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or vein to a diseased coronary artery, beyond the areas that are blocked by plaques. This procedure allows blood to bypass the diseased part of the artery, and improves the supply of blood to the heart muscle. How is Bypass Surgery Performed? Bypass surgery is performed under general anesthesia. The surgeon splits the breastbone to open the chest, then stops the heart using chemicals or cold (called hypothermia) so that he/she can attach the grafts without the heart moving around. Blood circulation is maintained, while the heart is stopped, using a cardiopulmonary bypass machine. Once the grafts are attached the heart is started again. The grafts used during bypass surgery usually come from veins from the legs (saphenous veins), or an artery from the chest wall (the internal mammary artery). Grafts using the artery often last longer than grafts using veins, and the artery grafts do not often develop stenosis, as vein grafts do. So internal mammary artery grafts should generally be used whenever it is feasible to do so (as determined by the patient's anatomy). It is fairly common for vein grafts to develop blockages due to atherosclerosis within 10 to 12 years of surgery. In recent years newer bypass surgery techniques are being developed called "minimally invasive bypass surgery." These minimally invasive procedures involve smaller incisions, and they avoid having to use the bypass machine. Unfortunately, minimally invasive bypass surgery is only suitable for patients whose diseased arteries can be readily reached with this approach. What are the Most Important Complications? Coronary artery bypass surgery is a major surgical procedure, and patients often don't return to "normal" for many weeks or even months after surgery. It is common to experience poor appetite, weakness, and pain over the incision for a few weeks. Depression is seen in up to one of three patients after surgery, and unless the depression is recognized and treated, it can lead to a greatly prolonged recovery time. Other possible complications after bypass surgery include myocardial infarction during or right after surgery (in less than 5% of patients), weakening of the heart muscle (which is often temporary), arrhythmias (especially atrial fibrillation), pleural effusions (fluid accumulation between the lung and the chest wall), infection of the incision site, and a cognitive (thinking) disorder that has been termed "pump head" (after the cardiopulmonary bypass "pump" that supports circulation during the grafting procedure, and that some have speculated is responsible for these cognitive changes). Because bypass surgery carries such serious risks, it is usually reserved for patients who are likely to have their lives prolonged by the surgery, or those whose symptoms of angina persist despite aggressive attempts at medical treatment. Coronary Artery Bypass Surgery CABG is a surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient’s own arteries and veins located in the chest (thoracic), leg (saphenous) or arm (radial). The graft goes around the blocked artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart. Download a Free Guide on Coronary Artery Disease and Treatment Options The goals of the procedure are to relieve symptoms of coronary artery disease(including angina), enable the patient to resume a normal lifestyle and to lower the risk of a heart attack or other heart problems. At Cleveland Clinic, bypass surgery may be performed in combination with other heart surgeries, when necessary, such as valve surgery, aortic aneurysm surgery or surgery to treat atrial fibrillation (an irregular heart beat). Who is eligible to receive coronary artery bypass graft surgery? Diagnostic tests have helped your heart doctor identify the location, type and extent of your coronary artery disease. The results of these tests, the structure of your heart, your age, the severity of your symptoms, the presence of other medical conditions, and your lifestyle will help your cardiologist, surgeon and you determine what type of treatment is best. At Cleveland Clinic, CABG surgery may be combined with other heart surgeries, such as valve surgery, aortic aneurysm surgery or surgery to treat atrial fibrillation (an irregular heartbeat). What happens during the cardiac bypass surgery? After general anesthesia is administered, the surgeon removes the veins or prepares the arteries for grafting. There are several types of bypass grafts. The surgeon decides which graft(s) to use, depending on the location of the blockage, the amount of the blockage and the size of the coronary arteries. Graft Preparation Grafts used for bypass
During surgery, the heart-lung bypass machine (called “on-pump” surgery) is used to take over for the heart and lungs, allowing the circulation of blood throughout the rest of the body. The heart’s beating is stopped so the surgeon can perform the bypass procedure on a “still” heart. Off-pump or beating heart bypass surgery allows surgeons to perform surgery on the heart while it is still beating. The heart-lung machine is not used. The surgeon uses advanced operating equipment to stabilize (hold) portions of the heart and bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body. More information about off-pump surgery Minimally Invasive Technique Minimally invasive coronary artery bypass (MIDCAB) surgery is an option for some patients who require a left internal mammary artery (LIMA) bypass graft to the left anterior descending (LAD) artery. Other minimally invasive surgery techniques include endoscopic or keyhole approaches (also called port access, thoracoscopic or video-assisted surgery) and robotic-assisted surgery. The benefits of minimally invasive surgery include a smaller incision (3 to 4 inches instead of the 6- to 8-inch incision with traditional surgery) and smaller scars. Other possible benefits may include a reduced risk of infection, less bleeding, less pain and trauma, decreased length of stay in the hospital (3 to 5 days) and decreased recovery time. Traditional incision Minimally invasive incision The surgical team will carefully compare the advantages and disadvantages of minimally invasive CABG surgery versus traditional CABG surgery. Your surgeon will review the results of your diagnostic tests before your surgery to determine if you are a candidate for any of these minimally invasive techniques. How long does the procedure last? The surgery generally lasts from 3 to 5 hours, depending on the number of arteries being bypassed. After Surgery After the grafts have been completed during the “on pump” procedure, the heart-lung machine is turned off, the heart starts beating on its own, and the flow of blood returns to normal. Temporary pacing wires and a chest tube to drain fluid are placed before the sternum is closed with special sternal wires. Then the chest is closed with internal stitches or traditional external stitches. Sometimes a temporary pacemaker is attached to the pacing wires to regulate the heart rhythm until your condition improves. The patient is transferred to an intensive care unit for close monitoring for about one to two days after the surgery. The monitoring during recovery includes continuous heart, blood pressure and oxygen monitoring and frequent checks of vital signs and other parameters, such as heart sounds. Once the patient is transferred to the step-down nursing unit, the hospital stay is about 3 to 5 more days. More information about the Cleveland Clinic Heart Surgery Program. How will I feel after surgery? For a while after the surgery, you may feel worse than you did before surgery. This is normal and is usually related to the trauma of surgery, not necessarily to the functioning of your heart valves. It may take you from 4 to 10 weeks to fully recover from surgery. How you feel after surgery depends on your overall health, the results of the surgery, and how well you take care of yourself after surgery. After recovering from surgery, most patients do feel better. To some extent, how you feel will depend on how you felt before surgery. Patients with more severe symptoms before surgery may experience a greater sense of relief after surgery. Call your doctor if you are concerned about your symptoms or rate of recovery. Recovery Full recovery from coronary artery bypass graft surgery takes about 2 months, or may be sooner if minimally invasive surgery techniques were used. Most patients are able to drive in about 3 to 8 weeks after surgery. Your doctor will provide specific guidelines for your recovery and return to work, including specific instructions on activity and how to care for your incision and general health after the surgery. Follow Up Care During the first few months after surgery, you will probably need to visit a few times with the doctor who referred you for surgery. You will need to schedule regular appointments with your cardiologist (even if you have no symptoms). Your follow-up appointments may be scheduled every year, or more often, as recommended by your doctor. Your appointments should include a medical exam. Diagnostic studies (such as an echocardiogram) may be repeated at regular intervals. You should call your doctor if your symptoms become more severe or frequent. Don’t wait until your next appointment to discuss changes in your symptoms. Importance of Making Lifestyle Changes Coronary artery bypass graft surgery increases the blood supply to your heart, but it does not cure coronary artery disease. You will still need to decrease your risk factors by making lifestyle changes, taking medications as prescribed and following your doctor’s recommendations to prevention future disease. Lifestyle changes include:
