Purpose of PTCA
If you have coronary artery disease (CAD) caused by atherosclerosis, you will be advised to undergo percutaneous transluminal coronary angioplasty (PTCA). This is a condition in which the walls of the coronary arteries (which supply blood to the heart) develop deposits of cholesterol, fatty compounds, calcium, and fibrin, a blood-clotting material. As the blockage worsens, the blood supply to the heart slows, resulting in angina pectoris.
Medication reduces the likelihood of blood clots forming at the site of blockages, but it does not clear the blocked arteries. In such cases, your doctor will advise you to have surgery to remove the blockages and lower your risk of having a heart attack.
PTCA and coronary bypass surgery are two ways of treating arterial blockages. The doctor will recommend which one to take after evaluating the extent of the artery narrowing, the number of arteries affected, their location, your risk of a heart attack, and personal health concerns.
Tests and investigations prior to the procedure
Prior to the procedure, your cardiologist will review your medical history and perform physical tests and investigations.
You will have a coronary angiogram, which will determine whether your arterial blockages can be treated with a PTCA procedure. Your doctor will evaluate the extent of the damage and will plan the procedure accordingly.
Procedure for PTCA?
PTCA, or percutaneous transluminal coronary angioplasty, can take anywhere from 30 minutes to several hours, depending on the number of blockages to be opened and the occurrence of any complications during surgery. The procedure does not require general anesthesia, and you will be awake throughout.
Local anesthesia is injected into the femoral artery in the groin, followed by the insertion of a guidewire through the needle. After an introducer is placed over it, the wire is removed and replaced with a wire of a different size.
Following that, your surgeon inserts a diagnostic catheter (a long, narrow tube) into the blood vessel via the introducer. Once in position, the guidewire is removed and the catheter is gently guided to the aorta until it reaches one of the coronary artery openings. To see if there are any blockages, a dye is injected and an x-ray is taken.
Risks of the surgery
The following are some of the most common PTCA complications:
- Re-narrowing of the artery – This condition, known as restenosis, occurs when PTCA is completed without the addition of stents in the blood vessel.
- Blood clots – Blood clots can form in the stents weeks or months after angioplasty, causing a heart attack. Aspirin and other pain relievers can help.
- Bleeding is common as a result of a bruise at the site of catheter injection, but severe bleeding may necessitate a blood transfusion or a separate surgical procedure.
- Other uncommon surgical complications include heart attack, coronary artery damage, kidney problems, stroke, and abnormal heart rhythms.
Precautions before and after PTCA
In preparation for the surgery, you will have routine tests such as blood tests, a chest x-ray, and an electrocardiogram (ECG), and your heart may be monitored overnight. Inform all medications you are taking with your doctor. You may be given anticoagulant medications as well as artery-relaxing medications.
