Cardiac Catheterization Procedure
Cardiac catheterization is an interventional diagnostic procedure performed to examine the blood vessels of the heart for blockages, narrowing and plaque build up. The procedure captures images of the heart muscle and the surrounding arteries with X-rays. This provides an accurate picture of the heart’s structure and determines the location of any damage.The number of arteries affected, or the size or location of the blockage in the artery, will determine whether surgery or medication will be most beneficial.
How does the cardiac catheterization procedure work?
During the procedure, a thin tube or catheter is inserted into an artery or vein in the groin, arm or neck. The catheter is advanced through the blood vessels to the heart. Dye is injected while simultaneous filming is done to visualize the coronary vessels. Images of the beating heart are captured and transmitted live to a computer monitor for the physicians’ reference.
What are the risks of a cardiac catheterization?
Although major complications are rare with cardiac catheterization, some risks are not uncommon. They include:
- Bleeding / bruising at the catheter insertion site
- Pain at catheter insertion site
- Heart attack
- Post-operative blood clotting
- Allergy to contrast dye
- Damage to the artery where catheter was inserted (pseudoaneurysm)
- Kidney damage
Why would I need a cardiac catheterization?
Cardiac catheterization procedures are done if your doctor suspects that you may have one of several conditions, including:
- Coronary artery disease (blocked or narrowed arteries)
- Valve or aortic disease
- Decreased heart muscle activity
- Decreased cardiac output
Your doctor will determine if a cardiac catheterization is indicated. If so, you will receive all necessary instructions which may include discontinuing certain medications and fasting before the procedure.
What should I expect upon arriving at The Heart Institute?
When you arrive at THI you will be greeted by our clerical staff. You will also meet our nursing staff who will get you prepared for the procedure and provide you with a hospital gown. Before you are moved to the cardiac catheterization laboratory, you will be briefed by the interventional cardiologist and the anesthesiologist.
Cardiac catheterization is generally performed under sedation with local anesthetic, without putting you to sleep. The anesthesiologist will be on-site throughout the procedure to ensure you are comfortable. General anesthetic can be used in certain circumstances.
PCI (Percutaneous Coronary Intervention)
Percutaneous coronary invertention, is a non-surgical procedure used in the treatment of coronary artery disease. PCI improves blood flow in the narrowed, blocked coronary arteries that supply the heart. PCI procedures are performed by an interventional cardiologist in the cardiac catheterization laboratory under sedation and local anesthetic.
There are several different PCI procedures that do various things. But, all PCI procedures are performed using catheters that are inserted in the groin or arm and fed through arteries to the heart.
For cases where there is arterial wall damage or narrowing, balloon angioplasty will be performed to open up the blood vessels to the heart. If the artery wall is weakened and can no longer support blood flow on its own, a coronary stent will be fed through the catheter guide wire.
In cases where damage is due to plaque buildup within the arteries, a catheter fitted with a rotoblade or laser may be introduced along the guide wire. This catheter will blast or cut plaque away from the wall to increase blood flow.
Catheter surgery is also used to treat narrowed or diseased aortic valves as an alternative to traditional valve surgery. The TAVI procedure is used in this instance using a combination of balloon inflation and using a stent to fix new valve tissue to the artery.
You and your physician will discuss which procedure may be right and will help you to maintain a better quality of life.
The physician may use assistive devices during a PCI to obtain a clear picture of the blockages within the arteries or to control the patient’s heartbeat. Two common assistive devices are IVUS and the Impella device.
What can I expect before the procedure?
Before the procedure you will meet with the doctor to discuss expectations, benefits, risks and projected outcomes. You may be asked to stop taking certain medications prior to the procedure and asked to fast in the hours before. Arrive at The Heart Institute in comfortable clothing for your procedure and be sure to remove all metal objects, jewelry and accessories.
Before you go into the lab, the exact PCI procedures that you will be receiving will be outlined.
What can I expect upon arriving at The Heart Institute?
When you arrive at THI you will be greeted by our nursing staff who will get you prepared for the procedure and provide you with a medical gown. Before you are moved to the cardiac EP laboratory, you will be briefed by the physician and the anesthesiologist.
PCI procedures are generally performed under sedation with local anesthetic, without putting you to sleep. The anesthesiologist will be on-site throughout the procedure to ensure you are comfortable. General anesthetic will be used in certain circumstances, particularly if the patient is a child.
You can expect to be at The Heart Institute laboratory for 3-6 hours, depending on a variety of factors. There is a chance during a PCI procedure that the surgeon may uncover an area of extensive damage that needs to be treated with hybrid surgery. This will often be done within the same hospital visit, which will extend your stay and recovery time.
What happens after the procedure?
Afterwards, you will be sent to a recovery room where you will be monitored for a few hours, which may be extended over night. During this time you may feel tired or dazed as you recover from the sedative. You may have some pressure bandages covering the catheter incision site.
You will be prescribed aspirin to take for 2-4 weeks after the procedure to reduce the risk of clotting and will be able to return to light activities.
Balloon Angioplasty is a catheter-based procedure that opens blocked arteries. The procedure involves inserting a catheter through the femoral artery in the groin or radial artery in the arm, which is then fed to the heart.
