Atherectomy :

• What is a PCI?
  Coronary artery disease is the narrowing or obstruction of the vessels that supply blood and oxygen to the heart muscle. This narrowing is caused by fatty deposits (plaque) on the walls of the arteries. These fatty deposits gradually build up and can cause a marked reduction of blood and oxygen to the heart. If the blood flow is significantly reduced, some form of medical treatment becomes necessary.
  Most common non-surgical treatments for opening obstructed coronary arteries are:
   

  • Percutaneous Coronary Intervention (PCI):
    One of the interventional procedures is atherectomy, used in special circumstances as decided by your physician based on the type of blockage you have.

  • Rotoblation:
    This procedure is normally reserved for the treatment of highly calcified areas in the arterial system. This specialized procedure involves the insertion of a rotating catheter at up to 180,000 rpm. The obstructing fibrous plaque is pulverized into minute micro particles and washed away into the bloodstream. Typically, after removal of the device, a balloon or stent procedure follows as previously described.

  
   

  • Atherectomy:
    The catheter used in this procedure has a hollow cylinder on the tip with an open window on one side and a balloon on the other. When the catheter is inserted into the narrowed artery, the balloon is inflated, pushing the window against the fatty matter. A blade (cutter) within the cylinder rotates and shaves off any fat that protruded into the window. The shavings are caught in a chamber within the catheter and removed. This process is repeated as needed to allow for better blood flow. Like rotoblation, this procedure is rarely used today.

  

  
  PCI PROCEDURE:
   

• Pre-Admission and Evaluation

  • You will not be permitted any food or beverages after midnight to prevent nausea during the procedure.

  • If you are a diabetic, you will be given special instructions.

  • Your groin area will be washed and the hair clipped in preparation for the PCI.
     

• Angioplasty Procedure:

  • The length of the procedure depends on the complexity of each individual’s situation, but in general, the duration is 1 to 2 hours.

  • An intravenous line will be started in your arm in the morning.

  • You will receive various medications in the angioplasty laboratory through this line. To help you relax, you will be given medication prior to leaving for the lab. You will remain awake, but slightly drowsy.

  • Upon your arrival in the lab, you will be placed on an X-ray table. It is the same type of room in which you had your cardiac catheterization. You will be covered by sterile sheets. Your groin (or arm) will be cleansed with an antiseptic (which might be cold) and then numbed with an anesthetic. You will feel the sting of the needle, but then your groin (or arm) will feel quite numb. Heart monitoring equipment will be placed on your arms and legs, and you may be given oxygen to breathe through a small tube near your nose. You will be given various medications through the intravenous line, including medication to relax you. You must still be able to talk and follow directions.

  • The angioplasty catheter (balloon-tipped) is inserted at the numb area, and advanced to your heart, using X-ray to guide it. 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 these sensations are normal. Always let your doctor know how you feel during the entire procedure. You may be asked at times to hold your breath for a few seconds, or to cough.

  • After the procedure, if the femoral approach was used, you will be moved to a recovery area for a short time, and then taken to the step down unit where your condition can be monitored closely. Nurses will periodically check the groin area and dressing.

  • If the transradial approach was used, the catheter is removed and a dressing will be put over the incision. You will be returned to a recovery area or your room. Your blood pressure and pulse, as well as the puncture site, will be checked periodically. Normal activities may be resumed immediately.
    
    You will be able to eat as soon as you wish after the procedure.
     

• Recuperation:

  • The catheter will be removed and most of the times a closure device may be placed in the blood vessel if conditions are suitable (to allow early mobility). Some facilities still do manual catheters pull out and firm pressure applied for about 20 minutes. Then a pressure bandage is applied and a small sandbag may be placed over it. This is to assure proper healing of the artery. Pain medication is available to you every few hours after the procedure. Please let your nurse know of any pain or discomfort you may feel at any time.
     

• Discharge:

  • Most of the time you spend the night in the hospital for observation. The reason for that is safety of the patient.

  • Your doctor could discharge you 4 to 48 hours after the procedure, depending on your condition.

  • Your nurse will go over medications, activities, follow-up care and give you prescriptions for new medicines as needed. You may be scheduled for a stress test after your discharge. This stress test will help plan further treatment and rehabilitation.

  POSSIBLE COMPLICATIONS AND RISK

  No invasive procedure occurs without a certain amount of potential risk and complications. You are followed closely by your doctor and nurses, precisely for the reason that if any complications arise, corrective action can be taken immediately. The incidence of complications is low, but nonetheless, you need to be aware of what they can be:
   

• Severe bruising / bleeding into the area of the procedure.

• Changes in your heart rhythm.

• Allergic reaction to the contrast (“dye”) or to other medications used.

• A tear in the lining of the artery which is being dilated.

• Possibility of a heart attack during or after the procedure (you are given blood thinners to minimize this risk).

• Possibility of a blood clot in the artery in which the catheter is inserted which may require surgical removal.

• Rupture of the artery requiring bypass grafting surgery.

• Significant blood loss requiring use of blood products (blood or blood component transfusion).

FOLLOW-UP CARE:

Periodic follow-up with your personal physician is quite important. It is important for you to realize that by PCI (angioplasty), your immediate problem has been taken care of, but it does not cure coronary artery disease. In some patients, narrowing of the artery may recur. If this happens, your original symptoms may return, or your stress test may become abnormal.

If you have chest discomfort, stop your activity, sit or lie down, and take nitroglycerine, as instructed. If the chest discomfort does not go away after 3 nitroglycerine tablets in a 15 minute period, DO NOT DELAY SEEKING MEDICAL ATTENTION. Go to the nearest emergency room where the staff should call your doctor.