coronary angioplasty

1. JAMIA MILLIA ISLAMIA
CENTER FOR PHYSIOTHERAPYAND
REHABILTATION SCIENCES
PRESENTATION OF PHYSIOTHERAPY IN CARDIOPULMONARY
CONDITIONS(BPT-402)
TOPIC:- CORONARY ANGIOPLASTY
SUBMITTED TO:- DR. JAMAL ALI MOIZ
SUBMITTED BY:- NADA ZAREEN
BPT 4TH YEAR
PRESENATION DATE:- 30.12.2020

2. Introduction
• A coronary angioplasty is minimally invasive procedure used to open
blocked or stenosed coronary arteries allowing unobstructed blood flow to
the myocardium. The blockages occur because of lipid-rich plaque within
the arteries, diminishing blood flow to the myocardium.
• The term "angioplasty" means using a balloon to stretch open a narrowed
or blocked artery.
• However, most modern angioplasty procedures also involve inserting a
short wire-mesh tube, called a stent, into the artery during the procedure.
The stent is left in place permanently to allow blood to flow more freely.
• Coronary angioplasty is sometimes known as percutaneous transluminal
coronary angioplasty (PTCA). The combination of coronary angioplasty
with stenting is usually referred to as percutaneous coronary intervention
(PCI).
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3. Others names of coronary angioplasty
• Percutaneous coronary intervention (PCI)
• Percutaneous intervention
• Percutaneous transluminal angioplasty
• Percutaneous transluminal coronary angioplasty (PTCA)
• Balloon angioplasty
• Coronary artery angioplasty
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4. Stent
• A stent is a tiny, metal mesh tube that is placed with a catheter and
permanently embedded within the artery wall to prop open and prevent it
from collapsing.
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5. • Types of Stents
• Bare metal stents (BMS) – While some arteries can be successfully treated
with bare metal stents, other arteries held open with bare metal stents may
have an increased rate of re-narrowing due to growth of scar tissue in the
stent.
• Drug-eluting stents (DES) – These stents were developed to combat the re-
narrowing that developed after bare metal stent implantation. These stents
are coated with medications that are slowly released to minimize the body's
ability to form scar tissue around the stent. The medication is delivered
directly to the site of the artery blockage.
• Bioabsorbable (also known as Bioresorbable) stents – Not yet approved
by the U.S. Food and Drug Administration, but approved for use in Europe
and in clinical trials in the United States, these stents are absorbed into the
body after the artery wall has healed. In addition to other possible benefits,
these stents may eliminate the need for to medications to prevent blood clots
(thromboses) from forming in the stent.
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6. Indications
• Acute ST-elevation myocardial infarction (STEMI)
• Non–ST-elevation acute coronary syndrome (NSTE-ACS)
• Unstable angina.
• Stable angina.
• Anginal equivalent (eg, dyspnea, arrhythmia, or dizziness or syncope)
• High risk stress test findings.
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7. Contraindication
• Critical left main coronary stenosis without collateral flow from a native
vessel or previous bypass graft to the left anterior descending artery
• Coagulopathy
• Hypercoagulable states
• Diffusely diseased vessels without focal stenoses
• A single diseased vessel providing all perfusion to the myocardium
• Total occlusion of a coronary artery
• Stenosis < 50%
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8. Preparation of patient
• past history
• laboratory tests include
• Prothrombin time
• Partial thromboplastin time
• serum electrolytes,
• Blood urea nitrogen test and creatinine
• BP and pulse rate is monitored before and during the procedure
• Chest x ray and EKG
• The patient is required to be well hydrated.
• cessation of anticoagulants if possible. Also, common medications
including NSAIDs, or ACEIs can be held to prevent worsening renal
insufficiency. The diabetes medication metformin is held prior to cardiac
catheterization to avoid worsening renal insufficiency and lactic acidosis.
• Fluids and food are restricted 6 to 8 hours before the procedure.
• When cases are performed via radial artery access, patients are often
given intra-arterial calcium channel blocker, nitroglycerin, and heparin to
prevent vasospasm.
• explain the procedure and its associated risks and complications to the
patient to obtain a signed informed consent.
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9. Procedure
• At the start of the procedure local anaesthetic is given to numb the area in
the groin or wrist where a catheter (a fine, flexible, hollow tube) is then
passed into an artery.
• The catheter is then guided to the heart and into a coronary artery until its
tip reaches a narrow or blocked section through guide wire. At the tip of the
catheter is a small inflatable balloon and a small tube of stainless steel
mesh, called a stent.
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10. • A special dye (contrast) is injected into the catheter so that coronary
artery can be seen on an x-ray screen. This helps show where the narrow
areas or blockages in the arteries are, and how severe they are. It's normal
to feel a hot flushing sensation when the dye is injected.
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11. • The balloon on the end of the catheter is then gently inflated so that it
squashes the fatty deposits (the atheroma) against the artery wall, widening
the artery.
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12. • As the balloon is inflated, the stent in place on the balloon expands so that
it acts as a scaffold and holds open the artery. The balloon is deflated and
removed, leaving the stent in place.
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13. Risks
• Bleeding from the blood vessel where the catheter was placed.
• Damage to blood vessels from the catheter.
• An allergic reaction to the dye given during the angioplasty.
• An arrhythmia (irregular heartbeat).
• The need for emergency coronary artery bypass grafting during the
procedure (two-four percent of people). This may occur when an
artery closes down instead of opening up.
• Damage to the kidneys caused by the dye used.
• Heart attack (three-five percent of people).
• Stroke (less than one percent of people).
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14. Complications of stents
1. Restenosis
• There is a chance that the artery will become narrowed or blocked again in
time, often within six months of angioplasty. This is called restenosis.
2. Blood Clots
• Recent studies suggest that there is a higher risk of blood clots forming in
medicine-coated stents compared to bare metal stents (nonmedicine-coated).
The Food and Drug Administration (FDA) reports that medicine-coated
stents usually don't cause complications due to blood clots when used as
recommended.
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15. Postoperative care
• Discharge from the hospital is usually 12 to 24 hours after the catheter is
removed. Many patients are able to return to work within a few days to a week after a
procedure.
• Medications: antiplatelets, statins,blood pressure medications (beta blockers, ACE inhibitors)
• Watch for infection where the catheter was inserted. Watch out for the area becoming warm or
red and for any drainage.
• Watch for and any bleeding where the catheter was inserted and any change in color or pain or
a warm feeling in that area.
• Drink plenty of water.
• Don’t lift heavy objects.
• Avoid strenuous exercise.
• Healthy diet
• Quit smoking
• Be physically active
• Lose weight if obese or over weight
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16. References
• www.ncbi.nim.nih.gov
• Medicine.umich.edu
• www.mayoclinic.org