PTCA -- Percutaneous Transluminal Coronary Angioplasty

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It's coronary angioplasty or more commonly referred to as just angioplasty!

One of the most common non-surgical treatment for opening obstructed coronary arteries is Percutanueous Transluminal Coronary Angioplasty aka PTCA. The name itself says a lot about the procedure:

* Percutanueous means access to the blood vessel is made through the skin.

* Transluminal means the procedure is performed within the blood vessel.

* Coronary specifies that the coronary artery is being treated.

* Angioplasty means "to reshape" the blood vessel with balloon inflation of a catheter.

It's often referred to as simply coronary angioplasty, balloon angioplasty, or just angioplasty.  Special "balloons" are used to open up obstructed arteries, and sometimes devices known as "stents" are used to help keep the arteries open.

My knowledge of PTCA came first-hand after serving as the "Office Manager" to Dr. Andreas R. Gruentzig, the inventor of PTCA, at Emory University Hospital in the early 1980s.  I personally never had a coronary angioplasty, but I knew alot about it thanks to Dr. Gruentzig.  He WAS an amazing person!

What is Angioplasty? 

Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel; typically as a result of atherosclerosis. Tightly folded balloons are passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres).

The word is composed of the medical combining forms of the Greek words ??????? aggeîos meaning "vessel" and ??????? plastós meaning "formed" or "moulded". Angioplasty has come to include all manner of vascular interventions typically performed in a minimally invasive or percutaneous method.

Tell me more about the Balloon Catheter ... Used in PTCA 

A balloon catheter is a type of "soft" catheter with an inflatable "balloon" at its tip which is used during a catheterization procedure to enlarge a narrow opening or passage within the body. The deflated balloon catheter is positioned, then inflated to perform the necessary procedure, and deflated again in order to be removed.

Some common uses include:

*angioplasty or balloon septostomy, via cardiac catheterization (heart cath)

*tuboplasty via uterine catheterization

What is a Coronary Catheterization? 

A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes.

Coronary catheterization is one of the several cardiology diagnostic tests and procedures. Specifically, coronary catheterization is a visually interpreted test performed to recognize occlusion, stenosis, restenosis, thrombosis or aneurysmal enlargement of the coronary artery lumens; heart chamber size; heart muscle contraction performance; and some aspects of heart valve function. Important internal heart and lung blood pressures, not measurable from outside the body, can be accurately measured during the test. The relevant problems that the test deals with most commonly occur as a result of advanced atherosclerosis -- atheroma activity within the wall of the coronary arteries. Less frequently, valvular, heart muscle, or arrhythmia issues are the primary focus of the test.

Coronary artery luminal narrowing reduces the flow reserve for oxygenated blood to the heart, typically producing intermittent angina. Very advanced luminal occlusion usually produces a heart attack. However, it has been increasingly recognized, since the late 1980s, that coronary catheterization does not allow the recognition of the presence or absence of coronary atherosclerosis itself, only significant luminal changes which have occurred as a result of end stage complications of the atherosclerotic process. See IVUS and atheroma for a better understanding of this issue.

Andreas Gruentzig, the inventor of PTCA 

Andreas Roland Grüntzig (1939?October 27, 1985) was a German cardiologist who first developed successful balloon angioplasty for expanding lumens of narrowed arteries.

Additional info on Andreas Gruentzig 

After employing Dotter's techniques of transluminal angioplasty, which he had learned from Eberhart Zeitler in Nuremberg, Andreas Gruentzig, a young German physician working at University Hospital in Zurich, Switzerland, began toying with the idea of adding a balloon to the Dotter catheters. He started fashioning prototypes in his own kitchen, searching for a viable material and design. In 1975 he developed a double-lumen catheter fitted with a polyvinylchloride balloon that would set in motion a revolution in medicine.

He presented the results of animal studies with the balloon at the American Heart Association meeting in 1976 and was met with skepticism, although a few individuals saw the potential of his work. Dr. Richard Myler of Saint Mary's Hospital in San Francisco suggested they collaborate and the two performed the first human coronary angioplasty intraoperatively during bypass surgery in San Francisco.

In September 1977, in Zurich Switzerland, Gruentzig performed the first coronary angioplasty on an awake human. Now, a year later, when he presented the results of his first four angioplasty cases to the 1977 AHA meeting, the audience burst into applause, acknowledging his breakthrough with a standing ovation.

Gruentzig began a careful, rigorous process of furthering and disseminating the technique through live demonstration courses and establishment of a PTCA registry at the National Heart, Lung and Blood Institute to gather and share experience. Throughout the 1980's, improvements in angioplasty technology continued exponentially.

Gruentzig's breakthrough was a synthesis of all that had come before and because of the brilliant way in which he fostered its acceptance, the field of interventional cardiology has forever altered the role of the cardiologist in treating coronary artery disease.
--ptca.org aka angioplasty.org.

Check out the above site for some INTERESTING video clips of an interview with Dr. Gruentzig, conducted in September of 1985, one month before a plane crash claimed his life on October 27. The interview was conducted in his office at Emory University Hospital by Burt Cohen ... titled these clips "Grand Rounds."

Andreas Gruentzig lens 

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Angioplasty medical info 

So You're Having a Heart Cath and Angioplasty

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Grossman's Cardiac Catheterization, Angiography, and Intervention

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Endovascular Skills: Guidewires, Catheters, Arteriography, Balloon Angioplasty, Stents

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PTCA Procedure: Pre-Admission and Evaluation 

http://www.hgcardio.com

You will first undergo a thorough evaluation by your physician. Any questions you still have before your procedure begins can be answered at this time. You may be permitted clear liquids in the morning of the procedure. However, this should be cleared with your physician first. Otherwise, food and beverages may be withheld after midnight.

