Cardiac catheterization is performed in a specially equipped x-ray room in the hospital called a Cardiac Catheterization Laboratory. The night prior to the test, you may not be allowed to eat or drink anything after midnight. Before the catheterization, a doctor will explain the procedure to you and ask certain questions about your health. While you are discussing this test, you should ask any questions or mention any concerns or worries that you have about the procedure. After the procedure has been explained, you will be asked to sign a consent form, which gives your permission for the test to be performed.

Before your procedure begins, you will be taken to the room where the cardiac catheterization will be done. Your heart rhythm will be monitored and an intravenous line (IV) will be placed to provide you with fluids and to make it easier to administer any needed medication.

Your arm or groin will be shaved and cleaned with an antiseptic solution and sterile cloths will be placed in this area. Before the procedure begins, you will receive a local anesthetic to numb the area. This may feel like a bee sting but will only last a few seconds.

During the procedure you will not need general anesthesia, but a sedative may be given to help you relax. It is important for you to remain awake so that you can move or breathe deeply when asked to do so by the doctor. Following these instructions will improve the quality of the x-ray.

During this procedure a long tube called a catheter is inserted into an artery in your arm or groin. The catheter is guided to your heart and then into the coronary arteries. The catheter provides a pathway for a special liquid dye to follow into the arteries. This liquid dye allows the doctor to see the shape and size of your arteries as well as the function of your heart muscle on an x-ray screen.

Once the catheter is positioned, the doctor will take pictures of your heart. With the catheter in the main pumping chamber of the heart (left ventricle), some dye will be injected through the catheter and a picture will be taken. The dye makes it easier for the doctor to see the shape and overall function of your heart. You may be asked to take a deep breath and hold it, which allows the doctor to have a clearer view of your heart on the x-ray screen. As the pictures are taken, the noise of the camera may sound like a motor. You may also feel a hot flush when the dye is injected. This feeling is to be expected and normally passes in 15 or 30 seconds.

Pictures will also be taken of your coronary arteries from several different angles. You may be asked to cough several times after each picture is taken. Coughing helps to clear the dye from your coronary arteries. Many x-ray pictures will be taken during your catheterization. Once all these pictures have been developed and your doctor has been able to review them, he or she will be able to discuss the final results with you. If the cardiac catheterization showed that there were one or more blockages in your coronary arteries, then further treatment will be recommended.

Can Heart Disease Be Treated?

Most patients with heart disease receive medication to help prevent a heart attack, and doctors usually recommend controlled exercise and a low-fat diet. Medication may also be prescribed to help lower cholesterol levels in the blood. However, there are no drugs available to eliminate blockages within the heart arteries. If heart disease is present, you may be at risk of having a heart attack if the disease is not treated. Until several years ago, the only treatment for blockages of heart arteries was Coronary Artery Bypass Graft (CABG) surgery.
Today, there are several options available to you. Your doctor can determine which option is best.

Angioplasty

This procedure may be done immediately following your catheterization or you may be sent home and instructed to return for the procedure. You will be asked not to eat or drink anything after midnight on the night before your procedure. It is important that you follow these and any other instructions carefully.

If you have had a cardiac catheterization procedure, angioplasty is similar in many ways. Your heart rhythm will be monitored, an intravenous line will be inserted in your arm, your arm or groin area will be shaved and cleaned and the procedure will be performed through that area. As with cardiac catheterization, it is important for you to follow your doctor’s instructions during the procedure.

Balloon Angioplasty Step-By-Step

It is not uncommon to experience some discomfort or a pressure sensation in your chest when the balloon is inflated. During the procedure you will be asked to remain very still. You will be asked how you are feeling; be sure to let your doctor know if you experience any discomfort.

  • After a local anesthetic is given, a tiny incision will be made and a long, thin tube called a sheath is inserted into the artery. Then, a narrower and longer tube, called a guiding catheter, is passed through the sheath to the heart.
  • Contrast dye (x-ray dye) is injected through the guiding catheter to allow the doctor to see the arteries of your heart on an x-ray machine called a fluoroscope.
  • While observing the arteries on the x-ray screen, (a) the doctor threads a guidewire through the guiding catheter and advances it to the diseased artery.
  • A balloon catheter is inserted over the guidewire (b) and positioned at the site of the blockage.
  • Once the balloon catheter is in place, the balloon is expanded (c). As the balloon expands, it compresses the fatty deposits (plaque) against the lining of the artery. The balloon may be expanded one or more times before it is removed. X-ray pictures are taken so that the doctor can monitor your artery as the blood flow is improved.
  • Once the catheter is removed, the fatty deposits remain compressed, and blood flow is restored to your heart (d). The balloon procedure may last from 30 to 90 minutes, but varies from patient to patient.

Coronary Artery Re-narrowing May Occur After Balloon Angioplasty

It is not uncommon for patients to develop a re-narrowing in the same site as the initial balloon procedure. In fact, one-third to one-half of patients who have successful balloon angioplasty will return in the first 3-6 months after the balloon procedure. This kind of narrowing is called “restenosis” and is due to a type of scar tissue formation.

In order to lower the risk for restenosis, your doctor may recommend a procedure called coronary stent implantation. Experience has shown that use of a coronary balloon-expandable stent reduces the rate of restenosis and improves the success rate of balloon angioplasty.

What is a Coronary Artery Stent?

A coronary stent is a small, slotted, metal tube that is mounted on a balloon catheter. It is inserted into your artery after a wider channel has been created by a balloon, and is positioned at the site of the blockage. When the balloon is inflated, the stent expands and is pressed into the inner wall of the artery. The balloon is then deflated and removed with the stent remaining in place. The stent acts as a scaffold that helps to hold the artery open, which improves blood flow and relieves symptoms caused by the blockage.

