Coronary Artery Disease
Cardiac catheterization with coronary angiography is the injection of a contrast media directly into the coronary arteries in order to take images of the coronary arteries to identify sites of arterial obstruction. In doing so, a local anesthetic will be injected at the groin or left or right wrist of the patient. Then the doctor will make a small puncture through the skin and insert a catheter with a diameter of about 2.5 mm to travel along the artery to reach the aorta. Next, the doctor will inject a contrast media via the catheter to enter the coronary arteries to inspect for stenosis or obstruction of the coronary arteries and to determine the treatment guideline. This method can be used to identify the number of coronary arteries that are blocked, the condition of the coronary arteries and whether or not balloon angioplasty can be used to expand the coronary arteries. The procedure can help determine the best treatment method for each patient.
Coronary angiography today can be performed at 2 main sites, namely, at the groin and the wrist. To perform this procedure at the femoral artery, a local anesthetic is used without surgery. About 30-60 minutes are required to perform the procedure, after which the catheter will be removed. Pressure then needs to be applied to the groin for about 15 minutes, but no stitches are required. Accordingly, the patient will have to lie flat and not bend their groin for about 6-10 hours. They will not be able to sit or walk around immediately after the procedure.
Meanwhile, for coronary angiography performed through the wrist or radial artery, the catheter can be inserted via an artery at the wrist, and the patient will require about 4-8 hours of recovery. After the procedure, the patient can get up, sit up or stand right away while wearing a wrist band (TR band) for only a short period of time. Although the doctor has to be skilled in this procedure, this procedure has many benefits, especially in very obese patients with peripheral arterial disease in their legs, who are more suitable for the procedure to be performed by the wrist. However, limitations exist to make it impossible to perform this procedure in cases where it is necessary to preserve the arteries of the wrist for other treatments such as dialysis, etc.
Coronary angiography begins with the injection of a contrast media to observe arteries suffering from stenosis. If stenosis is discovered, the doctor will judge whether or not balloon angioplasty is needed to expand the affected artery, or else the patient might be referred for coronary artery bypass surgery. The procedure takes no more than 30 minutes, and if the patient requires balloon angioplasty to expand an artery, they will require no more than 1 hour of additional time. Furthermore, the doctor will only use a local anesthetic, which is good considering that general anesthesia increases risks to the patient, and if the patient is conscious and alert all the time, the patient will be able to communicate to the doctor about their needs and abnormal symptoms, which makes it possible for the medical team to provide timely care in the event of an emergency. After performing balloon angioplasty, the patient will spend 1-2 days in recovery before being able to return home.
Coronary Artery Disease Treatment with PTCA and Bypass
- Percutaneous transluminal coronary angioplasty or PTCA and stent is a non-surgical treatment procedure for coronary arterial disease by being performed after coronary angiography. This procedure uses a balloon to expand a coronary artery in order to allow blood supply to reach the heart as normal, and it includes the insertion of a stent into the affected coronary artery of the patient with coronary arterial disease subsequent to using the balloon to expand the artery in order to prevent recurrent stenosis.
- In most cases, the average time required for performing PTCA is about 0.5-1.5 hours, depending on the location of the stenotic artery and the number of stenotic arteries. The benefits of PTCA include allowing the patient to quickly recover from chest pain symptoms and a very short recovery time in the hospital. Most patients can return home within 1-2 days and return to normal activities or events within 1 week. In any case, performing PTCA by use of ordinary balloons remains popular, with about 80% of cases also including the use of a stent, and new stents have been developed to be able to reduce new stenosis to less than 5%. PCI treatments today have a success rate of 85-99%, although some limitations still exist such as in some cases where this procedure cannot be used to replace surgery.
- Bypass surgery/coronary artery bypass grafting (CABG) is used to change the blood supply channel to the heart. Often, a vein in the leg or artery in the chest is used to redirect blood by bypassing the site of obstruction. Usually, it is necessary to perform this surgery on 2-5 blood vessels at the same time. There are two types of coronary artery bypass surgeries today, namely, off-pump CABG that do not require the use of a lung and heart machine or stopping of the heart and on-pump CABG, which completely stops the heart.
Off-pump bypass surgery requires less blood, less operation time and less anesthesia, not to mention less hospital recovery time than on-pump bypass surgery.
