your intravenous line will need to be discontinued for a couple of hours to let your bleeding times come back to normal before personnel can safely remove the sheath. When the sheath is removed from your artery, pressure is held for 20-30 minutes to stop the initial bleeding from the artery. An ice pack and sandbag is then placed. After the allotted time of bedrest is completed, the nurse will slowly raise the head of your bed and let you bend your leg and move around. When you initially get up out of bed and start walking, you will require a nurse to assist you.

Due to the long period of bedrest, your back may become stiff or you may have trouble sleeping at night. Pain and sleeping medication is provided if needed.

The nurse will be checking your blood pressure, pulses and catheter site frequently throughout the bedrest. If you notice warmth, bleeding or pain at the catheter site, or if you experience any chest pressure, tightness or pain, notify your nurse immediately.

Upon return to your room, you will be able to eat and drink. An abundance of fluids is encouraged for hydration and to flush the contrast dye out of your system. You may note frequent urination after the procedure because contrast dye acts like a water pill. While you are at bedrest laying flat, you may require assistance in using the urinal or bedpan.

Plan on staying in the hospital at least 1-2 days after the procedure. Before discharge, you will be visited by a nurse educator and dietitian for discharge instructions.