A stent is a permanent implant that remains in your artery. Over the next month, your cells will form a natural covering which will hold the stent securely in place. Stents will not rust or move once they are inserted inside your artery. Although you may be instructed to avoid having an MRI (Magnetic Resonance Imaging) within eight weeks after your stent implantation, tests have shown that this procedure will not affect the stent or make it move. Metal detectors found in airports and appliances such as microwave ovens also will not affect the stent or make it move.

Preparation for a Coronary Stent

If you know in advance that you will be receiving a coronary stent, your doctor will ask you to follow certain instructions, in addition to those listed for balloon angioplasty. For several days before the procedure, you will be asked to take aspirin and other prescribed medication.

Be sure to let your doctor know:

  • If you cannot take aspirin
  • If you are taking any other medications
  • If you have any drug allergies
  • If you have a history of bleeding problems

How is a Coronary Stent Implanted?

A coronary stent may be placed after the initial balloon procedure, which is done to create a wider opening for the stent. You will have the same feelings when the stent is put in place as when the balloon was expanded during the procedure.

  • The stent, which is mounted on balloon catheter, is inserted into the artery and placed at the site of the initial blockage.
  • When the balloon and stent are positioned, the balloon is inflated. The stent expands and becomes firmly pressed into the inner wall of the artery. Additional balloon inflations may be needed to fully expand the stent.
  • X-ray pictures are taken so that the doctor can see the stent in your artery. Additional balloon inflations may be needed to fully expand the stent.
  • The balloon catheter is deflated and removed along with the guidewire and guiding catheter.
  • The stent will remain in place permanently, keeping the artery open.

Coronary Stent Re-narrowing (In-Stent Restenosis) May Occur After Coronary Stenting

Occasionally some patients develop a re-narrowing within the stent. This kind of narrowing is called “In-stent Restenosis” and is due to a type of scar tissue formation. In fact, 10 to 20 percent of patients who have successful stent implantations develop in-stent restenosis.

Be sure to let your doctor know:

  • If you cannot take antiplatelet medication
  • If you cannot take aspirin
  • If you are taking any other medications
  • If you have any drug allergies
  • If you have a history of bleeding problems

What Happens After Your Angioplasty or Stent Procedure?

After your procedure, you will be moved to a special care unit where nurses will be able to monitor your heart rhythm and blood pressure very closely. At this time, the sheath (tube) may be removed and pressure will be applied to the puncture site, either your groin or arm, until the bleeding has stopped. Your puncture site will be watched closely for any signs of bleeding. If your groin or leg was used to insert the catheters, you will be instructed to lie flat for several hours or overnight, and you will not be allowed to bend the leg that was used. A restraint may be placed around your ankle as a gentle reminder not to move or bend that leg. Should you see any blood or feel warmth at the area of the puncture site, notify your nurse immediately.

Once you have returned to your room, you may eat and drink and your family may visit. It is recommended to eat foods that are light until you are able to sit upright. Drink all of the fluids that are offered, because they will help to flush the x-ray dye through your kidneys and out of your body. While you are resting in bed, blood samples will be taken, so your medical team can see how well you are doing. Your doctor may allow you to get out of bed with assistance the day after the procedure providing your puncture site is healing, an your activities will be increased gradually.

Many patients are able to go home the day following their procedure. The amount of time that you stay in the hospital will depend on several factors including any difficulties that you may have experienced during the procedure and how well the puncture site is healing. The amount of time may also depend on the hospital’s policy for patients undergoing your specific procedure.

Your Medications are Important

  • After you leave the hospital you will be instructed to take medications. It is very important that you take your medications exactly as prescribed.
  • Be sure not to miss any doses. Both aspirin and other antiplatelet medications can irritate your stomach.
  • It is recommended that you take these pills with food and avoid alcoholic beverages.
  • Call your doctor if you feel that you cannot tolerate your medications or develop any side effects such as bleeding, upset stomach, rash, or have any questions.

Depending on which antiplatelet medications are prescribed, you may need to have follow-up blood tests to monitor the effects of the medicine on your blood. This can be done at your local hospital laboratory or primary care doctor’s office and you may have breakfast before having it drawn.

It is very important to follow these instructions:

  1. You must follow your medication schedule exactly.
  2. Do not stop taking any of the prescribed medications unless you are instructed to do so by the doctor who performed the procedure.
  3. If you experience any side effects of the medications such as nausea, vomiting, and bleeding or rash, notify your doctor.
  4. Notify your doctor immediately if you experience chest pain (angina) or notice any changes such as more severe or frequent chest discomfort, especially in the first month after a procedure.
  5. If you report to an emergency room, show them your identification card, which identifies you as a stent implant patient.
  6. Keep all appointments for follow-up care including your blood tests. Avoid Magnetic Resonance Imaging (MRI) medical scans within eight weeks of stent placement without clearance from your cardiologist.
  7. If you are scheduled to see the dentist in the first month after your procedure, notify your cardiologist or family doctor of your appointment.

You will be discharged to the care of your cardiologist or family doctor. After returning home, if you experience any pain, discomfort, bleeding of any kind, rash or itching, contact your doctor or the hospital. Eventually, you should be able to return to your normal activities such as work, sports, and sex, but ask our doctor before doing anything that is physically strenuous.

After You Go Home

If you received a stent you will be given a small wallet-size identification card containing information about the location of your stent and the date it was performed, along with important doctors’ names and telephone numbers. This card should be kept with you at all times. It is important to alert any doctor that is treating you that you received a stent.

Follow-Up Visits

You will be instructed to return to see your cardiologist or family doctor. The first visit will usually take place within the first 2-4 weeks after your procedure and every six months for the first year. If you are doing well, the doctor may recommend yearly visits thereafter.