Heart Attack Treatment - Angiography or Angioplasty
Please discuss your experience with coronary angiography and PTCA.
Share your story with others:
MedicineNet appreciates your comment. Your comment may be displayed on the site and will always be published anonymously.
Coronary angiography and percutaneous transluminal coronary angioplasty (PTCA)
Coronary angiography and percutaneous transluminal
coronary angioplasty (PTCA) is the most direct method of opening a blocked coronary artery.
The procedures are performed in the catheterization laboratory in a hospital.
Under X-ray guidance, a tiny plastic catheter with a balloon on its end is
advanced over a guide wire from a vein in the groin or the arm and into the
blocked coronary artery. Once the balloon reaches the blockage, it is inflated,
pushing the clot and plaque out of the way to open the artery. PTCA can be effective
in opening up to 95% of arteries. In addition, the angiogram (X-ray pictures
taken of the coronary arteries) allows evaluation of the status of the other
coronary arteries so that long-term treatment plans may be formulated.
For optimal benefits, coronary angiography and PTCA should be
performed as soon as possible. Most cardiologists recommend that the time
interval between the patient's arrival at the hospital and the deployment of
the angioplasty balloon to open the artery should be less than 60 to 90 minutes.
For best results, the coronary angiogram and PTCA should be performed by an
experienced cardiologist in a well-equipped cardiac catheterization laboratory.
The cardiologist is considered experienced if he or she performs more than 75
such procedures a year. The catheterization laboratory personnel are considered
experienced if the facility performs more than 200 such procedures a year.
It also is important that there be a surgical team to perform immediate open-heart
surgery (coronary artery bypass grafting) in the event that PTCA is unsuccessful
in opening the blocked artery or if there is a serious complication of
PTCA. For example, in a small number of patients, PTCA cannot be performed because
of technical difficulties in passing the guide wire or the balloon across
the narrowed arterial segment. Open-heart surgery also will be necessary if
there is a serious complication such as coronary artery injury during PTCA or an
abrupt closure of the coronary artery shortly after PTCA. These complications may occur in
1% to 2% of patients.
The most serious complication of PTCA is an abrupt closure of the coronary
artery within the first few hours after PTCA. Abrupt coronary artery closure
(that can lead to further heart damage) occurs in 5% of patients after simple
balloon angioplasty (without stenting). Abrupt closure is due to a combination
of tearing (dissection) of the inner lining of the artery, blood clotting at the
site of the balloon, and constriction (spasm) or elastic recoil of the artery at
the site where the balloon is inflated. Individuals at an increased risk for
abrupt closure include women, patients with unstable angina, and patients having
The risk of abrupt closure of the coronary arteries can be reduced if:
Aspirin is given during or after PTCA to prevent blood
clotting. In fact, virtually all patients are maintained on aspirin
indefinitely after PTCA to prevent arterial clots.
Anticoagulants such as intravenous heparin or bivalirudin are given
during PTCA to further prevent blood clotting.
Combinations of nitrates and calcium channel blockers are used to minimize coronary artery spasm (see discussion that
Coronary artery stents are deployed to minimize
coronary artery closure.