Overview of Fluoroscopic Percutaneous Coronary Interventions, Assessment, Protocols, and Interpretation
Ischemic heart disease, a condition where the heart does not get enough blood and oxygen, is the top cause of death worldwide. A common treatment for this disease is a procedure called Percutaneous Coronary Intervention (PCI). It is used to open up the heart’s blocked arteries.
Mostly, this procedure is done using a technique called fluoroscopy, which uses X-rays to create real-time images of the inside of your body. Medical professionals use these images to guide them while clearing blocked coronary (heart) arteries. Fluoroscopy allows them to view the heart’s arteries and determine which segments are diseased.
Knowing the correct perspective under fluoroscopy can provide better coverage of the unhealthy part of the artery. It can also decrease the amount of radiation exposure for the patients and the medical team by shortening the time spent under fluoroscopy and lowering the radiation dosage. In the following section, we will explore the use of fluoroscopy in PCI in more detail.
Anatomy and Physiology of Fluoroscopic Percutaneous Coronary Interventions, Assessment, Protocols, and Interpretation
The heart gets its blood supply from three main arteries. These are the left anterior descending artery, which splits into the septal and diagonal branches; the left circumflex artery; and the right coronary artery, which divides into the right posterior descending artery and right posterior left ventricular branch.
But, if someone has had a heart problem, they might have had a surgery called a coronary artery bypass graft. This is where doctors use parts from other blood vessels in the body to make a new route for the blood to get past a blockage in a heart artery. These vessels could come from places like the saphenous vein in the leg, the left or right internal mammary artery in the chest, the radial artery in the arm, the gastroepiploic artery in the stomach, or the inferior epigastric artery in the abdomen. It’s important for your doctor to know where these new routes, or grafts, are and how many you have before they do any tests on them.
Why do People Need Fluoroscopic Percutaneous Coronary Interventions, Assessment, Protocols, and Interpretation
Percutaneous coronary intervention is a medical procedure that involves using a small tube to visualize and improve blood flow in the heart’s arteries. It’s used as a treatment option for several heart conditions. Below, we’ll discuss when this procedure might be used to enhance survival rates or relieve symptoms like chest pain, also known as angina.
To Improve Survival Rates:
1. When the left main artery is blocked, leading to a type of heart attack called ST-elevation myocardial infarction, percutaneous coronary intervention is considered if it can be done quickly and more safely than a heart bypass surgery (CABG).
2. If there are problems with the left main artery that lead to a non-ST-elevation myocardial infarction or unstable chest pain, the procedure may be required if a bypass surgery cannot be performed.
3. In patients with stable ischemic heart disease (a condition where the heart muscle doesn’t get enough blood), the procedure is advisable if there is low-risk involved or a higher risk of adverse events during surgery.
4. For people with blockages in all three coronary arteries or Proximal LAD, the procedure is a possible treatment option. This is also the case with two-vessel disease including or excluding proximal LAD.
5. For individuals who have survived sudden cardiac death due to presumed ventricular tachycardia, which is a rapid heartbeat due to problems in the lower heart chambers.
To Improve Symptoms:
1. Percutaneous coronary intervention can be used for patients who continue to have chest pain despite optimal drug therapy if the coronary artery disease is significant and able to be treated (revascularized).
2. It is can also be used when patients have ongoing chest pain, and medical management is not possible due to patients’ reactions to the medication, health conditions that make the drugs unsafe, or personal preference.
3. Another case where this procedure can be used is if chest pain continues despite optimal medical treatment and is associated with impaired blood flow.
When a Person Should Avoid Fluoroscopic Percutaneous Coronary Interventions, Assessment, Protocols, and Interpretation
There are certain conditions or situations when a percutaneous coronary intervention (a non-surgical procedure used to open up narrowed arteries in the heart) should not be done.
These are called contraindications and are divided into two categories:
Absolute contraindications: These are situations where the procedure is strictly not recommended. This includes:
1. If a patient cannot tolerate dual antiplatelets (specific type of blood-thinning medications).
2. If the patient has a severe illness that reduces their expected lifespan to less than one year.
Relative contraindications: These are situations where the procedure can be performed, but with caution or additional considerations. This includes:
1. If the coronary artery (the blood vessels that supply the heart with blood and oxygen) is less than 2.5 millimeters in diameter.
