Procedures/Coronary

Cath Lab Procedures

- Coronary

Percutaneous coronary intervention (PCI / stenting)

These are procedures that take place in the catheter laboratory under local anaesthetic and sometimes with the addition of sedation administered into a vein. The procedure can be a day case procedure or sometimes requires an overnight stay. This procedure is performed if you have an issue with the electrical functioning of the heart.

The ablation procedure is slightly different depending on the underlying condition that is being treated.

Some examples of these procedures are described below.

This is a procedure that is usually done at the same sitting as a coronary angiogram. It is a procedure that is performed to open up a blocked or tightly narrowed coronary artery. The procedure is a ‘keyhole’ procedure performed from the wrist or the groin under local anaesthetic. A stent is a small metal ‘scaffold’ which is introduced across a narrowing or blockage in the coronary artery to open up the artery and relieve it of the blockage or narrowing. A stent is usually about the same size of the little spring that you find if you take apart a pen. 

Over time, the body accepts this scaffolding as its own and a small layer of tissue grows over the surface of the stent so its present can barely be detected. However, during the early stages, there is a risk of the stent ‘blocking’ and therefore you will be asked to take blood thinner medication to stop the blood from ‘sticking’ to the stent. The type and duration of the blood thinner medication will depend on the type of stent used, your medical condition and the technicalities of the procedure and will be discussed with you by the medical team after your procedure. 

 

The most common reason that you may undergo this procedure is because you suffer with angina or because you have recently had a heart attack. The procedure starts with a coronary angiogram. Once the x-ray images of your coronary arteries have been taken, the doctor will decide which artery or arteries require a stent. A wire is introduced into the coronary artery and then the stent is ‘piggy-backed’ over the wire and positioned in place under x-ray guidance. You may experience chest discomfort during the procedure. This is very common but you should let your doctor know if you develop this or feel unwell in any other way.
 

We perform many stent procedures at Wythenshawe every year and consider it to be a mostly safe and straightforward procedure. Your Healthcare Professional will speak to you about the balance of the benefits and the risks. However, it is an invasive procedure and therefore can be associated with complications. The type of complications that can occur are similar to those listed under the coronary angiogram section (damage to artery / bleeding / bruising, allergy to x-ray dye, kidney damage, damage to the heart, heart attack, stroke) but as this procedure is more invasive than a coronary angiogram, the risks quoted to you will be different (and individual to your particular procedure) and will be discussed with you at the time of the consent process.
 

The length of the procedure varies according to the number of arteries and stents inserted and the complexity of the procedure, but typically takes 1-2 hours. If the procedure is performed from the wrist then after the procedure a band is applied to the wrist to prevent bleeding for several hours after the procedure. If the procedure is performed from the groin then the puncture site is pressed  using a clamp device (often referred to as a Femstop). If you have the procedure from the wrist you will be able to sit up immediately. If you have the procedure carried out from the groin then you will need to lie flat for several hours after the procedure. 

If you have had the procedure as an in-patient (for example if you have been admitted with a heart attack) then you will return to the ward following your procedure and usually will stay in overnight. If you had the procedure as an out-patient, you would usually stay overnight but in some cases may be discharged on the day of the procedure. 

Main points

1.  A diagnostic test to clarify whether narrowings in the heart arteries are significant

2. Performed at the same time as a coronary angiogram

You should always talk to your healthcare team about any procedure you're going to have and make sure it is right for you.

oct coro image.jpg

Image from:

Cuesta et al. Circulation: Cardiovascular Interventions. 2017;10:e005232