Once the surgeon has identified a blockage in an artery, a wire guideline is inserted through the blockage followed by a catheter that contains the balloon. Once in position, the balloon is rapidly inflated and deflated to stretch the artery walls and to compress fatty deposits that are blocking blood flow to the heart.
Balloon angioplasty is also known as percutaneous transluminal coronary angioplasty (PTCA).
A stent is a stainless-steel mesh scaffold that supports a damaged artery. When a stent is inserted it is compressed within a catheter and expands to form a supportive tube.
The catheter is guided into place in the coronary artery with wire. When the catheter is in place, a balloon tip is inflated to press the stent into position.
A coronary stent will be a permanent addition to the coronary artery and allows healthy tissue to grow amongst the mesh. The mesh is coated with a special treatment that reduces the risk of reblocking.
Stenting provides a fast solution to opening blocked or narrow arteries and is often used after heart attacks in emergency surgery.
IVUS (Intravascular Ultrasound)
IVUS is an imaging method, sometimes performed along with angiogram, which uses a catheter with an ultrasound probe attached to it in order to view the blood vessels from the inside out. It is used to determine the amount of plaque that has built up in the artery when angiogram or cardiac catheterization procedure is unreliable. IVUS’s 360-degree view of the inside of the coronary artery offers a more accurate assessment. It measures both plaque volume within the wall and the degree of stenosis in the artery lumen. It is proven to be very helpful in cases where the degree of stenosis in the coronary arteries is unclear.
An IVUS procedure is very helpful in determining the amount and severity of atherosclerotic plaque, which in turn will determine the need for further treatment such as angioplasty or surgery. If it is determined that a stent is needed, the ultra-sound images will reveal artery circumference which will indicate what size stent will be appropriate.
The Impella Device
The Impella is a minimally invasive catheter-based cardiac assist device. It is the world’s smallest heart pump, approximately the size of a pen, used temporarily during a PCI angioplasty procedure to support the patient’s cardiac function.
A catheter is inserted into the femoral artery in either leg and guided to the heart. The device then pulls or pumps blood from the left ventricle into the ascending aorta where it is then circulated through the body. The Impella temporarily supplements the heart’s pumping ability and allows the heart to rest and recover. It reduces myocardial workload and oxygen consumption while reestablishing blood flow. It also increases cardiac output and end organ perfusion.
The Impella device is typically used in patients with decreased heart pumping function who need revascularization and are considered high risk for surgery. Since the heart is deprived of blood during an angioplasty procedure, the Impella device can be used to support the patient’s cardiac function, preventing negative outcomes and allowing the blocked arteries to be treated. High risk patients can now be revascualrized without the need for surgery or general anesthesia.
The Impella has established a new standard of care for high-risk patients who were not eligible for angioplasty and revascularization.
The first part of a cardiac catheterization procedure involves inserting a small tube in the femoral artery in the groin. Through this tube the catheters used to perform the catheterization are passed. At the end of the procedure, this tube must be removed. In the old days, the tube was removed and a nurse or doctor would manually apply pressure at the puncture site for approximately 20 minutes. The patient would then have to lie flat for 6–8 hours, sometimes with a 10-lb. sandbag over the site. We now regularly use closure devices that seal the arterial puncture by actually suturing it closed or deploying a plug. This allows the patient to sit up immediately and to be discharged in two hours.
If the cardiac catheterization reveals a blockage that is amenable to an angioplasty (stent) it will usually be done at the same time. A coronary stent is a small, mesh-like metal tube that is mounted on an angioplasty balloon. It is inserted into the artery and positioned at the site of the blockage. When the balloon is inflated, the stent expands and is pressed into the inner wall of the artery. The balloon is then deflated and removed with the stent remaining in place. The stent acts as a “scaffold” that helps to hold the artery open, which improves blood flow and relieves symptoms caused by the coronary blockage. Some of the stents used have a drug coating that is slowly released into the surrounding tissue to prevent scar tissue formation and decrease the likelihood of the stent “closing up”. Our doctors will determine which type of stent is best for you.
What happens after the procedure?
Afterwards, you will be sent to a recovery room where you will be monitored for a few hours. In some cases you may be required to stay over night. During this time you may feel tired or dazed as you recover from the sedative. You may have some pressure bandages covering the catheter incision site. Your doctor will give you specific instructions and prescribe any necessary medication before you leave the hospital.
Your doctor will discuss the findings of the cardiac catheterization with you. He will inform you if stents were inserted. If medical therapy is indicated then medication will be prescribed. Surgery may also be indicated and a consultation with a surgeon will be arranged.
Radial Artery Access
In order to gain access to the arteries in the heart, a catheter is threaded through an artery or vein in the leg or arm. The transradial approach utilized in both diagnostic and interventional cardiac catheterization is widely recognized and performed at The Heart Institute. The radial artery is located in your wrist and is used as the port of entry for the catheter during the cardiac catheterization procedure. With the radial artery approach, bleeding can be easily stopped, there is little discomfort, fewer vascular complications and earlier ambulation. Evaluation and testing are necessary to determine if patients are candidates for this approach. Although this can be beneficial for some patients, it may be contraindicated for others. A cardiologist will determine if this approach is right for you.