2. If the patient’s anatomy makes the procedure unfeasible.
3. If the patient has a diffusely diseased saphenous vein graft (a type of surgery where a vein from the leg is used to bypass a blocked artery in the heart).
Equipment used for Fluoroscopic Percutaneous Coronary Interventions, Assessment, Protocols, and Interpretation
For a procedure called percutaneous coronary intervention, which is a non-surgical way to open up blocked coronary arteries that supply blood to the heart, specific equipment is critical. This equipment includes:
- A fluoroscopic machine, which is a device that makes real-time moving X-ray images to guide the doctor during the procedure.
- A contrast agent to improve the quality of the images from the machine.
- Guide catheters, which are thin tubes doctors use to reach the blocked artery and deliver medication or other treatments.
- Guide wires, thin flexible wires that help place the catheter correctly.
- A coronary balloon, which is a tiny balloon that can be inflated to open up the blocked artery.
- A coronary stent, which is a small mesh tube that’s used to treat narrow or weak arteries by providing support inside them.
During this procedure, it’s crucial for the medical staff to protect themselves from unnecessary radiation exposure. Safety gear they use includes:
- A lead apron, a protective garment that absorbs radiation and protects the wearer’s body.
- A thyroid collar, which shields the thyroid gland in the neck from radiation.
- Radiation protective glasses to shield the eyes.
- Radiation monitoring badges, which measure the amount of radiation exposure to ensure it stays within safe levels.
Who is needed to perform Fluoroscopic Percutaneous Coronary Interventions, Assessment, Protocols, and Interpretation?
The main doctor in charge of handling your heart health is known as an intervention cardiologist. They are specialized in treating heart diseases or conditions using less invasive techniques. A radiation technician works with them; their role is to safely handle and operate radiology machines used during the treatment.
Supporting these experts, there is a cath lab technician. They are primarily in the ‘catheterization laboratory’ or ‘cath lab’, a special hospital room where heart tests and procedures are done. They assist the doctor in examining how well your heart is working.
Another important member of this team is the staff nurse who ensures you are comfortable and well-cared for during your visit. They will also help monitor your health and respond to any immediate needs during your treatment.
Preparing for Fluoroscopic Percutaneous Coronary Interventions, Assessment, Protocols, and Interpretation
Before a medical procedure, it is important for the doctor to talk to you about what’s going to happen. This is known as getting your ‘informed consent’, which means you’re aware of the procedure and you agree to it. Before the procedure, your doctor will also ask you about your health history and conduct a physical examination. This helps the doctor know why the procedure is needed in the first place.
Additionally, your doctor might give you medications known as ‘antiplatelets’. These drugs help to prevent blood clots from forming, which can be a risk during medical procedures. It’s all part of the way your healthcare team prepares you for a safe and successful procedure.
How is Fluoroscopic Percutaneous Coronary Interventions, Assessment, Protocols, and Interpretation performed
Understanding where a particular part of the artery will be visible is vital when carrying out a coronary angioplasty using fluoroscopic assistance. So, let’s break down the different parts of the heart’s arteries, and identify the best views for seeing each during this procedure.
The Left Main Coronary Artery (LM) has three parts:
-The best way to view the uppermost part (Ostial part) is usually from the left side and a little below (LAO Caudal) or from the front-lower view (AP Caudal).
-The middle part (Mid part) is best seen from the right side from an upper (RAO Cranial) or lower (RAO Caudal) perspective, or sometimes from a front-lower view (AP Caudal).
-The lowermost part (Distal part) can be seen when looking from different angles: from the left side and a little below (LAO Caudal), or from the right-lower side (RAO Caudal), or from the left-upper side (LAO Cranial).
