Types of Interventional Procedures
Cardiac Catheterization : -
Cardiac catheterization, sometimes called cardiac cath, often is used to determine the severity and extent of cardiovascular problems. In this procedure, the cardiologist makes a small incision in the arm or groin and threads a catheter into a blood vessel. The catheter is then guided through the blood vessel to the heart.
Using cardiac catheterization, physicians can:
analyze the location and size of plaque deposits,
assess the strength of the heart muscle and valves,
collect blood samples,
take blood pressure readings, and
inject dyes that are visible on x-rays into arteries to see how well blood is flowing. Information from the cardiac cath can help determine if cardiac surgery or another interventional cardiology procedure, such as angioplasty, is necessary.
Angioplasty/Percutaneous Coronary Intervention : -
Coronary angioplasty, also called percutaneous coronary intervention (PCI), is used to open arteries that have been narrowed by atherosclerosis. In this procedure, a catheter is entered into a blood vessel through an incision (usually in the leg or wrist) and is threaded to the heart. This catheter has a collapsed balloon at its tip. When the balloon reaches the targeted area (e.g., blockage), it is inflated to push plaque to the artery walls and widen the artery to improve blood flow. In some cases, the balloon must be inflated and deflated more than one time during the procedure.
Stents : -
Approximately 70% of angioplasty procedures also involve stenting, which is the insertion of a small metal cylinder called a stent into a blood vessel. In this procedure, a collapsed stent is placed over the balloon at the tip of the catheter. When the balloon inflates, the stent pops open and reinforces the artery walls. The balloon and catheter are then withdrawn and the stent remains permanently. In a few weeks, tissue from the artery lining grows over the stent. There are two types of stents. Bare-metal stents are plain, untreated metal cylinders. Drug-eluting stents (also called drug-coated stents) are coated with medication before they are placed in the artery. This medication helps prevent scarring and lowers the risk for restenosis (re-narrowing of the artery). Drug-eluting stents may present a higher risk for blood clot formation than bare-metal stents.
Embolic Protection : -
The word "embolic" comes from the word "embolus," which refers to an abnormal particle flowing with the blood. During interventional cardiology procedures, plaque fragments can become loose, travel through the bloodstream, and increase the risk for injury or stroke. Embolic protection devices, often called "filters," can be used to trap these particles.
Percutaneous Valve Repair : -
The human heart has four valves that control the way blood flows through heart chambers. Interventional cardiologists can use catheters to guide clips or other devices through the blood vessels to a damaged valve. These devices can then be used to repair the valve to allow blood to flow properly again.
Balloon Valvuloplasty : -
Balloon valvuloplasty, also called balloon valvotomy, is used to repair narrow or constricted heart valves that do not open properly (e.g., aortic stenosis). In this procedure, a balloon at the tip of the catheter is inflated to stretch the valve open
Atherectomy : -
In this procedure, a rotary shaver (also called a "burr") is placed at the tip of a catheter, guided to the affected area, and used to remove plaque from the artery walls. In some cases, a laser catheter is used to vaporize the plaque
Risks of Interventional cardiology include the following: -
Heart attack—In rare cases, a patient may have a heart attack during angioplasty.
Stroke—Blood clots may form on catheters and break loose during the procedure or catheter movement through the aorta may free plaque in the heart. If these particles reach the brain, stroke can occur. Patients are given blood thinners before angioplasty to help prevent stroke.
Coronary artery damage—Arteries can be torn or ruptured during angioplasty. If this occurs, emergency bypass surgery is performed.
Kidney damage—Dyes used in angioplasty can damage the kidneys.
Heart rhythm problems—Angioplasty can disturb the heart so that it beats more quickly or more slowly than usual. This often resolves on its own, but patients may need medication or a temporary pacemaker to regulate the heartbeat.
Benefits of Interventional Procedures :-
Interventional cardiology procedures are generally less invasive than traditional surgery. In most cases, these procedures require only one small incision for insertion of the catheter. Most interventional cardiology patients do not require general anesthesia and some procedures can take as few as 30 minutes to perform.
In many cases, patients are hospitalized for only one night following interventional cardiology procedures, instead of the longer hospital stay required by other types of surgery. Recovery time often is shorter as well and symptoms, such as shortness of breath and chest pain, are usually relieved quickly and effectively.
Some heart attack patients benefit substantially from angioplasty. Opening an artery and restoring blood flow quickly is one step toward preventing heart damage. Balloon valvuloplasty is often the best option for infants and children with congenital heart defects
Some complications of interventional cardiology procedures, particularly angioplasty, include the following:-
Bleeding at the catheter insertion site:-
Patients with excessive bleeding may need a blood transfusion or surgery.
Patients with stents have an increased risk for developing blood clots. Blood-thinning medications (e.g., aspirin, clopidogrel) can reduce this risk, but they must be taken exactly as prescribed. Blood clots can form as long as a year after the stenting procedure, so patients should not stop any medication without the approval of their physician.
In some cases, the artery narrows again, sometimes just months after angioplasty. This occurs in approximately 30–40% of patients who have angioplasty without stents, in less than 20% of patients who receive bare metal stents, and in less than 10% of patients who receive drug-eluting stents.
Long-term Effects of Interventional Procedures :
Interactive cardiology procedures can be quite successful. In many cases, patients do not experience complications and their symptoms are alleviated for several years. Other patients may require additional treatment, sometimes involving surgery. For example, if restenosis occurs, another angioplasty or bypass surgery may be necessary.
Most patients who undergo interventional cardiology procedures need to take medications afterward, sometimes for life. These medications are monitored carefully and must be taken exactly as prescribed. It is important for patients to comply with their medication and treatment plan. Noncompliance can increase the risk for developing long-term complications
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