What is a coronary angiogram? A coronary angiogram is a test in which contrast is injected into the coronary arteries under local anesthesia and x-ray exposure. The contrast is used to visualize the coronary arteries and the areas of stenosis and obstruction under x-ray. How is a stenosis or occlusion treated after a coronary angiogram? Once a diagnosis is made, your doctor will recommend the most appropriate treatment plan for you, which may include the administration of medications, surgical coronary artery bypass surgery, angioplasty, and stenting. How is the coronary intervention procedure performed? Before the procedure, you may be given a small amount of sedation to help you relax, but you will not be put to sleep. This is done for two reasons: first, most patients find that they tolerate the discomfort they feel during the procedure well; second, your doctor will instruct you to take deep breaths or move your body during the x-ray to get a better quality picture. Once in the cath lab, you are moved to the x-ray table and covered with a sterile sheet. The puncture site where the catheter is to be inserted is disinfected with a special solution, and then a local anesthetic is administered. You will not feel discomfort most of the time, but you may experience pressure or chest pain as the balloon expands. This is normal and will disappear once the balloon is retracted. What is angioplasty? The purpose of this procedure is to open up a blocked artery. You may have heard of it by another name, PTCA (percutaneous transluminal coronary angioplasty). This procedure is performed in the same catheterization room (including an X-ray room and a control room) as angiography and requires local anesthesia. The procedure is usually performed by puncturing the groin or arm and inserting an arterial sheath through which a guiding catheter is placed into the vessel. Contrast is then injected through the catheter and the surgeon is able to see the patient’s coronary arteries on a fluoroscope (an x-ray device with a display). Once the coronary artery and the blockage are visible, the doctor inserts a guidewire and another catheter with a balloon on the end. The physician can watch the balloon catheter travel through the fluoroscope and manipulate it to reach the blocked coronary artery. When it is positioned at the site of the blockage, the balloon is expanded, squeezing the fatty accumulation against the vessel wall. In this way, the diameter of the vessel is expanded and blood flow is improved. Why is stenting necessary after angioplasty? Some time after angioplasty, the treated area may have a narrowed lumen and restricted blood flow due to elastic retraction of the vessel or re-blocking of plaque. To minimize this, your doctor may recommend that you have a coronary stent implanted. Angioplasty and stenting can be done in the same procedure. A coronary stent is a tiny mesh stainless steel tube that is fed into the vessel on a catheter with a compression balloon. How do I prepare for a coronary intervention? In the days before treatment, you should make sure you: take your prescribed medications on time; tell your doctor if you are taking any other medications; tell your doctor if you cannot take aspirin for some reason; let your doctor know your allergy history, past medical history; and follow your healthcare provider’s instructions. How will I recover after surgery? Immediately after surgery, you will be returned to a special observation room where your heart rhythm, blood pressure and surgical wound are carefully observed and monitored. During the stenting process, your doctor will administer anticoagulants or blood thinners. The effects of these medications take several hours to wear off. Once the medication wears off, the arterial sheath in the groin is removed and pressure is applied to the surgical wound until it stops bleeding. Once back in the room, you will be asked to drink plenty of fluids to allow the contrast to pass out of your body as soon as possible. If the puncture is made from the groin, you will need to rest in bed for a few hours after the procedure and keep the wound still by keeping the leg on the appropriate side straight. After a day of rest, you will be able to get out of bed and gradually increase your activity level with your doctor’s permission. You may need to stay in the hospital for a few days and maintain outpatient follow-up after discharge. If you feel any discomfort, pain or bleeding after you return home, contact your doctor or the hospital immediately for a review. What should I expect after discharge from the hospital? After your surgery is complete, you may have to return to the hospital for frequent follow-ups. 6 months later, your doctor may order a post-operative exercise ECG or angiogram, followed by regular checkups, which are a very important way to monitor your progress, so be sure to keep up with your checkups. Your doctor may also prescribe medications to ensure a rapid recovery, and it is important to follow your medication regimen to the letter. It is important to take the medications prescribed by your doctor until instructed by your doctor to stop taking them. If you maintain a healthy lifestyle, you will recover quickly and continue to live a normal life. If you have a stent implanted, this will not affect your ability to do any activities, but you should consult your doctor prior to any strenuous exercise and inform him or her of your stent implantation when another doctor is treating you. Caution: MRI should not be performed for at least eight weeks after the stainless steel stent is implanted. The new cobalt-chromium alloy stent does not have this restriction, so please consult your physician.