Coronary & Peripheral Interventions

Coronary and peripheral interventions refer to non-surgical procedures that use a catheter (a thin flexible tube) and small tools to remove plaque (a mixture of cholesterol, fat, calcium and other substances) and restore blood flow through the vessels in the heart and peripheral arteries. By using a catheter, doctors avoid making large surgical cuts when they remove the blockage thereby decreasing pain, risk of infection and recovery time.

Interventional procedures start out with cardiac catheterization (also called coronary angiogram). Once the catheter is in place one of the following procedures may be performed to open the artery:

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Balloon Angioplasty

In this procedure, a catheter which has a collapsed balloon at its tip is inserted into the blood vessel near the blocked or narrowed area. When the balloon is inflated, plaque is pushed to the artery walls widening the diameter of the blood vessel and improving blood flow.

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Balloon Angioplasty with Stenting

Angioplasty is often performed in combination with stenting. A stent is a small metal mesh tube which provides a scaffolding support to the vessel that has been opened via angioplasty. A wire placed inside a balloon catheter is used to insert the stent into the narrowed artery. After placement, the balloon is inflated expanding the stent to the size of the artery. The stent stays in place holding the vessel open while the balloon is deflated and removed.

Cutting Balloon

This procedure uses a long, thin tube (catheter) with a special balloon tip with small blades. When the balloon is inflated, the blades score the plaque and the balloon pushes the fat into the arterial wall. Cutting balloon may be used to treat plaque that is built up within a previously placed stent (restenosis) or other forms of blockages. It may also has the advantage of reducing vessel stretch and vessel injury by scoring the vessel longitudinally.

Rotablation (Rotational Atherectomy)

A rotablator is used to treat hardened, calcified coronary lesions that are not effectively treated with standard angioplasty balloons. The system is typically powered by pressurized nitrogen (or compressed air) rather than electricity and its speed is monitored digitally. A special guide wire is used to move the drill head to the site of stenosis. Drilling through plaque and calcified deposits produces tiny fragments of debris which can pass through the blood vessels and are absorbed by the body. Once the drill head is removed, balloon angioplasty is used to widen the site and drug-eluting stents are implanted in the vein to ensure long-term satisfactory treatment results.

Percutaneous Valve Repair

Most commonly performed on the mitral valve to treat valvular heart diseases such as mitral regurgitation and mitral stenosis, percutaneous valve repair could provide an alternative to open heart surgery. Most percutaneous valve repair procedures require detailed planning and complete evaluation of the patient. The procedure is usually performed using a guided catheter with a balloon at the tip and either using transoesophageal echocardiography and fluoroscopic guidance or transthoracic guidance. An example of percutaneous valve repair is balloon valvuloplasty described below. The potential advantages of heart valve repair are:

Preservation of heart muscle strength
Lower risk of infection
Less need for long-term anticoagulants (blood thinners)

Percutaneous Valve Replacement

This procedure, often referred to as transcatheter aortic valve replacement/implantation (TAVR or TAVI), is mainly used to replace the aortic valve of the heart through the blood vessels instead of replacement via open heart surgery. TAVR can alleviate the symptoms of aortic valve stenosis (narrowing) and may improve survival in people who can't undergo surgery or have a high risk of surgical complications. The replacement valve is a biological tissue valve. During the procedure, the doctor will access your heart through a blood vessel or a large artery using the most appropriate approach and location. A catheter is then inserted through the access point and guided through your blood vessels to your heart and aortic valve with the aid of advanced imaging techniques. Once the catheter is positioned, a balloon is expanded to press the replacement valve into place in the aortic valve. Some valves can expand without using a balloon. After the valve is securely in place, the catheter is withdrawn from the blood vessel. You may need to take certain medications (such as blood-thinners) for a period of time after your procedure as directed and prescribed by your physician.

Congenital Heart Defect Correction

Congenital heat defects refer to the abnormalities of the heart and blood vessels near the heart that are present at birth. Some congenital heart defects may be repaired by interventional cardiac catheterization. During these procedures, a thin tube called a catheter is inserted into a blood vessel in the arm, neck or groin and guided to the heart using X-ray or ultrasound imaging. Small, specialized tools or devices are advanced through the catheter to correct the heart defect. These corrections may include plugging holes in the septum (the wall that separates chambers of the heart) using implantable closure devices, widening narrow vessels, repairing hardened valves or closing abnormal blood vessels. Cardiac catheterization is less invasive and requires less recovery time than traditional heart surgery.

Valvuloplasty (Balloon Valvuloplasty or Balloon Valvotomy)

This method is used to repair a heart valve (usually mitral, aortic or pulmonary) that is narrowed, constricted and does not open properly. A catheter with a deflated balloon at the tip is inserted into an arm or groin artery and guided to the constricted heart valve using X-ray imaging. When the balloon is inflated, the valve opening expands and the leaflets separate increasing blood flow through the heart. This procedure is used to fix defects due to heart valvular diseases and often provides an alternative to heart valve replacement.

Coronary Thrombectomy

Thrombectomy is a catheter-based procedure for the removal of blood clots that form inside coronary arteries often as a result of a tear in the inner wall of the blood vessel. This minimally invasive procedure follows the typical steps involved in Percutaneous Transluminal Coronary Angioplasty (PTCA or Angioplasty for short) which is used for opening blocked coronary arteries. During thrombectomy, a small incision is made in a blood vessel for the insertion of the catheter and advancement of specialized instruments (such as an aspirator) to the heart. Blood clots are broken up into pieces and/or removed using aspiration. The aspirator is then removed and the affected area is treated using a balloon catheter and/or a stent. Subsequently, the balloon and catheter are removed and the insertion point is treated.