Cardiac Catheterization, Carotid Angioplasty, and Stenting

Treating Cardiovascular Diseases in Wisconsin and Northern Illinois

Cardiac catheterization (also called cardiac cath, coronary angiogram or heart catheterization) is a procedure that uses x-ray pictures to allow your doctor to evaluate your heart function and to determine if you have any blockages in the blood vessels in your heart. Coronary angioplasty and stenting are the procedures, sometimes called interventional procedures that the doctor will use to open any blockages in your heart vessels that he finds when doing the cardiac catheterization.

Cardiac catheterization is used to:

  • Check for the presence of coronary artery disease, which is seen as narrowing or blockages in your coronary arteries
  • Determine if you have any problems with your heart valves or aorta
  • Determine if you need coronary artery bypass graft surgery (also known as CABG surgery)
  • Determine if you need further treatment such as angioplasty or stenting
  • Evaluate the pumping function of your heart muscle

How Is a Cardiac Catheterization and Coronary Angiography Performed?

During a cardiac catheterization, a long, narrow tube called a catheter is inserted through a plastic introducer sheath (a short, hollow tube that is inserted into a blood vessel in your leg or arm). With this procedure, there usually is no incision, but a puncture from the sheath instead.  The catheter is guided through the blood vessel to the coronary arteries with the aid of a special x-ray machine.

Contrast material is then injected through the catheter and x-ray movies are created as the contrast material moves through the arteries. The x-ray movies of the contrast material are used to identify the site of the narrowing or blockage in the coronary artery.  This part of the procedure is called a coronary angiogram (or coronary angiography). Extra pictures called intra-vascular ultrasound (IVUS) and fractional flow reserve (FFR) may be taken along with cardiac catheterization to obtain additional images and measurements of the blockages in the blood vessels.

With IVUS, a miniature sound wave probe is positioned on the tip of a coronary catheter. The catheter is threaded through the coronary arteries and, using high-frequency sound waves, produces detailed images of the inside walls of the arteries. IVUS produces an accurate picture of the location and extent of plaque or blockage.  With FFR, a special wire is threaded through the artery and a medication is given to dilate your coronary arteries. This test is similar to doing a high quality stress test for a short segment of the artery.  FFR readings will tell the doctor if a blockage affects the blood flow through the artery

Interventional procedures are the non-surgical options used to open narrowed coronary arteries to improve blood flow to the heart.  An interventional procedure is usually performed right after the cardiac catheterization, when a blockage is identified, but it may be scheduled after a catheterization has confirmed the presence of coronary artery disease.

Interventional procedures may include balloon angioplasty, stent placement and less often, atherectomy. With atherectomy, the plaque is removed from the artery.  Interventional procedures can also be done on other blood vessels besides your heart such as the legs or kidneys, or the carotid arteries that feed blood to your brain.

Coronary Angioplasty and Stenting

Coronary angioplasty or stenting are the procedures where the coronary artery is actually opened by pushing the plaque against the wall of the artery, increasing blood flow to the heart.  If your doctor finds blockages during your cath, coronary angioplasty will usually be done at the same time you have your cardiac cath. 

During this procedure, the doctor will use the same puncture site where the cardiac cath was done to thread a deflated balloon through the blood vessel up to the blockage in your heart.  Once the balloon is placed within the blockage, the doctor will inflate the balloon to push the plaque against the blood vessel walls. 

Sometimes, the doctor will choose to place a coronary stent here as well.  The stent is a small, expandable metal mesh tube that helps to keep the narrowed artery open. The stent is mounted on the balloon.  The balloon is then inflated to expand the stent once it is in the right position in your artery.  This will help reduce the symptoms of chest pain and prevent heart attack from the blockage. 

Some stents are coated with medicine that is slowly released into the artery. These are called drug-eluting stents. The medicine helps prevent scar tissue from blocking the artery after angioplasty.

How to Prepare for Your Cardiac Catheterization and Coronary Angioplasty Procedure

To prepare for your cath, your doctor is likely to ask you to stop taking your blood thinner medication and possibly other medication before the procedure. Please bring all of your home medications with you, including over-the-counter. When you arrive for your appointment, please tell your nurse if you have been taking blood thinner medication, diuretics (water pill) or insulin.

