Invasive procedures

Diagnostic procedures

• Coronary angiography

Often referred to as a cardiac catheterization or “cath,” this test is used to diagnose coronary artery disease, or blockages in the arteries. A small hollow tube (catheter) is inserted into an artery in the groin or arm and carefully threaded through the aorta to the coronary arteries using X-ray guidance. Contrast dye is injected allowing the doctor to visualize blood flow to the heart using an X-ray camera.

• Cardiac catheterization; Ventriculography 

This test is used to diagnose valvular heart disease, congenital heart disease and to evaluate the pumping function of the heart. A small hallow tube called a catheter, is inserted into an artery in the groin or arm. It is carefully threaded through the aorta, to the heart using X-rays for guidance. Pressures are measured in the heart chambers and contrast dye can be injected to allow the doctor to evaluate the function of the main pumping chamber (left ventricle) and valves. This test is usually performed in conjunction with a coronary angiography. Patients are usually awake during the procedure, although a small amount of sedating medication will be given prior to the procedure. The patient will need to lie for flat for several hours after the procedure to be sure there is no bleeding at the insertion site. 

• Flow reserve measurement
  A fine hollow wire is threaded through blockage and pressures is measured to determine how “tight” the blockage is.
• Intravascular ultrasound
  Intravascular ultrasound uses sound waves to produce pictures of the coronary arteries from the inside. For this exam, an ultrasound transducer, which takes pictures of your heart, is mounted on the end of a thin, flexible tube called an catheter, and carefully threaded into the coronary arteries. By looking at the walls of the arteries, doctors can determine the location and pattern of blockage, as well as what the best treatment will be.

Coronary interventions

After obtaining diagnostic images, your cardiologist may recommend coronary intervention to "fix" a blocked artery. This is usually performed as a "follow on" to the diagnostic procedure.

• Coronary balloon angioplasty

Coronary balloon angioplasty is used to open blocked coronary arteries and to restore arterial blood flow to the heart tissue without open-heart surgery. The doctor inserts a catheter (a thin, flexible tube) with a tiny balloon on the end into an artery and is positioned within the blockage. The balloon is inflated to open the artery, and then deflated and removed. In most cases, this procedure is followed by placing a stent in the artery to help keep it from narrowing or closing again.

• Coronary stents implantation

A stent is a small, expandable metal tube that is placed within a blood vessel to keep it open. The stent is mounted on a tiny balloon on the end of a catheter. It is positioned within the blockage in the coronary artery and when the balloon is inflated, the stent expands pushing the blockages open. The balloon is deflated and removed from the vessel. The stent remains, embedded in the vessel wall. Drug-eluting stents (also called coated stents) slowly release medication that helps to prevent plaque from accumulating again within the stent.

• Rotational atherectomy
  This procedure uses a high speed rotational "burr” to drill through plaque that is calcified or hardened. Hydrodynamic or extraction thrombectomy may be used to break up or remove blood clots contributing to blocked arteries.