Internal mammary arteries [also called IMA grafts or internal thoracic arteries (ITA)] are the most common bypass grafts used, as they have shown the best longterm results. In most cases, these arteries can be kept intact at their origin because they have their own oxygen-rich blood supply, and then sewn to the coronary artery below the site of the blockage. If the surgeon removes the mammary artery from its origin, it is called a “free” mammary artery. Over the last decade, more than 90% of all patients received at least one internal artery graft. The radial (arm) artery is another common type of arterial graft. There are two arteries in the arm, the ulnar and radial arteries. Most people receive blood to their arm from the ulnar artery and will not have any side effects if the radial artery is used. Careful preoperative and intraoperative tests determine if the radial artery can be used. If the radial artery is used as the graft, the patient may be required to take a calcium channel blocker medication for several months after surgery. This medication helps keep the artery open. Some people report numbness in the wrist after surgery. However, long-term sensory loss or numbness is uncommon. Saphenous veins can be used as bypass grafts. Minimally invasive saphenous vein removal does not require a long incision. One to two incisions are made at the knee and a small incision is made at the groin. This results in less scarring and a faster recovery. Your surgeon will decide if this method cardiac bypass surgery is a good option for you.
Following up with your doctor for regular visits Information on prevention and making lifestyle changes can be found at Heart and Vascular Health and Prevention. For more information:
• • • • • • • • • • • • • • • • •
Quitting smoking Treating high cholesterol Managing high blood pressure and diabetes Exercising regularly Maintaining a healthy weight Eating a heart-healthy diet Controlling stress and anger Taking prescribed medications as directed Participating in a cardiac rehabilitation program, as recommended
The gastroepiploic artery to the stomach and the inferior epigastric artery to the abdominal wall are less commonly used for grafting. What are the risks? As with any surgery, there are risks involved. Your surgical risks are related to your age, the presence of other medical conditions and the number of procedures you undergo during a single operation. Your cardiologist will discuss these risks with you before surgery; please ask questions to make sure you understand why the procedure is recommended and what all of the potential risks are. Types of coronary artery bypass grafts Surgical Procedure To bypass the blockage, the surgeon makes a small opening just below the blockage in the diseased coronary artery. If a saphenous (leg) or radial (arm) vein is used, one end is connected to the coronary artery and the other to the aorta. If a mammary artery is used, one end is connected to the coronary artery while the other remains attached to the aorta. The graft is sewn into the opening, redirecting the blood flow around this blockage. The procedure is repeated until all affected coronary arteries are treated. It is common for three or four coronary arteries to be bypassed during surgery. Before the patient leaves the hospital, the doctor or nurse will explain the specific bypass procedure that was performed. Heart-Lung Machine
Cleveland Clinic Heart Center Surgical Outcomes Arterial bypass grafts Cleveland Clinic Heart Center Department of Cardiovascular & Thoracic Surgery Recovery after heart surgery Tips to help you sleep after heart surgery Guided imagery and heart surgery
Herbals and heart surgery What is a Coronary Artery stent? A coronary stent is stainless tube with slots. It is mounted on a balloon catheter in a "crimped" or collapsed state. When the balloon of is inflated, the stent expands or opens up and pushes itself against the inner wall of the coronary artery. This holds the artery open when the balloon is deflated and removed. Coronary artery stents were designed to overcome some of the short comings of angioplasty. Angioplasty is a technique that is used to dilate an area of arterial blockage with the help of a catheter with an inflatable, small, sausage-shaped balloon at its tip. Although introduced over two decades ago, angioplasty continues to be the most frequently employed procedure in the cardiac cath lab
it expands the stent and opens up the diseased segment into a rounder. soft plastic tube or guiding catheter is advanced and the tip positioned into the opening or mouth of the coronary artery. Your heart rate. Others Who Viewed This Page Also Saw: Angioplasty You most likely will start walking within 12 to 24 hours after an atherectomy. the majority of these stents can be reopened. This is known as "recoil. The guide wire which is an extremely thin wire with a flexible tip is inserted into the catheter.6 weeks. Why It Is Done Atherectomy is a procedure used to open up narrowed coronary arteries to increase blood flow. and if it had the same good short and long term results in every case. The tip of the catheter is directed or controlled when the cardiologist gently advances and rotates the end of the catheter that sits outside the patient. and with availability of modern day technology. why is it not used in every single case? Good question! If stents could be delivered to every lesion. To prevent bleeding.1 Risks Risks of atherectomy may include: • • • • • • • Atherectomy Of A Coronary Artery Atherectomy of a coronary artery Atherectomy For Coronary Artery Disease Coronary Artery Disease-Other Treatment Atherectomy Cardiac Catheterization Heart rhythm problems. Results of coronary artery stenting: The video on the left (above) shows a 95% blockage in the proximal portion of the left anterior descending coronary artery (arrow).12 and sometimes as high as 20 atmospheres. Once it is confirmed that there is no bleeding. After several days. Heparin (a "blood thinner" or medicine used to prevent the formation of clots is given. Inflation is initially carried out at a pressure of 1 . But the latest devices used for atherectomy can filter or capture these small pieces and remove them from the blood. The unexpanded stent is mounted just inside these visible metallic markers that helps the cardiologist know the location of the otherwise poorly visible stent. The irregular surface and the cracks on the inner lining of the artery increases the risk of complete arterial blockage in a very small number of patients. What To Think About • • • • Heart attack during the procedure (small percentage). A mixture of saline and contrast material is used to inflate the balloon. to help prevent the formation of blood clots. or another. If not satisfied by the results. the material within the expanded channel starts to multiply after the channel is expanded. Special precautions have to be taken to prevent them from being covered with clot. If patients are allergic to aspirin or Plavix(R) or are unable to take medication because of bleeding or other problems. With prompt treatment. Secondly. it is estimated that the risk of death is during a stent procedure is usually less than 1%. This wire now serves as a "guide" or rail over which the balloon catheter is passed. Through this sheath. After atherectomy you will most likely take medicine. the opening created by the procedure is