For the Left Anterior Descending Artery (LAD), viewing options are very similar to the LM artery. For both the upper (Ostial part) and middle (Mid part) of this artery, views from the left-lower side (LAO Caudal), right-lower side (RAO Caudal), and front-upper view (AP Cranial) may be used. For the bottom-most part (Distal part), additional views from the left-upper side (LAO Cranial) or right-upper side (RAO Cranial) can be helpful.
For the Left Circumflex Artery (LCX), the best views for seeing the different sections vary, but typically include left-lower side (LAO Caudal), front-lower side (AP Caudal), right side (RAO), and left-upper side (LAO Cranial) perspectives.
The Right Coronary Artery (RCA) can be viewed using a similar range of positions. Specialized views for the lower part of the RCA include where it splits to become the Right Posterior Descending Artery (RPDA) and the Right Posterior Left Ventricular branch (RPLV).
When following a Saphenous Vein-Graft to Coronary Artery, different views will work best depending on exactly where the graft is headed. For instance, a graft going to the Left Anterior Descending Artery (LAD) might be best viewed from the front-upper side (AP Cranial), or right-upper side (RAO Cranial).
In cases where the Left Internal Mammary Artery is being directed towards the LAD, the uppermost part of this arrangement is often best seen from the left-upper side (LAO Cranial). The middle part would need a right-upper view (RAO Cranial), while the point of insertion might be best seen from a completely sideways (left) view (Left Lateral).
Pictures are usually taken before and after the heart vessel treatment of RCA to analyze the results.
Possible Complications of Fluoroscopic Percutaneous Coronary Interventions, Assessment, Protocols, and Interpretation
After having a procedure to unblock the heart arteries called a percutaneous coronary intervention, there can be some risks. These might include:
1. Damage to the heart artery.
2. An injury causing the heart artery to leak.
3. Clots being accidentally pushed further down the heart artery.
4. A side branch of the heart artery being blocked.
5. A clot forming in the stent that was placed to widen the artery.
6. Bleeding at the site where the tools were inserted.
7. A blood-filled swelling called a hematoma forming at the site where the tools were inserted.
8. The kidneys getting injured.
9. A stroke.
10. An allergic reaction to the contrast dye used during the procedure.
Also, there are risks related to the use of fluoroscopy, which is an X-ray technique used during the procedure. These risks include:
Skin Injury: Exposure to fluoroscopy could harm the skin at the site where the tools were inserted.
1. A mild red color may appear on the skin a few hours to several days after exposure.
2. More noticeable redness might develop a week to several weeks after exposure.
3. Severe skin damage including skin ulcers may occur in rare cases, 4 to 8 weeks after exposure.
Bone Injury: There is a small chance that the X-rays could cause damage to bones near the skin’s surface, like the ribs.
Eye Injury: Exposure to a certain level of radiation could cause a cataract, which is a cloudy area in the eye’s lens, with a minimum delay of one year.
One of the most serious risks is the potential for radiation-induced cancer. It’s important for both patients and healthcare workers to be aware of this risk. Protective measures, such as wearing lead aprons, can help to reduce this risk.
What Else Should I Know About Fluoroscopic Percutaneous Coronary Interventions, Assessment, Protocols, and Interpretation?
Fluoroscopic percutaneous coronary intervention is a common procedure that’s been done for many years. It’s a treatment for heart problems where a small tube, called a catheter, is threaded through your blood vessels to open up blocked or narrowed arteries. This procedure is done using a special type of x-ray (fluoroscopy) to guide the catheter to the right place in your heart.
This procedure is particularly beneficial for patients who have had a heart attack. Compared to breaking up the clot with drugs (called thrombolysis), this procedure significantly reduces health complications and chances of death.
For patients who experience recurrent heart discomfort due to restricted blood flow (a condition known as chronic coronary syndrome), this procedure has shown to improve their quality of life.
Compared to open-heart surgery (also known as Coronary Artery Bypass Graft, or CABG), this procedure has many advantages. Patients usually spend less time in the hospital, avoid noticeable chest scars, and recover mobility soon after the procedure due to it being less invasive.
Advancements in this procedure over time have led to better survival rates for patients who have coronary artery disease, which is the narrowing or blockage of the arteries that supply blood to your heart.
