A picture of the partially blocked vessel.
The same vessel after the blockage was fixed using a stent.
Cardiac catheterization (also known as angioplasty, coronary angiography, coronary stenting) are the most invasive tests utilized in modern cardiology. These procedures are frequently considered to be the "gold standard" in making a diagnosis of a diverse array of cardiac disease. The most common reasons for this test include: signs of obstructive coronary artery disease (unstable angina, abnormal stress test and myocardial infarction), forms of valvular heart disease, forms of heart failure and cardiomyopathy. For patients with coronary artery disease who are found to have an obstructive lesion (big enough blockage to limit blood supply to a region of the heart muscle), a stent is usually placed to reopen the artery. The types of stents and other therapeutic options are highly specific for each patient and are always carefully considered by treating physicians.
Prior to the procedure, the patient will be instructed to take specific medications as well as their usual medications. The patient cannot have anything to eat or drink 6 hours prior to the procedure. The procedure is performed at a hospital and requires a signed consent, which describes the benefits and possible risks of the procedure. The benefits include identifying the presence or absence of coronary artery disease, heart valve disease or heart muscle disease. Documenting these findings allows the patient's cardiologist to determine the best way to treat the disease identified. The risks of the catheterization procedure include heart attack, stroke, emergency bypass surgery or death (extremely infrequent, usually quoted as under 1%). A change in the heartbeat can occur (too fast or too slow), as can an allergic reaction to the contrast material (also referred to as the X-ray dye) or bleeding from the catheter insertion site. Patients with diabetes or preexisting kidney impairment can develop worsening kidney function. Patients who are overweight, have diabetes or preexisting vascular disease have increased risks of bleeding at the insertion site.
Prior to the Cardiac catheterization, the patient will change into a hospital gown, have an IV placed, and the site of the catheter insertion cleaned and clipped. In the actual cardiac catheterization laboratory, the patient will be placed on a long, narrow table and then prepped and draped in sterile sheets. The patient will be asked to lie as still as possible and will be given intravenous medication for sedation to maximize his or her comfort level. Then the cardiologist or his/her assistant will give local anesthesia to numb the skin and deeper tissues at the catheter insertion site. An access sheath is inserted in the artery in the groin or arm, and allows easy subsequent multiple catheter insertion as needed to successfully complete the procedure and look at each of the coronary arteries. The catheters are placed over leading guide wires to maximize safety. Since the inside of the blood vessels have no pain nerve endings, catheter passage in and out of the heart is painless.
Coronary angioplasty involves the insertion of a balloon-tipped catheter over a guide wire into the narrowed segment of the coronary artery. The balloon is inflated to widen the channel. Most of the time, this widening process is followed by the placement of an intra-coronary stent. The stent is a slotted, flexible stainless steel tube and is mounted on a balloon delivery to the diseased segment. The delivery balloon/stent is carefully positioned and then the balloon is inflated to expand and deploy the stent against the diseased segment. The stent is a permanent implant and serves to scaffold the diseased segment open. Recently, most of the stents used are "drug-eluting," meaning they are coated with a medication that is slowly released, to minimize scar formation within the open channel of the stent. This serves to prevent a re-narrowing of the artery at the stented site. Not all artery segments are appropriate for the new drug-eluting stents.
At NSCA, Board Certified interventional cardiologist Dr. Jonathan Weinstein performs cardiac catheterization five days a week (on out-patient and in-patient bases) at Stony Brook University Hospital. A newly remodeled cardiac facility provides our doctors and our patients with the latest technology and excellent nursing care.
Partially obstructive coronary artery plaque
Collateral coronary artery circulation
Prior to the procedure, the patient will be instructed to take specific medications as well as their usual medications. The patient cannot have anything to eat or drink 6 hours prior to the procedure. The procedure is performed at a hospital and requires a signed consent, which describes the benefits and possible risks of the procedure. The benefits include identifying the presence or absence of coronary artery disease, heart valve disease or heart muscle disease. Documenting these findings allows the patient's cardiologist to determine the best way to treat the disease identified. The risks of the catheterization procedure include heart attack, stroke, emergency bypass surgery or death (extremely infrequent, usually quoted as under 1%). A change in the heartbeat can occur (too fast or too slow), as can an allergic reaction to the contrast material (also referred to as the X-ray dye) or bleeding from the catheter insertion site. Patients with diabetes or preexisting kidney impairment can develop worsening kidney function. Patients who are overweight, have diabetes or preexisting vascular disease have increased risks of bleeding at the insertion site.
Prior to the Cardiac catheterization, the patient will change into a hospital gown, have an IV placed, and the site of the catheter insertion cleaned and clipped. In the actual cardiac catheterization laboratory, the patient will be placed on a long, narrow table and then prepped and draped in sterile sheets. The patient will be asked to lie as still as possible and will be given intravenous medication for sedation to maximize his or her comfort level. Then the cardiologist or his/her assistant will give local anesthesia to numb the skin and deeper tissues at the catheter insertion site. An access sheath is inserted in the artery in the groin or arm, and allows easy subsequent multiple catheter insertion as needed to successfully complete the procedure and look at each of the coronary arteries. The catheters are placed over leading guide wires to maximize safety. Since the inside of the blood vessels have no pain nerve endings, catheter passage in and out of the heart is painless.
Coronary angioplasty involves the insertion of a balloon-tipped catheter over a guide wire into the narrowed segment of the coronary artery. The balloon is inflated to widen the channel. Most of the time, this widening process is followed by the placement of an intra-coronary stent. The stent is a slotted, flexible stainless steel tube and is mounted on a balloon delivery to the diseased segment. The delivery balloon/stent is carefully positioned and then the balloon is inflated to expand and deploy the stent against the diseased segment. The stent is a permanent implant and serves to scaffold the diseased segment open. Recently, most of the stents used are "drug-eluting," meaning they are coated with a medication that is slowly released, to minimize scar formation within the open channel of the stent. This serves to prevent a re-narrowing of the artery at the stented site. Not all artery segments are appropriate for the new drug-eluting stents.
At NSCA, Board Certified interventional cardiologist Dr. Jonathan Weinstein performs cardiac catheterization five days a week (on out-patient and in-patient bases) at Stony Brook University Hospital. A newly remodeled cardiac facility provides our doctors and our patients with the latest technology and excellent nursing care.
Partially obstructive coronary artery plaque
Collateral coronary artery circulation