not very smooth because the balloon does not evenly expand all areas that have different degrees of hardness (atheroma is soft. you will be moved to a recovery room or to the coronary care unit. However. Atherectomy might be done along with stenting. This can help keep the artery from narrowing again. Bleeding. The balloon is kept inflated for 30 to 60 seconds and then deflated. Such patients develop symptoms of a heart attack. you may resume exercise and driving. Pressure is applied to the groin with a clamp. In other words. the cardiologist may employ alternative medications (depending upon the problem) and even delay or avoid the use of a stent The picture on the left (above) shows a cross-section of a coronary artery at the level of a blockage or stenosis. The balloon is situated on the tip of the catheter shaft and is inflated by connecting it to a special hand-held syringe pump. The handheld inflation syringe has markers that are used to determine the pressure. The duration is dependent upon the technical difficulty of the case and the number of balloon catheters that have to be employed. This is known as "predilation. The risk of a heart attack and bleeding that requires a blood transfusion is increased when compared to cardiac cath. After approximately 6 hours. artery in the future. This usually resolves when the balloon is deflated. the build-up of material can be large enough to cause the blockage to return to its original (or worse) severity. please review the cardiac cath section. coronary stenting is preceded by angioplasty. There are other types of technical considerations that also come into play. coronary stents physically opens the channel of diseased arterial segments. or in conjunction with other procedures such as coronary stenting). However. medications or surgery. It might be done if an artery has hard plaque with a lot of calcium. flexible. The iodinated solution blocks the passage of x-rays and causes the coronary arteries to be visualized in the angios. they can be made temporarily seem by filling them with a contrast solution that blocks x-ray. Cardiac catheterization (cath) is a specialized study of the heart during which a catheter or thin hollow flexible tube is inserted into the artery of the groin or arm. When the balloon is inflated. This helps the cardiologist decide whether it is appropriate to proceed with angioplasty or to consider other treatment options such angioplasty. The aggravation of kidney function (particularly in diabetics and those with prior kidney disease) is higher than that expected with cardiac cath because of the larger amount of contrast material that is usually required. Today. How Well It Works Atherectomy can work as well as angioplasty to widen narrowed arteries. Patients who are uncomfortable can be given intravenous medication to alleviate this problem. In 30-60% of cases. depending upon the type of stent that is used." It helps open up the blockage area. coronary arteries are not ordinarily visible on x-ray film. An "out patient" or an inpatient uncomplicated stent case usually require 23 hours or less of hospitalization after the procedure. The difference is that atherectomy uses a cutting device (a blade or a whirling blade) to remove the plaque buildup from the artery wall. A Band-Aid or small dressing is applied over the tiny needle hole. The deflated balloon and wire are withdrawn when the cardiologist is satisfied with the results. For a description of the equipment. The tip of the wire is then guided across the blockage and advanced beyond it. while the chance of requiring emergency bypass surgery is around 2% or less. Since it is performed through a little needle hole in the groin (or sometimes the arm) it is much less invasive than surgery and can be treated with another needle or percutaneous procedure should the patient develop disease in the same. such as aspirin and another antiplatelet such as clopidogrel. Another risk is that small pieces of plaque that are cut off during atherectomy can lodge in smaller arteries and damage heart tissue. which is shown in the middle picture as having a more "frayed" appearance). Slight bruising around the site is not uncommon. a long. It is not uncommon for patients to experience chest discomfort while the balloon is inflated. The tip of the stent balloon catheter is then positioned across the lesion. The sheath is removed when the effect of Heparin wears off. the patient is ambulated or allowed to walk with assistance and is usually discharged the following morning. The diagram on the extreme right shows an increased opening after the blockage was treated with a coronary stent. The balloon catheter has metallic markers (at either side of the balloon). In most cases. In such cases. If coronary artery stenting is superior to angioplasty. holding it open. . atherectomy. This produces a channel with an irregular shape and a rough surface that is covered with superficial or deep cracks. Like angioplasty. plaques are hard and mixture of the two have a medium and uneven degree of hardness).(either by its self. Closing off of the artery. and the catheter insertion site will be checked for bleeding. you may have a large bandage or a compression device on the catheter insertion site. Aspirin is continued indefinitely if the patient is not allergic to the medication and does not develop any problems with it. However. The stent is completely covered by natural tissue in a matter of 4 . and blood pressure will be closely monitored. What special treatment is needed after a coronary stent procedure? Coronary artery stents are foreign metallic objects that are left inside the coronary artery." Recoil causes the channel to become smaller shortly after being enlarged by balloon expansion. A combination of soluble aspirin (Bayer Aspirin* is an example) and Plavix* is very popular in the USA. How long does the procedure take? It can take anywhere from 30 minutes to an hour to perform the entire case. increases the quality of life and reduces other complications of the disease. The patient remains awake throughout the procedure and mild sedation is used to ensure relaxation and comfort.6 weeks because the stent is usually completely covered by natural tissue during that period and the risk of clot formation is nearly absent by that time. Stents are difficult to deliver across tight bends in blood vessels (particularly if they have a lot of calcium deposits in the wall) and are not usable in very small blood vessels. The risk of a other serious complication is estimated to be less than 4 and probably around 1 to 2 per thousand.". some of the compressed material tends to "spring back" to some degree. The expanded stent is embedded into the wall of the diseased artery. However. The video to its right shows no remaining blockage after the patient was treated with a coronary artery stent. a sandbag or ice bag is placed over the groin. The average hospital stay is 1 to 2 days for uncomplicated procedures. This is determined by obtaining blood tests at specified intervals. a sheath is introduced in the groin (or occasionally in the arm). This causes a gradual build-up of material. the catheter tip is positioned in the mouth of the left main coronary artery. The medications are started either before or during the procedure. and makes it easier to deliver the stent. and similar to that described for cardiac cath. A stent is a metal "mesh" that is mounted on an angioplasty balloon. Pressures are measured and an xray angiogram (angio) or movie of the heart and blood vessels is obtained while an iodinecontaining colorless "dye" or contrast material is injected into the artery through a catheter. • Atherectomy for Coronary Artery Disease Atherectomy involves techniques similar to those used forangioplasty. relieves the recurrence of chest pain. a sealant device is applied in the cath lab after removal of the sheath. See a picture of types of atherectomy of a coronary artery. reduces the risk of the artery abruptly closing off during the procedure and also decreases the chance of restenosis (recurrence of the blockage) by nearly 50% (from 30-50% in cases of angiopalsty. the tip of the catheter is guided to the heart. What To Expect After Treatment After an atherectomy. The risk for complications during atherectomy can be reduced if it is performed by a cardiologist who is experienced with the procedure. The picture on the left (below) shows a blockage prior to angioplasty. How is Coronary Artery Stenting performed? Prior to performing stenting. the cardiologist takes extra precautions