Cardiac Catheterization

[Ace5813]

Hope I spelled that right. Anyways, is this a generally routine procedure? What is involved in the procedure, and what is recovery like for most patients? What I do know is that it is a procedure which is used to un-block arteries. Thanks for your help!

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[MD2b06]

It's a fairly routine procedure (<1 hr). Most patients can go home the same day. Often done on an outpatient basis. Used to detect the extent of blockage in coronary arteries. A catheter is inserted into the femoral artery and guided upwards toward the coronary vessels. Dye is injected and any blockages can be visualized on a fluro monitor. The actual process of unblocking an artery is done via balloon angioplasty. Drug coated stents (coated w/ clopidrogrel) are also often placed in order to prevent reocclusion. Interventional cardiologists are trained to perform angioplasties and stent placements. The training is another 1-2 years after your cards fellowship. All in all 3 years IM + 3 years Cardiology + 1-2 years Interventional Fellowship = 7-8 years of training.

 

[Eidolon6]

This is a routine procedure for cardiologists and a handful of cardiac surgeons. The invasive cardiologists tend to perform the higher risk interventions/stenting. This topic is better served in the IM/Subspecialties forum.

Cardiac cath has many flavors
diagnostic catheterization identifies coronary anatomy and possible stenoses
PCI or percutaneous coronary intervention (which often includes PTCA w or w/o stenting) involves intervening upon lesions/stenoses with angioplasty, stents, roto-bur, etc.

The general procedure is the patient is lightly sedated in the cath lab equiped with a fluoroscopy setup. A femoral arterial sheath is placed under local anaesthetic and a catheter is throught the artery up into the aorta and manipulated into the right and left coronary arteries. Radiocontrast is injected into the vessels under fluoro, demonstrating filling defects, flow. The left ventrical is usally also assessed unless there are concerns about excess contrast use. Once the pictures are taken, the catheter is removed, the sheath is removed, and the vessel is repaired usually w/ a fibrin plug or angioseal device and pressure is applied to the puncture. Patients generally need to remain supine for 4 hours after the procedure. Depending on interventions performed, complications, the patient may stay overnight or frequently will go home after 4 hours. The intricacies are a little more detailed and invasive cardiology is exploding with new procedures and philosophies.

Complications include bleeding, femoral artery aneurysm, mycotic aneurysm, arrythmia, dye toxicity, stroke, coronary rupture/dissection, myocardial stunning.