Please tell the staff if you are allergic to anything, especially x-ray dye, penicillin-type medications, and latex or rubber.  The doctor will give you specific instructions about what you can or cannot eat or drink before the procedure.  Depending on the time of your procedure, you may be asked not to eat or drink anything after midnight the night before.

Even though a cardiac cath takes usually takes less than one hour to perform, you should allow the majority of the day for your procedure.  You will be asked to arrive up to three hours before your scheduled procedure time and you may stay overnight, depending on what the results of the procedure are.

There are many things that need to be done to get you ready for your procedure.  Once you arrive, you will be taken to your pre procedural room.  You will be asked to change into a hospital gown so that we can prepare you for the procedure.  

Some of the things we must do to prepare you for your procedure include drawing the blood work your doctor has ordered and starting IV fluids to help protect your kidney function.  The staff will start an IV line in your arm so that we can give you IV fluids before and during the procedure.  You may also have an EKG or chest x-ray done.  Your caregiver may need to clip or shave some of your body hair in the area that the doctor will be working on you.  We keep you covered as much as possible, but please tell us if you are uncomfortable at any point.

If this is a longer procedure, you may have a urinary catheter placed.  This usually is removed right after your bed rest is finished.

Once you have had all the labs, IV’s and x-rays done and you have changed into a gown. You will then be ready for the procedure.  Most of the time your procedure will go as scheduled.  Sometimes, there might be a delay due to an unexpected event.  If this happens, we will keep you informed and we will try and make you as comfortable as possible until you go for your procedure.

What to Expect During the Procedure

When you enter the cath lab, you will be wearing a hospital gown.  We will give you warm blankets to help keep you comfortable.  You will be asked to lie on a narrow table.  We will put some safety straps around you to keep you safe.  We will attach EKG patches to your chest to monitor your heartbeat during the procedure. We will then wash and clip hair from the area that your doctor will be working from.  Your blood pressure will also be checked at intervals.

You may receive a mild sedative to help you relax, but you will be awake and conscious during the procedure.  The room will be dimly lit. A large camera and several TV monitors will hang above the table.   A doctor will numb the groin or arm site where he will be placing a sheath.  The sheath is like a long IV.  This is the place where the doctor will guide other equipment into the blood vessel with the help of an x-ray machine.

After the sheath is inserted, you will be given IV contrast, a liquid containing iodine.  This helps your blood vessels show up more clearly on the x-ray film. You may feel a warm sensation when the contrast liquid is given.

As each x-ray picture is taken, you may be asked to lie still or hold your breath.  Movement can result in blurry pictures.  If the doctor finds any blockages, he will speak with you in the procedural room and tell you if he is going to do the angioplasty or stenting.  If this is the case, you will stay right where you are, and it will be done right away.  Sometimes, the doctor will recommend surgery.  When the doctor has finished his procedure, he will go and speak with your family if they are here with you.

Cardiac Catheterization Recovery

Following the procedure, you will have the sheath removed.  This requires you to lie flat while we pull the sheath out.  Afterwards, we will hold pressure in this area for up to 20 minutes or more, to make sure that that there is no bleeding. 

Your recovery instructions will vary depending on whether your sheath was inserted into your arm or groin, and into an artery or vein. The arterial approach requires bed rest for about 4 – 6 hours after the sheath is pulled out, requiring you to keep the affected leg straight.  If you will be going home later that day, you will go back to your pre procedure room.  If the doctor has done the angioplasty or stenting, you will stay overnight.

It is important to drink plenty of water after the procedure to help eliminate the contrast agent through your kidneys.  You will be given instructions on your medication, when to follow up with your doctor, and how to care for your procedure site before you leave the hospital.

Leading the Region in Cardiac Catheterizations

Aurora Health Care performs many cardiac catheterizations, angioplasties and stenting procedures each year. With this high volume comes expertise. Should the need for surgery be discovered during a heart cath procedure, our patients have access to some of the nation’s most respected surgical teams.