to prevent this possible complication. preparation and experiences during the procedure. down to 15-25% in cases of stents). As discussed in the cardiac cath section. Atherectomy may make it easier for your doctor to place a stent in the artery. Moreover. this is not the case. which requires emergency bypass surgery. Medications that make platelets less active has been found to be extremely effective in preventing clots. the location and type of blockage plus the shape and size the coronary arteries have to be defined. In some labs. In the picture below. Firstly. bigger and smoother opening (compared to angioplasty." After evaluating the x-ray movie pictures. it is estimated that stents are employed in nearly 50-75% of cases. In very few cases (1 chance out of 200) a clot may form during the first two weeks after a stent procedure). Under x-ray visualization. The tube measures 2 to 3 mm in diameter. How safe is the procedure? In the hands of experienced cardiologists. coronary angioplasty has two shortcomings. Plavix* is usually stopped in 4 .and the risk of clot formation is nearly absent by that time. Once the catheter tip is seated within the opening of the coronary artery. Stents induce a more predictable and satisfactory result. the risks are relatively low and acceptable in most cases when one balances the potential benefit against the expected risk (risk-benefit ratio). It is a relatively safe procedure and is carried out all over the world.2 times that of the atmosphere and then increased to 8 . the cardiologist estimates the size of the coronary artery and selects the type of balloon catheter and guide wire that will be used during the case. pulse. the cardiologist will further expand the stent using another balloon (frequently it is the same balloon catheter that was used for "pre-dilation. while the picture in the middle demonstrates the artists rendition of the angioplasty results. You will be instructed to keep your leg straight if the insertion site is in your groin area. The sheath is secured to the groin and the patient is sent to his or her room. x-ray movie pictures are recorded during the injection of contrast material or "dye. (* = Trade Names of the manufacturers). it would be used in 100% cases of angioplasty. This occurs over a 6 week to 6 month duration of time and is known as restenosis.
and others. and interpretation of the devices' risks and effectiveness. (Do not exceed total daily dose of 10 ml/kg) 2. There are two main categories of atherectomy devices-those that shave or cut plaques. Exercising aerobically. Once the physician has selected the appropriate device. pass guidewire through needle and advance until tip is is in thoracic aorta. which implies re-canalizing blocked vasculature via a needle puncture in the skin. rotational. The site where the catheters are inserted (usually above the femoral artery in the groin) is cleaned and shaved and is numbed with a local anesthetic. with heart rate in a given patient the systolic time interval at a given heart rate can be used to predict the STI at other rates. or splitting open a blood vessel. Dissection. based on a review of the medical literature. heparinise patient prior to insertion of catheter providing there are no contraindications such as recent surgery. After cardiac surgery patient should be given low-molecular weight dextran at 20 ml/hr instead of heparin. stroke volume decreased. cardiac output decreased and myocardial oxygen demand increased. it might help your doctor open up a narrowed artery. Typically. balloon should be positioned so that the tip is about 1 cm distal to the origin of the left subclavian artery. They include the type of lesion being treating. Drive units are preprogrammed with families of STI/heart rate curves. Distal embolization. remove wire. or current drive units unable to realise maximal benefits of IABP during many arrhythmias Balloon catheters • • • 30-40 ml displacement volume usually have central lumen concentric with and inside the helium channel. the physician chooses the appropriate device to perform the atherectomy. The physician then makes a tiny incision in the skin and inserts a guide wire and then a catheter sheath over the wire. Today. wire and catheter access can occur from wherever a doctor is willing to stick. It has also been used to treat coronary artery disease. Other common places are the brachial artery. repeatability in light of new occlusions. dorsalis pedis. varying from patient to patient and in a given patient. can increase shunting in patients with a septal defect if inflation is too late or deflation is too early diastolic augmentation is suboptimal LIFESTYLE Atherectomy does not address the cause of hardening of the arteries. and balloon inflation can be triggered by R wave. which push plaque into the vessel wall. It also serves as a chance for non-surgical candidates. reduces claudication and pushes amputation levels more distal. and Heart attack. In addition. WHAT TO EXPECT The patient is given a mild sedative and any necessary medications. thus increasing aortic pressure during diastole and increasing coronary blood flow balloon deflated prior to and during early left ventricular ejection thus reducing aortic pressure and thus afterload Indications Indicated in the following conditions if further medical treatment judged likely to be ineffective: pump failure. Latter is a potentially lethal mode as loss of capture may result in balloon inflation during systole as the pump will continue to follow the pacing rate rather than the ventricular contraction rate Complications During insertion • • • During use failure to advance catheter beyond iliofemoral system because of atherosclerotic disease (most common complication) aortic dissection and arterial perforation limb ischaemia most common. However. decreased systemic complications. such as: increases coronary blood flow Basic mechanism • • • • • • • • • • • • • • • • placed in the thoracic aorta balloon inflated during diastole. based on a number of factors. Abrupt vessel closure. pass balloon over guidewire through sheath. most patients can resume normal activities. Wire should pass very easily 6. Patients should address risk factors for atherosclerosis by making the following lifestyle changes: Quitting smoking. POSSIBLE COMPLICATIONS Complications that occur at the site of atherectomy depend on the arteries being treated and which device is used and include: • • • Computerized tomography (CT) scan. 10. The remains alert during the procedure. Intra-aortic balloon pumping Beneficial effects • • • • • Eating a healthy diet. or pieces of blood clot that break off at the atherectomy site and travel downstream to arteries beyond the atherectomy. also known as angiogram. The drive unit then selects the STI/heart rate curve that most adequately corresponds to those values to calculate balloon timing parameters Magnetic resonance angiogram (MRA). and those that pulverize plaques. it is generally used to effectively treat peripheral arterial disease of the lower extremities. radial artery. While atherectomy is usually employed to treat arteries it can be used in veins and vein grafts as well. he or she advances it through the arteries to the plaque. laser. This results in an increase in afterload which may result in premature valve closure and increase LV work. ventricular emptying is incomplete. which involves the surgical cut down and removal of plaque from the inner wall of a diseased vessel. thus eliminating need for a separate arterial line to obtain waveform required for IABP Insertion 1. Atherectomy Devices There are four types of atherectomy devices: orbital. The advantages of atherectomy when compared to balloons (angioplasty) and stenting are less vessel barotrauma. the physician's experience with each device. faster patient recovery. Advantages The procedure is considered less invasive than endarterectomy. Procedure Unlike angioplasty and stents. Atherectomy patients usually stay overnight in the hospital following the procedure. Catheters may be withdrawn and inserted through the sheath during the procedure. Must be inserted to at least the level of the manufacturer’s mark (usually double line) to ensure that entire balloon has emerged from sheath 8. Withdraw needle until strong pulsatile jet of blood is obtained 5. Talk to your doctor if you are worried about risks of having atherectomy Atherectomy From Wikipedia. atherectomy involves removing the plaque burden within the vessel. atherosclerosis from a large blood vessel within the body. The advantages of