If you are a diabetic, you will be given special instructions. Your groin area will be washed and shaved in preparation for the PTCA/Stent.

Cardiac Catheterization with Angioplasty & Stent video 

Podcast: Cardiac Catheterization with Angioplasty & Stent...

On Wednesday, May 16, at 4 p.m., CST, an Internet audience will have a rare chance to watch a heart care procedure as it happens. During a live webcast from Saint Joseph's Hospital in Marshfield, Wisconsin, Marshfield Clinic interventional cardiologists will perform a live cardiac catheterization procedure as well as a possible angioplasty and stent placement. A physician moderator will be on hand to walk the audience through the procedure and give them the inside scoop on the crucial decisions the heart care team is making as they happen. Juan Mesa, MD; Kamilla Buddemeier, MD; Milind Shah, MD; and Sherief Rezkalla, MD, all Marshfield Clinic interventional cardiologists on staff at Saint Joseph's...

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PTCA Procedure: During 

http://www.hgcardio.com

The length of the procedure depends on the complexity of each individual's situation, but in general, the duration is between 1 and 2 hours.

An intravenous line will be started in your arm this morning. You will receive various medications in the angioplasty laboratory though this line. To help you relax, you will be given medication prior to leaving for the lab. You will remain awake, but slightly drowsy.

You will be placed on an x-ray table upon your arrival in the lab. It is the same type of room in which you had your cardiac catheterization. All personnel in the lab will be wearing surgical attire. You will be covered by sterile sheets, and so will some of the equipment. Your groin (arm) will be cleansed with an antiseptic (might be cold) and then numbed with an anesthetic. You will feel the sting of the needle, but then your groin (arm) will feel quite numb.

Heart monitoring equipment will be placed on your arms and legs, and you may be given oxygen to breathe. You will be given certain medications through the intravenous line, and periodically medication will be given to relax you and decrease any restlessness. Remember, 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. You will be asked at times to hold your breath for a few seconds. You may also be asked to cough.

After the procedure, you will be moved to a recovery area for a short time, and then taken to your room where your heart can be monitored. Nurses will closely monitor your vital signs and general well being. They will also frequently check the groin area and dressing. A small, flexible catheter is routinely left in the groin for 4-6 hours unless a percutaneous suture is used to close the hole. You will be required to remain in bed and keep your leg immobilized.

You will be able to eat as soon as you wish after the procedure.

Coronary Angioplasty animated video 

Coronary Angioloplasty

Animated video for coronary angioplasty brought to you by Medflux www.medflux.110mb.com

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PTCA Procedure: Recuperation 

http://www.hgcardio.com

The catheter or sheath will be removed approximately 4-6 hours after theprocedure is over. This waiting period is crucial as the physician uses blood-thinning agents to implant the stent, thus the sheaths cannot be removed until the blood thinning reverted back to normal and firm presssure applied for about 20 minutes. Then a pressure bandage is applied and a small sandbag 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. The rest of the day is basically for rest, recuperation, and a gradual return to your activities.

Angioplasty Stenting and Heart Attack video 

Angioplasty Stenting and Heart Attack

this is an angiogram of a patient who underwent angioplasty with stenting during an ongoing heart attack!!this obviously saved his life as well as damage to his heart muscle!!!

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PTCA Procedure: Discharge 

http://www.hgcardio.com

Your doctor will see you the morning of discharge. Your doctor's nurse will go over medications, activities, and follow-up care. You will receive prescriptions for medicines you will need, and will usually undergo a low-level stress test very shortly after your discharge.

Percutaneous Coronary Interventions video 

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PTCA Procedure: Complications & Risks 

http://www.hgcardio.com

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 of these complications arise, corrective action can be taken immediately. The incidence of complications is low, but they can be:

* Severe bruising/bleeding into the groin area.
* Changes in your heart rhythm.
* Allergic reaction to the contrast or dye.
* A tear in the lining of the artery being dilated.
* Possibility of a heart attack during or following inflation of the balloon or stent implantation.
* Possibility of a blood clot in the artery in which the catheter is inserted.

Balloon Angioplasty videos 

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PTCA Procedure: Follow-up 

http://www.hgcardio.com

Periodic follow-up with your personal physician is quite important. It is important for you to realize that by angioplasty (PTCA), your immediate problem has been taken care of, but it does not cure coronary artery disease. In some patients, re-narrowing (Restenosis) of the artery may occur over the ensuing 3-6 months. If this happens, your original symptoms may return, or your stress test will be 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 nitrolycerin tablets in a 15 minute period, DO NOT DELAY SEEKING MEDICAL ATTENTION. Either call your doctor, or go to an emergency room.

Drop me a line ... 

Are you familiar with PTCA or coronary angioplasty? Have you had one or know of someone who has?

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  • Reply
    Wes Wes Nov 14, 2008 @ 9:34 am
    Hi Jaguar Julie,

    Your PTCA lens readers may be interested in this upcoming chat from Cleveland Clinic:

    Tuesday, December 9, 2008 at 12 noon (EST) Cleveland Clinic will host an online health chat on Interventional Procedures.

    During this chat, Dr. Ravi Nair will answer questions about stents, angioplasty and new approaches to treat heart disease. More information on this chat can be found at http://www.clevelandclinic.org/health/ChatReg/nair.html

    Dr. Nair is on the staff of the Department of Cardiovascular Medicine at Cleveland Clinic. His specialty interests are ischemic heart disease, advanced cardiac invasive diagnostic procedure, and coronary intervention. Dr. Nair is certified by the American Board of Internal Medicine in the subspecialties of Interventional Cardiology and Cardiovascular Disease.

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