ALL ABOUT P.T.C.A
(Percutaneous Transluminal
Coronary Angioplasty)
What is
coronary artery disease?
Coronary artery disease means that the inside of one (or more) of the
arteries that feed your heart has become narrowed (partly or mostly blocked)
with fatty material. Because of the narrowing, part of your heart does not always get enough oxygen-filled
blood to do its work. This has probably caused you to have chest discomfort,
pressure or pain at times.
What is PTCA
(Percutaneous Transluminal Coronary Angioplasty)?
The procedure means introducing into an artery through the skin
(i.e. percutaneously) a specially
designed soft fibre (catheter) which is advanced through the aorta to the lumen
of the narrowed coronary artery. Close to the tip of the tube, there is a tiny
uninflated balloon. When your doctor inflates the balloon inside your blocked
artery, the fatty material becomes squashed and the artery is widened. This
allows more oxygen filled blood to flow through the artery to feed your heart.
Do I need any
special preparation before PTCA?
Before performing this procedure, a dye study called cardiac
catheterisation (coronary angiogram) must be done to locate the narrowing and
to determine whether it is suitable for angioplasty.
If the narrowing in the artery is too long or if it is completely
blocked, it may not be suitable for angioplasty.
On the day of having PTCA you may have a small tube placed into a vein
in your hand (to give you fluids and medicine).
Your cardiologist will explain the procedure to you and when you have
signed your consent for PTCA, you will be asked to sign for open heart surgery
as well. This is routine in most hospitals.
If the procedure is to be done before noon, you are not permitted to eat
or drink after midnight the night before. If you are scheduled for late
afternoon, then you will be given a light breakfast after which you will not be
allowed to eat or drink.
What happens
during the procedure?
If you have had a cardiac catheterisation, the PTCA will appear much
the same. Like cardiac catheterisation it is normally performed under local
anaesthetic to the groin. The patient is usually well sedated. However, he can
still watch the procedure.
During the procedure, the site where the catheter will be inserted (in
the groin) will be cleaned with an antiseptic solution. Most of your body will
be covered with sterile sheets and you should not touch these sheets. Do not
move unless you are asked to do so. If you need any assistance, the nurse will
be ready to help. Your doctor will use a needle to numb the area already
cleaned. Then he will make a small hole in your artery with the needle. Next,
he will place a tube into your artery called an "introducer sheath".
Then he will place a catheter through that sheath. This is called a
"guiding catheter". This will move up to your heart and once it
reaches the blocked coronary artery, the doctor will thread the "balloon
catheter" through it. He may inject a small amount of dye to see the
artery more clearly.
Once the balloon is placed in the middle of the blockage, it will be
inflated with contrast solution. The balloon will be inflated and deflated once
or more until the doctor is satisfied that the artery is opened. A stent may be
inserted into your artery to hold it open.
Inflation of the balloon in the artery is frequently painless but may
give rise to a brief episode of chest pain. This usually is the only discomfort
that most patients have with PTCA. The doctor will then take out the balloon catheter
and then inject some contrast to
see that the coronary artery has opened.
When
can I return to my room?
Once the PTCA is finished, the introducer sheath which was placed in
your groin will remain in situs
there for 24-48 hours. You will be moved back to your room, and you will
be told not to move your leg for several hours. You will not be able to sit up
for several hours. If you want to pass water or turn round, ring for the nurse
to help. You should not move until you are told to do so. Your nurse will check
your pulse and blood pressure frequently.
Are there any
complications of PTCA?
The procedure is normally uneventful, but in a small proportion of
cases, instead of opening the artery it
may lead to a complete obstruction causing a myocardial infarction. If
this complication occurs, the patient
may need emergency coronary artery bypass surgery. A patient agreeing to
undergo angioplasty must therefore
be made aware of the possibility of going on to surgery because of this or as a
result of other complications.
Can the
narrowing of the artery reoccur?
Yes. In about 30% of
patients, the artery narrows again in the succeeding six months. A further
PTCA is then usually successful.
When can I go
home?
You will stay in hospital for 3 days and you will probably be able to
return to work and resume your normal daily activities within a short period of
time. You will be advised about diet and medicines you may be asked to take.
By : Dr. Hassan Chamsi Pasha & Dr. Fawaz
Akhras