Types of Percutaneous Coronary Interventions for CAD PDF

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PCI...

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Types of Percutaneous Coronary Interventions (PCI) for CAD Percutaneous Transluminal Coronary Angioplasty (PTCA)

Coronary Artery Stent

Atherectomy Bracgytherapy

Complications

Post-Procedure Care

Balloon-tipped catheter is used to open blocked coronary vessels and resolve ischemia Used for patients with angina and as an intervention for ACS Purpose is to improve blood flow by compressing and “cracking” the atheroma Catheters called sheaths are inserted through the femoral artery and threaded till it reaches the coronary arteries  Angiography is performed, where dye is injected to locate and see the extent of blockage  A balloon-tipped catheter is passed through the sheath and inflated to crack the arethoma  Several inflations and balloon sizes may be used  Stent may be placed to prevent or overcome the risks of tissue damage (which can cause vasoconstriction and clotting) and keep the artery open  Some stents may be coated with medications to minimize the formation of thrombi or scar tissue  Patient receives anti-platelet medications (aspirin or clopidogrel) because of the risk of thrombus formation  Invasive interventional procedure that involves the removal of the atheroma, or plaque, from the coronary artery by cutting, shaving, or grinding  PTCA and stent implantation cause a cellular reaction in the coronary artery that promotes proliferation of the intima, increasing the posibiliy of arterial obstruction  Brachytherapy reduced the recurrence of obstruction preventing vessel restenosis by inhibiting smooth muscle cell proliferation During PCI: Post PCI:  Dissection  Abrupt closure of artery  Perforation  Bleeding at insertion site  Abrupt closure  Retroperitoneal bleeding  Vasospasm  Hematoma  Acute MI  Arterial occlusion  Acute dysrythmia  Acute renal failure  Cardiac arrest  Monitor closely for bleeding  Patient must remain flat in bed and keep the affected leg straight until the sheaths are removed  Patients with renal insufficiencies are at risk for agent-induced nephropathy and must be infused IV with saline or sodium bicarbonate and acetylcysteine  Diagnostic cardiac caths, outpatient, requires 2-6hrs of bed rest after the procedure before the pt can ambulate o Size of catheter used determines recovery time  Patients hospitalized for angina or acute MI who require cardiac cath usually return to hospital for recovery    ...