Percutaneous coronary heart catheterization and interventions (balloon dilatation and stent implantation)

Overview

In most cases, your doctor will refer you for a cardiac catheterization and possibly a procedure on the coronary arteries (percutaneous transluminal coronary angioplasty, PTCA) or stenting because your symptoms indicate a narrowing of the coronary arteries. If deposits have formed in your coronary arteries, leading to constrictions, these can reduce the blood flow to the heart muscle and therefore lead to symptoms such as chest tightness and shortness of breath. In this case, the narrowing can be treated minimally invasively with a balloon dilatation (PTCA) and stent placement.

Before, during and after the intervention, you will be looked after by a senior doctor. You will be kept informed about the results of the examination and the individualized therapy proposal.

Procedure

The intervention (PTCA and stenting) is performed while the patient is fully conscious. Local anesthesia is only required at the small puncture site. If you are nervous or have any discomfort, we can give you medication to calm you down or relieve the pain. After a local anesthetic at the wrist or in the groin, a thin, flexible tube (catheter) is inserted via the aorta to the heart.

Your coronary arteries are visualized under X-ray control using a few milliliters of contrast medium. If constrictions or occlusions are present, the affected area of the vessel is first dilated using an inflatable balloon at the tip of the catheter (balloon dilatation). After dilatation, a tubular metal mesh (stent) is also implanted in this site so that the previously narrowed area remains permanently open. The stent remains in the coronary vessel for the rest of the patient’s life and grows into the vessel within a few weeks to months.

The illustration on the left shows the heart (gray) and the coronary vessels that supply it (red). The anterior wall vessel (ramus interventricularis anterior, RIVA) shows a constriction in the anterior section caused by a cholesterol plaque (yellow). This constriction is shown enlarged in the rightmost section of the image. The middle section of the image corresponds to the X-ray image of the vessel with contrast medium, the so-called coronary angiography. The white circle illustrates the narrowing of the coronary vessel, which almost completely compromises the flow of contrast medium in the vessel.

Until the stent has grown into the coronary artery, you will receive two blood-thinning medications to prevent the formation of clots in the area of the stent and thus a blockage of the coronary artery. After the procedure, a pressure bandage will be applied to the puncture site and you will have to lie still for a few hours. You can usually leave the hospital the same evening or the following day.

Occasionally a stent insertion is not performed immediately and your case will be discussed by our heart team in order to define the most suitable therapy for you. Of course, factors such as age, concomitant diseases and patient preference also play an important role here. After the heart team meeting, you will be informed about our individualized therapy proposal and can give your thoughts on it.

Treatment team