Interventional Catheterization Procedure

By its very nature, cardiac catheterization offers unique opportunities for the cardiologist to correct heart abnormalities at the site of the problem. The preparation a patient undergoes for an interventional heart cath procedure is essentially the same as for a diagnostic procedure. Generally speaking, you will be asked to abstain for eating and drinking anything after midnight prior to the procedure. The same routine blood tests, ECG, and chest x-rays that are performed for any routine hospital admission are done prior to the procedure. The area of your arm or leg where the catheter will be placed is prepped and shaved. An IV will be started to allow the cath lab team to administer fluids and medications intravenously. Before the procedure, you will receive medication to help you relax.

The following are the general types of interventional heart cath procedures:

Coronary Angioplasty (Balloon Procedure)

The coronary angioplasty procedure works by compressing the fatty build-up against the artery wall. A catheter with a tiny balloon is placed into the constriction. The cardiologist gently inflates the balloon. As the balloon expands, it compresses the plaque against the artery wall, thereby enlarging the opening. The balloon is then deflated and the catheter removed. The widening of the artery allows for increased blood flow to the regions of the heart served by the vessel.

	The cardiologist maneuvers a guiding catheter (a long, thin tube) to the point of the blockage.
	The cardiologist positions the balloon-tipped catheter at the narrowed region of the coronary artery.
	The balloon is gently inflated and deflated several times while the cardiologist monitors the effects on x-ray screen.
	Once the catheter is removed, the enlarged opening allows for improved blood flow to regions of the heart served by the artery.

Stent Placement

In some instances, the cardiologist will place a delicate metal device inside the artery to help it remain patent (open) after he completes the angioplasty (balloon) procedure. The stent is a metal coil or mesh structure that is permanently placed in the affected coronary artery. It provides a rigid structure to give the blood vessel shape and keep it open so blood may flow to the cardiac muscle tissue it serves. Because the stent is larger than balloon catheters, the artery must be dilated with a balloon before placement. In addition, the size of the stent limits its use to only larger coronary arteries.

	The stent is a metal coil or mesh structure that can be placed at the end of a balloon catheter. It is positioned in the artery where the plaque was compressed by the angioplasty (balloon) procedure.
	The balloon at the end of the catheter is inflated causing the stent to expand. The expanded stent further compresses the plaque and insures that the blood vessel remains open.
	Once the balloon catheter is removed, the stent remains in place. It provides a rigid structure to keep the artery open and the blood flowing freely.

Coronary Atherectomy (Rotoblader procedure)

During a coronary atherectomy procedure, the cardiologist uses a catheter with a precision, rotating blade or burr at its tip to shave the plaque accumulation and open the blockage. Because there is still plaque after this procedure, the doctor inserts a balloon catheter to compress the remaining plaque against the artery wall (angioplasty procedure).

There are several variants on the atherectomy (rotoblader) procedure. These procedures are named by the type of cutting device that is at the tip of the catheter.

	Rotational Atherectomy A small burr with diamond cutting chips at the tip of the catheter rapidly rotates to grind the plaque. The particles cut by this device are smaller than even the red blood cells in the bloodstream. Generally, they cause no problems by floating in the bloodstream.
	Directional Coronary Atherectomy (DCA) A rotating blade at the tip of the catheter shaves the plaque. Small particles are collected at the tip of the catheter and then extracted when the device is removed.
	Extraction Atherectomy A rotating blade at the tip of the catheter shaves the plaque. The small particles are vacuumed into the catheter and removed from the body. This device is larger than other units and works only on soft plaque. For that reason, it is limited to removing plaque from bypass grafts.
	Desired Result - Patent (Open) Artery The goal is to open the blockage so blood may freely flow to the regions of the heart muscle served by the coronary artery.