During cardiac catheterization, your doctor may find that there is a blockage that may be helped by a non-surgical (or “interventional”) procedure such as an angioplasty (balloon), atherectomy (shaving), or a stent (mesh tube).
These procedures may be performed immediately after the catheterization or at a later time, depending on the circumstances. If you have any of the following procedures, they usually last an additional 1-2 hours beyond the catheterization procedure. You will spend the night at the hospital and be able to return home the next morning.
Balloon angioplasty (percutaneous transluminal coronary angioplasty or PTCA)
This is performed by inserting a specially designed catheter with a small balloon tip into the narrowed coronary artery. Once the catheter is in place, the balloon is inflated to compress the plaque (fat deposit) in to the artery wall, increasing the flow of blood to the heart. When the balloon is inflated at the point of the blockage, you may feel chest pressure, or discomfort, and this is normal. It will subside when the balloon is deflated. You may also feel your heart thump or skip, feel flushed, or have a headache. All of these sensations are normal. The success rate of this procedure by itself is 70-80% and people will have diminished chest pain and will reduce their risk for heart attack. Approximately 20-30% of those undergoing PTCA will have re-narrowing of the artery (restenosis) and need a repeat PTCA or a stent within 3-12 months. The risks of this procedure are similar to cardiac catheterization, however there is an added risk of abrupt closure of the artery, which may result in a heart attack or require emergency coronary artery bypass surgery. In rare instances, the artery can separate from the wall (dissection) requiring emergency surgery as well.
A stent is a very small tube made out of stainless steel. It looks similar to the “Chinese handcuffs” you might have played with as a child and is used as a scaffolding to keep the artery open. It is often used with PTCA to decrease the risk of the artery re-narrowing. After opening the vessel, the stent is placed with a different catheter that places the stent and then expands the stent with a balloon. The balloon and catheter are then removed. The stent stays in place permanently and over the next several weeks, the artery actually “heals” around the stent.
For this special procedure, a special catheter, with a special tip is guided to the point of narrowing in the coronary artery. The tip will either grind or shave the plaque. Depending on the procedure, the shavings will be “caught” in a special chamber in the catheter and removed, or if ground, the microscopic particles are washed safely away in the bloodstream.
After the Procedure
After the catheterization and intervention, if a closure device was not used, the sheath is removed from the artery and pressure is held for twenty to thirty minutes to stop the initial bleeding from the artery. An ice pack and sand bag are then placed. You will be required to lie flat for 6-8 hours, with the involved leg straight.
You will need assistance in eating, drinking, or urinating during this time. Your nurse will be checking your blood pressure, pulses, and the insertion site. If you feel any intense pain or warmth at the site, notify your nurse immediately. If you become uncomfortable from lying still, pain medication can be provided. After a set time, the nurse will slowly raise the head of your bed and allow you to carefully move and bend. If a closure device is used, the time of immobilization is less and the ice and sand packs are not used. Depending on the procedure performed and what additional medications are used, you could be asked to lie in bed for as much as 24 hours, but this time is usually an average of 8-12 hours.
Discussion of results
Your doctor will discuss preliminary results with you during and immediately following the procedure. He will discuss the conclusions with your family after the procedure. Your doctor or his nurse practitioner will then review the results and the treatment plan prior to your discharge.
Post discharge instructions
Driving: You should not drive home the day you leave the hospital. It is safe to resume driving the following day.
Bathing: Showers are allowed. Wash normally with any kind of soap and water but do not apply unusual pressure at the site of the catheter insertion. It is normal for this area to be tender, have a small lump, and be discolored. It is best to pat this area dry instead of rubbing. No baths are allowed for three days.
Site Care: If you would like, you may use a band-aid at the incision site. Watch for any signs of infection such as: drainage of pus, warmth, redness, or any fever greater than 100 degrees F. Bruising should gradually fade within one to two weeks as will lumps and bumps. If there is any increase in bruising, welling or any signs of infection, notify our office immediately at 303-744-1065.
Activity: To allow the artery to heal, avoid lifting more than 5-10 pounds or doing any strenuous activity or housework for 7 days. You can walk or climb stairs to get where you are going. Generally, you may return to work within a week, unless your job requires physical demands beyond the above restrictions. In addition to the above restrictions, it is recommended that you do not raise your heart rate above 120 for approximately 30 days. To accomplish this and to keep your blood pressure low you should only exercise at about 75% of your normal level.
See your doctor: An appointment will be made for you to come to our office in one week for the office to check your incision site and to answer any questions you may have. At that time we will decide when you should visit your physician for a follow up appointment.
Cardiac rehabilitation: Your physician may recommend the cardiac rehabilitation program. If you choose to attend, you will begin your customized exercise and recovery program within a week of leaving the hospital.