atherectomy when compared to endarterectomy include less procedure time. The procedure takes approximately 1 to 3 hours. Vessel spasm. Increasing the vessel lumen by removing the plaque burden improves downstream wound healing. arterial waveform or pacing spike. Also. pass sheath over wire in similar manner to insertion of PA catheter sheath 7. Leads to catheter tip and allows use of guide wire to introduce catheter and also allows recording of central arterial pressure. • • • • • • • • • Hematoma (the collection of blood in tissues). Atherectomy is usually followed by angioplasty and stenting to widen the artery. At the initiation of pumping the operator estimates the intervals from the QRS complex to aortic valve opening and closure and enters them into the machine. Hemoglobinuria (hemoglobin in the urine). imminent or frank acute mitral regurgitation unstable angina Also useful in: high risk patients undergoing PTCA ventricular arrhythmias refractory to conventional treatment patients at high risk of cardiac decompensation during non-cardiac surgery Contraindications aortic insufficiency aortic dissection (prosthetic graft in thoracic aorta) severe aortoiliac disease Practical aspects of use of balloon pumps Drive units operation is based on recognition of the fact that the interval between electrical and mechanical events of cardiac cycle is variable. Clot formation. If fluroscopy is not available during insertion the distance from the angle of Louis down to the umbilicus and then to the femoral artery insertion site should be measured to approximate the distance the balloon should be advanced and the position should be checked on CXR 9. The physician also orders imaging tests prior to the procedure. Return of blood via central lumen confirms that the tip is not subintimal and has not caused a dissection. After 2 days. Sufficiently severe to require removal of balloon in 11-27% • • reduces cardiac work by decreasing afterload . Directional PRE-TREATMENT GUIDELINES A few days before the procedure. POST-PROCEDURE GUIDELINES AND CARE The patient is asked to drink fluids and hospital staff monitors his or her vital signs during recovery. Based on an arteriogram. monitor Doppler ankle pressures and compare with preinsertion value Balloon pump timing • • • • using central aortic pressure waveform and ECG identify dicrotic notch (aortic valve closure) determine time delay between R wave and aortic valve opening and closure and enter these values into the pump turn on pump and compare assisted and unassisted waveforms to determine whether timing is optimal (figure 1) if inflation is too early or deflation too late the balloon waveform is superimposed to varying degrees over the LV systolic component of the central aortic pressure waveform (ie inflation starts when the aortic valve is still open). ease of use. Arteriogram. Artery perforation. the free encyclopedia Atherectomy is a minimally invasive surgical method of removing. people scheduled for atherectomy should not eat or drink anything for 8 to 12 hours before the test. The decision to use which type of device is made by the interventionist. prep skin 3. fully collapse balloon applying 30 ml vacuum with 60 ml syringe 4. Losing weight. popliteal artery. flush central lumen with heparin saline and connect to transducer to monitor intra-aortic pressure 11. no foreign object (stent metal) left in the body and leaving all future options open for the patient at the treated site. mainly. The most common access point is near the groin through the common femoral artery (CFA). Atherectomy falls under the general category of percutaneous revascularization. and directional. But in certain cases. albeit ineffectively.Atherectomy is not done for most people who have angioplasty. the physician performs blood tests and the patient may be advised to stop taking aspirin or other drugs known to interfere with blood clotting. insert needle into femoral artery at 45° and pass it through both walls of artery.
diets high in saturated fats. Clean the shaved area to make it germ free. please call the radiology department at 513-867-2311. They reduce the risk of needing another procedure and are used for people who have a high risk of developing renarrowing of the artery after the initial procedure. First used in 1977. the cells that line the blood vessel will grow around the stent. the balloon inflates. When medications or lifestyle changes aren’t enough to reduce the effects of blockages in your arteries. increasing blood flow to the heart muscle. the balloon deflates. If you take insulin. Your blood pressure and heart rate will be monitored. or pain at the insertion site develop a fever notice a change in temperature or colour in the arm or leg that was used feel faint or weak . vascular injuries should be dealt with directly by surgical interventions and repair. which tell the physician exactly where the blockages are and how narrow the artery is. There are other types of angioplasty sometimes used in combination with the balloon: • Vascular obstruction with limb ischemia: regular examination of radial and dorsalis pedis arteries may be helpful for quick evaluation of peripheral arteries. this deflation occurs at the time that blood is being ejected from the left ventricle. A small amount of dye may be injected through the tube into the blood stream to help show the blockage on X-ray. They are usually sent home early the next day. 2. The catheter includes a small balloon and a small wire tube. In general. In rotational atherectomy. Check with your doctor if you take blood thinners such as warfarin. you may have to adjust the dose. the balloon is inflated. The balloon is guided into the descending aorta. The doctor will then inflate the balloon. The whole procedure usually lasts 30 minutes but may last as long as several hours. This is also known as an angiogram and functions as a map for the doctor. Map and Directions For maps and directions from major routes.    It can also cause compartment syndrome. At the beginning of systole. When the wire reaches the area of the blockage. usually to treat peripheral artery disease. please contact one of our clinical coordinators at 513-527-9999. bleeding. For best results. holding the blood vessel open and restoring blood flow to the arteries. What happens during my angioplasty? Angioplasty is performed by a specially-trained doctor. It's sometimes called percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). Your doctor may tell you to not smoke for a period of time before or after angioplasty. Once the balloon has been deflated and withdrawn. What should I expect after my procedure? Your catheter site will be checked for bleeding and swelling after the procedure. May be heralded by high balloon inflation pressures. This in turn decreased the left ventricular stroke work and myocardial oxygen requirements. Balloon Angioplasty) In this factsheet: The Facts on Angioplasty The Facts on Angioplasty Angioplasty is a technique for reopening narrowed or blocked arteries in the heart (coronary arteries) without major surgery. the stent remains in place permanently. Why do I need angioplasty? The most common reason for angioplasty is to relieve a blockage of an artery caused by atherosclerosis. You should tell the interventional radiologist or nurse if you are allergic to any medications. Sometimes. Angioplasty usually requires an overnight hospital stay. You can usually continue to take your medications. • • • • • • • What is angioplasty? What is the benefit of having angioplasty? What causes blockages in the arteries? Why do I need angioplasty? What should I expect before my angioplasty? What happens during my angioplasty? • Drug-coated stents are specially-treated stents that gradually release a special medication into the wall of the artery after they have been put into place and inflated. Studies are ongoing to identify safety and outcomes of the use of these stents. A small incision is made in the skin to find an artery. In this manner. augmenting coronary perfusion. myocardial ischemia. The surgeon makes a small incision in the groin or arm and inserts a thin tube. Directional atherectomy involves using a miniature rotating blade to cut out the fatty deposit and remove it from the body. Call your doctor if you: have shortness of breath or chest pain Angioplasty or coronary artery bypass surgery? • • • • • experience swelling.5 cc to 50 cc) that will fit patients of any age and size. During or following removal haematoma false aneurysm Numb the area. The deflation of the balloon decreases