ptca rfa ppt.pptx, PTCA RFA, Percutaneous translu

PTCA

1. Percutaneous T ransluminal Coronary Angioplasty

2. PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) Is performed to open blocked coronary arteries caused by coronary artery disease and to restore arterial blood flow to the heart tissue without open heart surgery.

3. MEANING PTCA is a minimally invasive procedure to open up blocked coronary arteries allowing blood to circulate unobstructed to the heart muscle.

4. Intracoronary stents are used to treat abrupt or threatened abrupt closure and re- stenosis following balloon angioplasty.

5. STENTS:- A stent is an expandable mesh like structure designed to maintain vessel patency by compressing the arterial walls and resisting vasoconstriction

6. stents

7. INDICATIONS:- Acute ST-elevation myocardial infarction (STEMI) Non–ST-elevation acute coronary syndrome (NSTE-ACS) Stable angina Anginal equivalent ( eg , dyspnea , arrhythmia, or dizziness or syncope)

8. Asymptomatic or mildly symptomatic patient with moderate to severe ischemia on noninvasive testing Angiographic indications that include hemodynamically significant lesions in vessels. Atherosclerosis

9. USES OF STENTS:- Short lesions in large native coronary arteries not previously treated with PTCA Focal lesions in saphenous vein grafts Treatment of abrupt closure during PTCA

10. CONTRAINDICATIONS:- ABSOLUTE CONTRAINDICATIONS:- Lack of cardiac surgical support Significant obstruction of the left main coronary artery without a non-obstructed bypass graft to the left anterior descending or left circumflex arteries

11. RELATIVE CONTRAINDICATIONS:- Coagulopathy Hypercoagulable states Diffusely diseased vessels without focal stenosis A single diseased vessel providing all perfusion to the myocardium Total occlusion of a coronary artery Stenosis  < 50%

12. Bare metal stents (BMS) Made of nickal titanium alloy  Drug-eluting stents (DES) Traditional stents that are coated with drugs which release certain drugs over time- Zotarolimus ,  sirolimus ,  everolimus   These types of stents help prevent re- stenosis of the artery

13. Bare metal stent

14. DES STENT

15. TYPES OF ANGIOPLASTY BALLOONS:- Standard Small vessel balloon catheters High pressure balloon catheters Large vessel balloon catheters Special angioplasty balloon catheters

16. 1)Standard catheters (0.035-inch) balloon catheters ( eg , Ultra-thin Diamond, Boston Scientific; OPTA Pro, Cordis Endovascular

17. 2)Small vessel balloon catheters (0.014/0.018-inch) balloon catheters ( eg , Coyote, Sterling SL, and Symmetry.

18. 3)High pressure balloon catheter ( eg , Mustang, Boston Scientific; Dorado and Conquest, BARD)

19. 4)Large vessel balloon catheters ( eg , XXL, Boston Scientific; Atlas)

20. 5) Special angioplasty balloon catheters ( eg , Cutting Balloon and PolarCath , Boston Scientific)

21. Before procedure:- a consent form must be signed after explaining the procedure Notify the physician if patient is allergic to iodine or seafood or contrast material in the past NPO from the previous night .  If patient is pregnant or suspected to be pregnant, notify the physician.  Notify the physician of all medications (prescription and over-the-counter) and herbal supplements that patient is taking. 

22. Notify the physician if patient has had heart valve disease, as antibiotics may be needed prior to the procedure.  Notify the physician if patient has a history of bleeding disorders or is on any anticoagulant medications, aspirin, or other medications that affect blood clotting.

23. Notify the physician if patient has a pacemaker.  Part preparation must be done Remove any jewelry or other objects that may interfere with the procedure but dentures or hearing aid can be worn. Provide gown to wear. Ask patient to empty the bladder prior to the procedure.

24. An intravenous (IV) line must be started prior to the procedure Explain that patient may feel some effects when the contrast dye is injected into the IV line. These effects include a flushing sensation, a salty or metallic taste in the mouth, and/or a brief headache. The effects usually last for a few moments.

