|Cardiac Catheterization & Intervention
Despite dramatic improvements in noninvasive imaging techniques cardiac catheterization with coronary angiography remains the standard by which coronary heart disease is assessed. With coronary artery disease the normally smooth and flexible arteries manifest build up of fatty deposits known as plaque within the wall of the vessel. By advancing a small plastic tube (catheter), inserted by entry into the femoral, brachial, or radial artery, to the level of the ascending aorta injections of iodinated contrast (dye) are made into the three major coronary arteries surrounding the heart. X-rays video imaging of the arteries as they are filled with contrast allows detailed pictures identifying any plaque buildup or blockages. Injection of contrast within the pumping chamber of the heart allows assessment of heart muscle function as well as valve function.
Should narrowed coronary arteries be identified with diagnostic angiography it is possible to open the blocked vessels without surgery. During angioplasty a thin flexible tube with a small balloon at the catheter tip is inserted inside the angiographic catheter (the catheter used to inject dye) and advanced over an extremely thin guide wire to the point of obstruction and the balloon is inflated. This stretches the artery, compresses the plaque against the vessel wall, and expands the channel allowing normal blood flow. The balloon dilatation catheter is removed and very frequently a new catheter carrying a stent is advanced to the angioplasty site and expanded. The stent is an extremely thin stainless steel coil which is permanently implanted and serves as a scaffold that supports the artery wall preventing collapse and renarrowing. Subsequently all the catheters are removed and pressure applied to the access site to prevent bleeding. Generally patients remain hospitalized overnight and are allowed to return to normal activities the following day.