end diastolic aortic pressure and consequently reduces left ventricular myocardial oxygen requirements in the following beat. Before the operation You shouldn't eat after midnight on the night before your angioplasty. Helium is used because its low viscosity allows it to travel quickly through the long connecting tubes. Atherosclerosis is a gradual process in which cholesterol and other fatty substances in the bloodstream form a substance called plaque on the inside of the blood vessel walls and clog the artery. This delation of the balloon reduces the afterload on the heart. The expanding balloon forces the blockage to open by pushing the walls of the artery outward. If you have extremely hard plaque deposits. What should I expect before my angioplasty? Prior to the procedure. "Angio" means relating to a blood vessel and "plasty" means repair. such as X-rays and blood tests. Usually you will stay at the hospital overnight and return home the day after the procedure. AV fistula Mechanism of action and physiologic benefit The balloon is inflated during diastole by a computer controlled. and can lead to peripherial thrombosis. At the start of diastole. the platelet count rapidly returns to normal Hemorrhage at the site of insertion Hemolysis Angioplasty (Heart Artery Dilation. The procedure Angioplasty is performed while you are awake. holding it in place. or blood vessel spasms that don’t go away. into the artery. and the tip of the balloon is positioned approximately 2 cm from the left subclavian artery. or hardening of the arteries. usually the arm or groin. Positive blood cultures require prompt removal and culture of IAB and treatment with antibiotics thrombocytopaenia embolization of platelet aggregates from surface of balloon and cholesterol emboli balloon rupture leading to embolization of helium (2-4%). This treatment may continue for one year. For more information regarding appointments or locations at The Fort Hamilton Hospital. For more information about this procedure or general information about our interventional radiology practice. Once home.    Mechanical failure of the balloon itself is also a risk which may entail vascular surgery to remove the IABP. What causes blockages in my arteries? Blockages in arteries and veins can be caused by smoking. or if you have worsening chest pain or heart problems your doctor may suggest angioplasty. avoid any type of lifting or other strenuous physical activity for a week. This X-ray picture of the heart is called an angiogram. After the procedure is complete. Your doctor will advise you when you will be able to return to work and resume driving and other physical activity. If signs of ischemia appear the balloon should be removed.• • • • • • • • sepsis. infection. people will have to return to get their arteries redone because of renarrowing (restenosis) at the site of the balloon inflation. as you may need to stop them 5 days before the procedure. This can dramatically increase the profile of the balloon and complicate the removal of the balloon. Once the catheter is in place. A helium leak: should the balloon begin to leak helium. called a stent. and cardiovascular disease. This controls the flow of helium from a cylinder into and out of the balloon. restoring blood flow to your tissues and relieving your symptoms without the need for surgery. Since the device is placed in the femoral artery and aorta it can cause ischemia in limbs (such as the leg) and organ beds (such as the renal and mesenteric beds). Angioplasty What should I expect after the procedure? What is angioplasty? Angioplasty is a minimally-invasive procedure that repairs and restores blood flow through a narrowed or blocked artery in the heart. a dye is injected and X-rays are taken. called a catheter. These stents may increase the rare risk of clotting. Monitoring for Complications Continuous monitoring of the function of the IABP and vigilance for complications are essential. a diamond-studded drill bit is used to pulverize tough blockages. You may have to go for some preliminary blood tests. The IABP has two main benefits: 1.    The success rate for percutaneous inserton of IAB is more than 90%. The interventional radiologist will use an intravenous (IV) line to give you fluids and medicines that will relax you and prevent blood clots. When the tube reaches the blockage. visit The Fort Hamilton Hospital Web site at: Infection Thrombocytopenia: After balloon removal. It's sometimes uncomfortable. Make sure you arrange for transportation home. Other possible complications are cerebral embolism during insertion. called an interventional radiologist. Relatively unusual but associated with high mortality. since angioplasty involves injecting you with an iodine-based dye. which is generally inserted into the aorta through the femoral artery in the leg. but not usually painful. The pump is available in a wide range of sizes (2. ECG linked mechanism. Entrance of blood into the balloon and contact of the blood with helium in the balloon can lead to the formation of clot inside the balloon. Dry helium dessicates the collected blood which then forms a hard pellet which may prevent removal of balloon except by surgical aortotomy. but you should discuss this with your doctor. PCI. Ask your doctor if you can drink clear liquids after this. You will be asked not to eat or drink anything after midnight the night before your procedure. the interventional radiologist will begin the procedure. hemodynamic decompensation. You must also tell your doctor if you are allergic to iodine or shellfish. the balloon supports the heart indirectly. you may have several tests performed. If you have a stent. you should quit smoking permanently. you will usually have to take an extra blood thinner medication such as clopidogrel* in addition to acetylsalicylic acid for at least the first few months in order to prevent blood from clotting on the metal stent. perforation of the artery and hemorrhage in the mediastinum. under local anesthetic. and increases the cardiac output by as much as 40 percent. it's now as common as heart bypass surgery. Angioplasty is also used in other parts of the body. dissection of the aorta or iliac artery. Continuous monitoring is required for the early detection of the following major complications of IABP insertion: A stent usually is placed at the site to keep the artery open. • • • Intracoronary radiation involves irradiation of the section of artery after balloon angioplasty. After the operation Most people are admitted to hospital and monitored overnight after angioplasty. PCTA. the balloon must be removed immdediately. • • • • • • • • Shave the area where the catheter or tube will be inserted. After balloon removal there is also a risk of 'embolic shower' from micro clots that have formed on the surface of the balloon. opening the stent and pushing it against the artery wall. you probably are not a good candidate for angioplasty. Your physician may prescribe medication to relax you and protect your arteries against spasm and to prevent blood clots. You typically will be able to walk within two to six hours following the procedure and return to your normal routine by the following week. The IABP is a polyethylene balloon mounted on a catheter. Studies show this experimental technique reduces restenosis in your artery by 70%. high cholesterol levels. When you are comfortable. What is the benefit of having angioplasty? Angioplasty can prevent a heart attack or stoke by opening your blocked artery. You may also have to put off dental work for several months due to the risk of endocarditis (an infection of the heart). Next the nurse will: small perforation in balloon membrane may allow small leak of blood into balloon lumen. and late pseudoaneurysm. The procedure is performed by an interventional radiologist. The inflation of the balloon displaces blood into the ascending aorta which in turn increases the pressure there thereby increasing flow into the coronary arteries. a tube (called a catheter) with a deflated balloon on the end is threaded into the blocked artery under X-ray guidance. Blood in connecting tubing is hallmark of rupture and requires immediate cessation of counterpulsation. Antibiotic cover should be broadened as the gas chamber of the balloon is not sterile. blockages. Balloon related problems and infection require removal and / or replacement of the intra aortic balloon. placement of patient head down and IAB removal. The doctor then threads a very thin wire through the artery up to the coronary artery that is blocked.
