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Percutaneous Coronary Intervention

Percutaneous coronary intervention (also known as angioplasty) is a minimally invasive procedure to open clogged heart arteries. A thin tube called a catheter is inserted into an artery and moved into the blocked blood vessel of the heart. Contrast is used to visualize the path of the catheter. The narrowed or blocked artery is then expanded using a balloon. For better results, a stent, which is a small wire mesh tube, may be placed or other medical equipment may be used.

Two types of stents
Without a stent, when the balloon is removed, there is a risk of immediate recurrence. The stent supports the walls of the blood vessel and keeps it open. There are two types of stents used, with differing materials:
  1. Metallic stent
  2. Bioresorbable scaffold system
The stent will be in the body for the rest of the patient’s life so metal stents are normally made from stainless steel or cobalt-chromium as these are more mechanically stable with the contractions of the blood vessel in the long-term than other metals.
Stents can also be:
  1. Bare metal stents with no medication
  2. Drug-eluting stents
Since the stent is considered a foreign object, the body will react to it as such and begin repairing the tissue. This will thicken the walls of the stent and cause recurrence of the narrowing or blockage. This is more likely with bare metal stents than drug-eluting stents, which have a coating of medication to prevent the body’s natural reaction to the foreign object that slowly releases.
A metal stent has a hard structure and it prevents natural contractions of the blood vessel so a bioresorbable stent has been developed. It is also coated with a medication that will slowly dissolve the stent within two to three years, but due to numerous limitations in comparison with metal stents, the bioresorbable scaffold system is not as popular in hospitals. If you have any questions, please talk to your doctor.
 
The purpose of expanding a blocked blood vessel and placing a stent is to allow for better blood flow. The plaque causing the narrowing or blockage is pushed into the walls of the artery. When the blood flow improves, the patient will experience less chest pain and breathe more easily. Furthermore, it is a procedure that produces immediate results, prevents tearing of the blood vessel, reduces the risk of recurrence, and prevents heart attack.
 
To allow for the most effective treatment, the patient’s health and disease must be assessed. The patient’s medical history is also important. The doctor will explain your medical condition, the reason for the procedure, and the risks and benefits of treatment. Other recommendations include:
  1. Before the procedure you will undergo a physical examination as well as several laboratory tests.
  2. Please let your medical team know if you have any allergies to medication, food, and other substances.
  3. Patients who take anticoagulants, such as aspirin, clopidogrel, prasugrel, etc., do not need to stop their medication, but those taking other blood thinners or certain diabetes medication, such as Metformin, will need to speak to the doctor for specific instructions.
  4. Fast for at least four hours before the procedure.
  5. Avoid drinking alcohol and smoking cigarettes for at least one week.
  6. On the day of the procedure, please bring all current medication with you to the hospital.
  7. The doctor may prescribe medication to help you relax and to prevent allergies to contrast.
The procedure is done using a sterile technique. You will be given an anticoagulant to prevent blood clots. Medications/fluids will be given through intravenous lines. A local anesthetic will be injected to numb the area of your body that is used (the groin, the wrist, or the inside of the elbow). A thin tube with a small, deflated balloon at the tip will be guided into the narrowed or blocked artery. Once the balloon-tipped catheter is at the site of the blockage, the balloon is inflated. This compresses the plaque against the artery wall, widening the blood vessel. In most cases, a stent will be placed to help decrease the chance of the artery narrowing again. The stent stays in place permanently. The procedure will take approximately 60-120 minutes to complete.
 
 
After the procedure, you will be taken to a recovery area for observation and monitoring. If the procedure was done at the groin, it is important to lie flat for several hours to avoid bleeding. Pressure may be placed at the site to prevent bleeding. If the catheter was inserted through the wrist, after the procedure you will be able to get up. A bandage will be placed at the insertion site.

Depending on your condition, you will remain in the hospital for one or more days. Ask your health care team when you can shower, return to work, and resume other normal activities. Your puncture site will remain tender for a while. It may be slightly bruised and have a small bump. Your doctor will likely prescribe medications to prevent blood clots. It is important to follow your doctor’s instructions regarding the blood thinning medications.
While this procedure will open blocked arteries, it will not cure coronary artery disease. It is up to you to be committed to living a heart-healthy lifestyle. You can make dietary changes, quit smoking, exercise regularly, keep your appointments, and be an active member in your treatment.
 
  • Bleeding, infection, and pain at the catheter site
  • Blood clots causing heart attack or stroke
  • Re-narrowing of the artery
  • Damage to blood vessels
  • Allergic reaction to the dye used
  • Kidney problems caused by the dye
  • Fluid around the heart
  • Arrhythmias (irregular heartbeat)
  • Death
 
Let your doctor know if you experience any symptoms such as:
  • Dizziness
  • Shortness of breath
  • Nausea
  • Back Pain
  • Chest discomfort
  • Bleeding, new bruising, or swelling at the catheter site
  • Signs of infection such as redness, drainage, or fever
Before the procedure
  1. You should plan to stay in Thailand for at least one week through the duration of your treatment.
  2. It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure or from the day of the procedure to the day of your follow-up appointment.
After the procedure
  1. At your follow-up appointment you will undergo a physical examination and your wound will be checked. You will receive documentation regarding your surgery or procedure and all other relevant documentation for traveling.
  2. You will receive information about caring for yourself when you return home and be given the document “Discharge Instructions for Percutaneous Transluminal Coronary Angioplasty (PTCA)/Stent.” Please read all information you are given carefully and follow your medical team’s instructions.
  3. Keep the injection site at the wrist or groin dry and clean until it is fully healed. Please let the doctor know if you experience redness, swelling, and/or severe pain. If there is bleeding from the injection site, place pressure on the site for at least 10 minutes. If the bleeding doesn’t stop, please talk to your doctor immediately.
  4. When traveling by air, if you are seated in Economy Class, please choose an exit row or bulkhead seat for convenience in getting up and moving around every 15-30 minutes. Flex your ankles regularly to prevent deep vein thrombosis.
  5. Please take all medication prescribed by your doctor. Carry the appropriate dosage of mediation in your carry-on luggage when you travel as well as a few extra doses in case of an emergency. Carry the prescription for all your medication to avoid problems at the airport.
The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.
 
What if this procedure is not performed?
When the heart does not receive enough blood it also doesn’t receive enough oxygen and nutrients to function properly. This can lead to loss of blood flow to the heart and a heart attack.
 

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