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What Happens During a Cardiac Catheterization With Atherectomy

Clip Number: 7 of 38
Presentation: Atherectomy
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Reviewed By: Arthur Schoenstadt, MD
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Now, let's discuss your procedure.
First your doctor chooses an artery for the catheter entry site. Most commonly, an artery in the groin area of the leg is used. However, an artery in the bend of the elbow may also be used. Once this site is chosen, the area will be scrubbed with a special disinfectant soap and may also be shaved.
Your doctor will then numb the area with some numbing medication.
Once the area is numb, your doctor will insert an introducer, which is a small hollow plastic tube into your artery. You may feel some pressure or slight discomfort as the needle guides the introducer into the artery. A guide wire is then lowered into your artery and a catheter, another small, flexible hollow tube, is then inserted over the wire and carefully advanced to your heart, through the aorta and to the coronary arteries. The catheter movement is viewed on an X-ray screen. You will not feel the catheter as it moves through your blood vessels.
You may experience the feeling of a "skipped" heartbeat, as the catheter moves through your heart. This is normal.
Once the catheter reaches the coronary arteries, dye is injected into them. You may feel a heat flash or some nausea for about 30 seconds when the dye is injected. This special dye shows up on the x-ray screen, and allows your doctor to see the blockages that may be present. Your doctor will repeat the injection of dye several times, looking at the arteries from many different angles.
After your arteries have been examined, the catheter will be redirected to your left ventricle. You will feel a 20-30 second heat flash when a large amount of dye is injected into the ventricle. This is to test how your ventricle is contracting and if your valves are functioning properly.
During the procedure your doctor will talk to you, explaining each step along the way. Your participation and feedback will be needed. For example, you may be asked to cough, to help move the dye out of your coronary arteries. Also, you will be asked to hold your breath for 3 to 5 seconds while x-ray pictures are being taken, to prevent blurring of the pictures.
During the procedure, it is important to let your doctor know if you are experiencing any chest or back pain, a tight squeezing feeling in your chest or between your shoulder blades, shortness of breath, a severe headache, dizziness or changes in your vision. These sensations might indicate that something is not right.
If your doctor locates and studies a blockage, a decision is made as to what procedure will be performed to achieve the goal of coronary artery opening.
If the blockage is too hard or calcified for the balloon angioplasty catheter to get through, your doctor may use atherectomy to help create a pathway. The atherectomy catheter device will be inserted to pulverize or scrape off the blockage into very small particles. These particles will either be removed or will be dissolved into your bloodstream and filtered out through the liver. If your doctor encounters a clot blocking the artery, medication will be given to dissolve the clot before continuing.
After atherectomy your doctor may find it necessary to perform balloon angioplasty to expand your coronary artery. During angioplasty your doctor inserts a special balloon tipped catheter into your artery and guides it to the center of the narrowed artery. The balloon catheter is inflated and deflated several times, pushing the plaque against the artery wall to create a wider channel for the blood flow. When the balloon inflates, it briefly blocks the flow of blood. This might cause you to experience chest discomfort. If this happens you should tell your doctor, as pain medicine can be given. With a successful angioplasty, the remaining blockage is squeezed outward against the wall of the artery and blood flow is restored.
Depending on the specifics of the blockage, your doctor may place a stent in your artery. It will look something like this. The stent is an expandable device that is mounted on a balloon catheter similar to the one used for the angioplasty. The stent and balloon are advanced to the blockage area and the stent is expanded into place. A stent supports the artery and helps it remain open for a longer period of time. After stent placement, the body will grow tissue over the stent to help maintain its position. The stent will not move around inside your body.
The procedure usually takes from 1 to 3 hours but this varies from patient to patient. Your doctor will tell you what is happening throughout the procedure.
Once the procedure is complete your doctor will take out the catheter, but the introducer may remain in the artery. Your doctor leaves the introducer in place for a period of time in case signs of artery re-closure are encountered or happen. If you experience chest pain, back pain or other unusual feelings after your procedure, the coronary artery may be re-closing. For this reason your continued communication is essential.

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