Heart attack (3–5 percent of people). You'll be given medicines to help you relax. After the procedure. or other treatments for angina can be considered such as coronary artery bypass grafting. Angioplasty is a common medical procedure. such as clopidogrel and aspirin. Abnormal heart rhythms. Most people go home the day after having angioplasty. Blood vessel damage from the catheters. then the procedure can be repeated.Coronary artery bypass grafting (CABG) is a successful but more invasive technique for restoring blood flow to the heart. Mechanism of action .g. The stent helps prevent the artery from becoming narrowed or blocked again. Other treatments. However. flexible tube called a catheter with a balloon at the end. This may occur if an artery closes down instead of opening up. most hospitals don't perform angioplasty if there are several major arteries blocked. When medicine-coated stents are used in people who have advanced CHD. In figure B. Over time. and the use of drug-eluting stents has reduced the risk to less than 10 percent. A catheter is a thin. reduce damage to the heart muscle caused by a heart attack. the treated coronary artery can become narrowed or blocked again. You heart may get irritated during the procedure and beat too quickly or too slowly. Kidney problems. As with all procedures. brachial or radial) and maneuvered into the stenotic segment of coronary vessel. Also. While you recover. especially in people who already have kidney problems. Non-fatal serious complications occur in 1% to 5% of people who undergo this procedure. The brand name is what a specific manufacturer calls the product (e. acetaminophen). about 1 in 10 people has restenosis. no matter how many arteries are blocked. Research on angioplasty is ongoing to make it safer and more effective. Moreover. The original bare-metal stents reduce the chance of restenosis to less than 20 percent. People who have medicine-coated stents usually are advised to take anticlotting medicines. These clots may cause a heart attack. but sometimes medications or a temporary pacemaker is needed. If it does. The dye used during angioplasty and stent placement can cause kidney damage. doing physical activity regularly. Angioplasty is less invasive than surgery. but sometimes serious bleeding occurs and may require blood transfusion or surgical procedures. blood clots that may form on the catheters can break loose and travel to your brain. they can happen no matter how careful your doctor is or how well he or she does the procedure.. • • • • tearing of the lining of the artery resulting in total blockage and possible heart attack . You also should take all of your medicines exactly as your doctor prescribes. Serious complications don't occur often. The great advantage of angioplasty is that the artery is returned to normal size without resorting to major surgery. causing them to harden and narrow. blood clots. Blood clots can form within stents even weeks or months after angioplasty. and reducing stress. Your coronary artery may be torn or ruptured (dissected) during the procedure. Before angioplasty is done. allowing normal blood flow. they can happen no matter how careful your doctor is or how well he or she does the procedure. Angioplasty is done in a special part of the hospital called the cardiac catheterization laboratory. The inset image on figure A shows a cross-section of the compressed plaque and stent-widened artery. you may have a heart attack during the procedure. Stents coated with medicine reduce the growth of scar tissue around the stent and lower the chance of restenosis even more. for months to years to lower the risk of blood clots. Researchers continue to study medicine-coated stents. When these stents are used. Other rare risks of angioplasty include: • • • • • • Stroke (less than 1 percent of people). flexible tube which is inserted into a coronary artery. When a stent (small mesh tube) isn't used during angioplasty. These complications include: • • • • • • • • • • • • Angioplasty can restore blood flow to the heart if the coronary arteries have become narrowed or blocked because of CHD. Stroke. However. if you're over 80 years of age or have other serious medical problems. An arrhythmia (irregular heartbeat). Blood thinners are given during the procedure to reduce this risk. A stroke can also occur if plaques in your heart break loose when the catheters are being threaded through the aorta.this can usually be repaired with a stent stroke from a clot that is dislodged while the catheter is inside the body bleeding or bruising kidney problems. Tylenol®). General anesthesia isn't needed. When a stent is used. The inset image on figure B shows a cross-section of the tissue growth around the stent. However. you may be considered too vulnerable for the trauma of openheart surgery. you'll be moved to a special care unit. and death. and the patient is kept alive by a heart-and-lung machine. Key Points • • • • • People aged 75 and older People who have kidney disease or diabetes Women People who have poor pumping function in their hearts Coronary Angioplasty ( Percutaneous coronary interventions(PCIs)) • • • • • • Coronary angioplasty is a procedure where a narrowed section of a coronary artery is widened by using a balloon and a stent attached to a catheter. A 'stent' (a small tube) is left in place to keep the artery widened. there is a higher risk of blood clots. Stents were developed to reduce restenosis. Your doctor may recommend lifestyle changes after angioplasty to improve CHD and to prevent arteries from becoming narrowed or blocked again. angioplasty allows people to come back for more treatment. You may have bleeding at the site in your leg or arm where a catheter was inserted. the atheroma re-forms within the stent over the next few months and years. The procedure improves blood flow to the heart muscle. The procedure can improve symptoms of CHD. Though rare. During angioplasty. this could trigger a heart attack. Then the balloon is deflated and the catheter is removed from the body. It is inserted through a peripheral artery (usually femoral. especially in people with underlying kidney disease and diabetes . In figure A. During angioplasty. When plaque builds up in the coronary arteries. With angioplasty alone — without stent placement — restenosis happens in as many as 30 to 40 percent of cases. Damage to the kidneys caused by the dye used. Usually strips of vein are removed from one or both of the patient's own legs to be used as bypass grafts. to prevent treated arteries from closing again. A small mesh tube called a stent usually is placed in the newly widened part of the artery. For this procedure. though rarely. For more information on brand names. Bleeding. multiple coronary blockages. the condition is called coronary heart disease (CHD). quitting smoking. 