Coronary Angiography and Angioplasty

Summary

Through illustrations and live footage this video takes patients through the angiography, angioplasty, and stenting procedures. The video shows how the heart works, what atherosclerosis is, and the risks of the procedures. It stresses to the patients the importance of taking their antiplatelet agent if they have had an Angioplasty. Actual patients offer reassuring recollections of the procedures and recovery process.

Details

Coronary angiography is a diagnostic procedure used to find out if the symptoms you've been experiencing are caused by coronary artery disease.

The heart is a muscle which pumps blood throughout the body. The heart needs oxygen and nutrients. These are supplied by large blood vessels, called coronary arteries. The arteries and their branches wrap around the surface of the heart.

Fatty deposits called plaque can build up on the artery wall. The artery can become partially blocked, reducing the flow of blood to the heart. This narrowing of the artery is called atherosclerosis.

Reduced blood flow can cause chest discomfort, called angina pectoris, especially during physical activity,. It's a warning sign that you may be at risk for a heart attack.

Coronary angiography allows your doctor to take moving pictures of your arteries to find out if there are places where and artery has narrowed.

To do this, a long thin tube, called a catheter, is inserted into your arm or leg and guided to your heart.

Then a contrast material, containing iodine, is injected. Using an x-ray camera, the doctor can see where an artery has become narrowed, how much it has narrowed, and if there is any damage to the heart.

Risks:

• small risk of a heart attack, stroke or death
• excessive bleeding or a blood clot at the site where the catheter was inserted
• impaired kidney function, which may be reversed
• an allergic reaction to the iodine in the contrast material
• arrhythmia, or irregular heartbeat, which can be corrected during the procedure

Tests before procedure:

• a blood test
• a chest x-ray
• an electrocardiogram

It is important to let your health care team know if you are allergic to iodine or to shellfish. Iodine is in the dye used in the procedure and also in shellfish.

The procedure room may be called a catheterization or cath lab. The procedure usually takes about one to two hours. Throughout it you'll be relaxed, but not asleep.

You'll be given a local anesthetic to numb the area of your leg or arm where the catheter will be inserted.

A device called an introducer sheath will be inserted into your arm or leg.

The catheter will be threaded through the sheath into an artery and guided towards your heart.

The doctor will then inject contrast material which will travel through the arteries.

The x-ray camera will be moved around you so that your doctor will be able to identify any places where the arteries have narrowed.

The catheter will be guided into the heart’s main chamber, called the left ventricle. A larger amount of contrast material will be injected to evaluate the heart's pumping action.

As the contrast material flows away from your heart, you may feel a warm sensation move through your body for about twenty to thirty seconds.

Two possible outcomes of angiography procedure:

• no blockage, additional testing may be done
• blockage is found

Treatment options:

• performed at the same time:
  • angioplasty
  • angioplasty with stenting and atherectomy
• carried out later:
  • coronary artery bypass surgery
  • medication

Angioplasty:

• a catheter with a tiny balloon attached to it will be guided to the narrowed spot
• balloon will be inflated to press the plaque against the artery wall
• sometimes more than one inflation is used

Angioplasty with a stent:

• a small metal device called a stent is guided to the spot
• a balloon will be inflated to expand the stent
• stays in place permanently to reduce the risk of re-narrowing
• a platelet inhibitor is given to prevent blood clots from forming

Atherectomy:

• an instrument is guided to the narrowed spot to cut or shave the plaque from the artery wall

Sometimes both the atherectomy and angioplasty procedures are used to achieve the best result.

Risks:

• treated artery narrows again - restenosis
• the artery closes up during the procedure, requiring emergency bypass surgery
• heart attack, stroke or death
• a blood clot may form on the stent, medication will reduce this risk

If the catheter was inserted into your leg, you'll be asked to keep your leg still and straight for a few hours. You may bend your other leg to make your back more comfortable.

Stent implanted:

• blood thinning medication needs to be taken for the next two to four weeks

You may be advised not to drive for the first couple of days after the procedure, so arrange to have someone take you home.