25. TECHNIQUE

26. AFTER CARE The removal of the sheath, is done after approximately four to six hours, to allow the effects of blood-thinning medication given during the procedure to wear off.  Instruct patient to lie flat until sheath is removed NOTE: If the insertion was in the groin, do not allow to bend the leg for several hours. IF in the arm , it must be kept elevated on pillows and kept straight by placing the arm in an arm guard or arm board

27. PRESSURE DRESSING

28. Anticoagulation :- to reduce the incidence of thrombosis at the site of balloon dilation . Clopidogrel ( in combination with aspirin) is continued for 9 to 12 months after PCI. Ca channel blockers and nitrates may also reduce risk of coronary spasm.

29. Complications:- a)Abrupt block of the artery: It may result in a heart attack during the procedure and require an emergency bypass surgery. b)Perforation of the artery may occur rarely c) Restenosis of the artery could occur, requiring a repeat procedure.

30. d)others:-stroke, damage to the kidneys caused by the dye used during angiography, and infection at the site of the catheter e)Thrombosis or hematoma formation f)Bleeding from the site of insertion g)Death could occur due to heart failure or occlusion of the coronary artery

31. R adiofrequency ablation

32. Definition is a medical procedure where part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from the high frequency alternating current to treat a medical disorder Cryoablation , which damages tissue by freezing rather than heating, may be used rather than radiofrequency energy

33. RFA

34. RFA Special wires or catheters are threaded into the heart and radiofrequency energy (low-voltage, high-frequency electricity) are targeted towards the areas that are causing the abnormal heart rhythm, and permanently damages those small areas of tissue with heat.

35. The damaged tissue will no longer be capable of generating or conducting electrical impulses. If the procedure is successful, this prevents the arrhythmia from being generated, curing the patient.

36. RFA procedures are performed under image guidance (such as X-ray screening, CT scan or ultrasound) by an interventional pain specialist (such as an anesthesiologist),interventional radiologist or a cardiac electrophysiologist , a subspecialty of cardiologists.

37. Indications:- Paroxysmal supraventricular tachycardia (PSVT), which includes : Wolff-Parkinson-White syndrome AV nodal reentrant tachycardia Atrial tachycardia Atrial flutter Ventricular tachycardia and premature ventricular contractions Atrial fibrillation

38. PREPARATION:- Patients may be asked to discontinue certain medications in the days before the procedure. Most patients are advised to stop eating and drinking at midnight the night before the procedure. A pregnancy test is usually done immediately before the procedure in women of child bearing capacity because of the radiation exposure.

39. PROCEDURE:-  Before the procedure ,a sedative medication is given. Small catheters are threaded into the heart. The catheters are usually inserted into the vein or artery in the right and left femoral site and are positioned within the chambers of the heart using fluoroscopy . Other sites:- subclavian,internal jugular brachial or radial arm. The doctor tests various parts of the heart and usually will try to provoke the arrhythmia

40. The sections of the heart that are causing arrhythmia can be identified. The doctor will then use the radiofrequency energy or cryoablation to treat the problem area. During the procedure, heart rate and rhythm, oxygen level, and blood pressure are monitored.

41. When the procedure is completed, the doctor will again try to provoke the arrhythmia. If it cannot be initiated, the procedure is considered to be a success. However, if the arrhythmia can still be initiated, additional radiofrequency energy is delivered. Typically, the procedure lasts two hours or more.

42. POST ABLATION CARE The catheter site will be monitored for bleeding and the heart rhythm is observed closely during this period. Several hours of bed rest is advised to reduce the risk of bleeding from the catheter site. Analgesics are needed for only a short time,

43. Some patients are admitted to the hospital after the procedure while others go home later the same day. Certain activities are not recommended for a brief period to avoid straining the catheter site example flexing the arm or leg at insertion site. Aspirin every day for several weeks after the procedure to prevent blood clots is prescribed

44. COMPLICATIONS:- Problems related to threading the catheters through the blood vessels such as bleeding, infection, blood clots, bruising, and injury to the vessel(s) Injury to the heart as a result of the catheters; this includes a perforation through the muscle or damage to one of the valves within the heart

45. pulmonary embolism or brain (stroke) Heart block-This complication, if permanent, requires implantation of a pacemaker. New arrhythmias Exposure to radiation during the procedure,causes small risk of cancer or genetic defects. Death