4 out of 10 people have restenosis. and to make the procedure an option for more people. This is because angioplasty temporarily blocks the artery completely when the balloon is inflated. The stent remains in place after the procedure. If the angioplasty lasts six months. such as radiation. angioplasty may be a more attractive option. However. A medication may have many brand names. nurses will check your heart rate and blood pressure. What Are the Risks of Coronary Angioplasty? Coronary angioplasty is a common medical procedure. a second angioplasty is far less traumatic to the body than a second open heart procedure. It's important to take aspirin. Talk to your doctor about how long you'll need to take these medications and whether they can be discontinued if you need surgery. As with any procedure involving the heart. • • Coronary angioplasty is a procedure used to open blocked or narrowed coronary (heart) arteries. and to make the procedure an option for more people. In that case. Serious complications include: • • • • • • • • Bleeding from the blood vessel where the catheters were inserted. it's important to talk with your doctor about your treatment options. Sublingual Nitroglycerin (organic nitrates) Treatment for acute angina attacks. heart attack. This may narrow the artery again and angina pains may return again.. but only one common name. These complications may require emergency bypass surgery. cause death. It is difficult to give figures as to how often this occurs. Possible complications Angioplasty is safer than bypass surgery.g. Usually this simply results in a bruise. Coronary artery damage. These heart rhythm problems are usually short-lived. The risk of complications is higher in: Heart attack. if used as recommended. losing weight or maintaining a healthy weight. Complications may include bleeding. The need for emergency coronary artery bypass grafting during the procedure (2–4 percent of people). a fatty substance called plaque can build up in your arteries. can help prevent tissue growth within a stent. Sometimes. The common name is the medical name for the medication (e. your doctor will use a thin. or those who have diabetes may be better off with CABG. Serious complications don't occur often. This pushes the plaque against the artery wall. intravenous fluids and medications can be given before and after the procedure to try to reduce this risk *All medications have both common (generic) and brand names. Sometimes chest pain can occur during angioplasty because the balloon briefly blocks blood supply to the heart. a wire is put through a catheter to where the stent is placed. People with many severe blockages. This article lists medications by their common names. Less than 2 percent of people die during angioplasty. the expanded stent compresses plaque. scar tissue grows through and around the stent. This is when the artery renarrows due to scar formation and possibly further plaque formation. This test uses dye and special x rays to show the insides of your coronary arteries. circumstances will make the choice for you. and more. If an artery re-narrows after CABG. Long-term complications In some cases. Less than 1% of people die from complications of angioplasty. over time. your doctor will need to know the location and extent of blockages in your coronary arteries. The wire releases radiation to stop any tissue growth that may block the artery. your doctor may give you a medication to try to protect your kidneys. Re-narrowing of your artery (restenosis). An allergic reaction to the dye given during the angioplasty. Complications From Stents Restenosis After angioplasty. Effective dilatation of the stenosis results from compression of the atherosclerotic plaque and often by creating a farcture within the lesion and stretching the underlying media. The growth of scar tissue in and around a stent also can cause restenosis. Taking medicine as prescribed by your doctor can lower your risk of blood clots. Lifestyle changes may include changing your diet. Stent Restenosis The illustration shows the restenosis of a stent-widened coronary artery. He or she will thread the balloon catheter through an artery in your arm or groin (upper thigh) to the blockage in your coronary artery. relieving the blockage and improving blood flow. This is called restenosis (RE-sten-o-sis). often within 6 months of angioplasty. Your doctor will then inflate the balloon. Blood clots. complications can sometimes. your doctor will use coronary angiography. If you're at increased risk. The improvement in the size of coronary lumen increases the coronary perfusion and myocardial oxygen supply. but you'll be awake during the procedure. to prevent treated arteries from closing again. including the risks and benefits. there's a good chance it's permanent. On the other hand. The drawback to angioplasty is restenosis. and reduce the risk of death in some patients. including their use in people who have advanced CHD. there may not be enough vein or artery segments elsewhere in the body to perform a second graft. The heart is usually stopped and chilled. If the other arteries are also blocked. renarrowing of the artery. The balloon at the tip of the catheter is blown up (inflated) at the narrowed section of artery to dilate the stenosis. Blood Clots Studies suggest that there's a higher risk of blood clots forming in medicine-coated stents compared to bare metal stents. To find this information. speak with your doctor or pharmacist. 2 out of 10 people have restenosis. clopidogrel (Plavix) and other medications exactly as prescribed to decrease the chance of clots forming in your stent. but restenosis is far more likely after angioplasty than after a CABG. People who have extensive heart disease and blockages in their coronary (heart) arteries Research on angioplasty is ongoing to make it safer and more effective. This causes a partial blockage of the artery and abnormal blood flow.this is caused by the iodine contrast dye used for the X-ray. no conclusive evidence shows that these stents increase the chances of having a heart attack or dying.
because they are rapidly absorbed into the bloodstream via the oral mucosa. nitroglycerin produces greater dilation of veins than arterioles. ADR – hypotension. .- Produce vascular smooth muscle relaxation The mechanism involves the conversion of the administered drug (nitroglycerin)to nitric oxide at or near the plasma membrane of vascular smooth muscle cells. headache. as the drug deactivated in the liver. falling off within 15 to 30 min. reflex tachycardia. Onset .Peak action occurs within 3 min. diminished venous return and hence decreased right and left ventricular filling. Effect – diminished rapidly. Overdose – symptoms include vasodilatation. The venodilation results in venous pooling. reduced CO and hypotension. NO activates guanylate cyclase to produce cGMP and the intracellular accumulation of cGMP leads to smooth muscle relaxation At low doses. venous pooling. flushing.