تعريف

A coronary angioplasty is a procedure to open an artery in the heart that has become narrowed. This allows better blood flow through the artery and to the heart muscle. It is often done with a balloon that is passed through a special catheter (tube).

قسطرة الشريان التاجي

أسباب هذا الإجراء

Atherosclerosis is a disease of the arteries. Cholesterol and fatty deposits build up on the walls of the arteries. This restricts blood flow. When this buildup happens in the heart, it may lead to a heart attack. Lifestyle changes and medicines can be used to treat atherosclerosis. If they are not enough, an angioplasty may be done.

المضاعفات المحتملة

If you are planning to have an angioplasty, your سيقوم الطبيب بمراجعة القائمة of possible complications which may include:

  • Bleeding at the point of catheter insertion
  • Damage to the walls of arteries, causing you to need more procedures or surgery
  • Heart attack or abnormal heart beats called arrhythmia
  • Allergic reaction to x-ray dye
  • Blood clots
  • العدوى
  • سكتة دماغية
  • Temporary kidney failure

بعض العوامل التي قد تزيد من خطر المضاعفات تشمل:

  • Allergies to medicines, shellfish, or x-ray dye
  • السمنة
  • التدخين
  • اضطراب النزيف
  • زيادة العمر
  • Recent pneumonia
  • Recent heart attack
  • مرض السكري
  • مرض كلوي

ما يمكن توقعه

قبل الإجراء

Your doctor will likely do the following.

  • طبيبك قد تحتاج إلى اختبار سوائل الجسم. ويمكن أن يتم هذا مع اختبارات الدم.
  • You may need heart pictures and function tests. This can be done with:
    • مخطط كهربية القلب (ECG، EKG)
    • الأشعة السينية الصدر

في الأيام التي تسبق الإجراء الخاص بك:

  • تحدث مع طبيبك حول الأدوية التي تتناولها حاليًا. قد يلزم التوقف عن تناول بعض الأدوية قبل الإجراء، مثل:
    • Anti-inflammatory drugs (eg, ibuprofen) for up to one week before surgery
    • Blood-thinning medicines such as warfarin (Coumadin)
    • Metformin (Glucophage) or glyburide and metformin (Glucovance)
  • You should take aspirin before and during the procedure. Your doctor may also prescribe clopidogrel (Plavix) before the procedure.
  • في الليلة السابقة، تناول وجبة خفيفة. لا تأكل أو تشرب أي شيء بعد منتصف الليل.
  • للترتيب من الإجراء.
  • رتِّب للحصول على المساعدة في المنزل بعد العودة من المستشفى.

التخدير

Local anesthetic will be given. It will numb the area of the groin or arm where the catheter will be inserted. You will also be given sedation and pain medicine through an IV. This will help to keep you comfortable during the procedure.

الوصف الداخلي

The area of the groin or arm where the catheter will be inserted will be shaved, cleaned, and numbed. A needle will be inserted into the artery. You will receive blood-thinning medicines during the procedure. A wire will be passed through the needle and into the artery. The wire will be guided through until it reaches the blocked artery in the heart. A soft, flexible catheter tube will then be slipped over the wire and threaded up to the blockage.

The doctor will be taking x-rays during the procedure to know where the wire and catheter are located. Dye will be injected into the arteries of the heart. This will provide a better view of the arteries and blockages.

After the blockage is reached, a small balloon at the tip of the catheter will be rapidly inflated and deflated. This will stretch the artery open. The deflated balloon, catheter, and wire will be removed.

Your doctor may also insert a small mesh tube called a stent into the artery where there was a narrowing. A stent acts to keep the artery open by providing support inside it.

After the procedure is done and the blood-thinning medicines have worn off, the catheter will be removed. Pressure will be applied for 20-30 minutes to control bleeding.

A bandage will be placed over the groin or arm.

كم من الوقت سيستغرق ؟

30 minutes to three hours

هل سيكون هناك ألم؟

The anesthetic should numb the area where the catheter is inserted. You may feel a burning sensation when the anesthesia is given. You may also feel pressure when the catheters are moved. Some people have a flushed feeling or nausea when the dye is injected. You may feel some chest pain during inflation of the balloon.

متوسط ​​الإقامة في المستشفى

The usual length of stay is overnight. If the catheter is inserted in your arm or wrist, you may be able to go home the same day. Speak to your doctor to see if this is an option for you.

رعاية ما بعد العملية

في المستشفى

You will likely need to lie still and flat on your back for a period of time. A pressure dressing may be placed over the area where the catheter was inserted. This will help prevent bleeding. Or, a vascular closure device may be used to seal the site. This will allow earlier movement and hospital discharge. It is important to follow directions.

في البيت

  • You may be sent home on blood-thinning therapy. This may include one or more of the following:
    • أسبرين
    • Warfarin
    • Clopidogrel
    • Prasugrel (Effient)
    • Dabigatran etexilate (Pradaxa)
  • Ice may help decrease discomfort at the insertion site. You may apply ice for 15-20 minutes each hour for the first few days.
  • You can make lifestyle changes to lower your risk of complications of heart disease. These include eating a healthier diet, exercising regularly, and managing stress.
  • اسأل طبيبك حول, عندما هي آمنة للاستحمام, السباحة, أو نقع في الماء.
  • تأكد من اتباع تعليمات طبيبك.

Sometimes the procedure is not successful or the artery narrows again. You may require repeat angioplasty or coronary artery bypass grafting (CABG).

استدعاء الطبيب

بعد مغادرة المستشفى، اتصل بطبيبك في حالة حدوث أي مما يلي:

  • علامات الإصابة, بما في ذلك حمى وقشعريرة
  • احمرار أو تورم أو ألم متزايد أو نزيف شديد أو أي إفرازات من موقع الشق
  • Your arm or leg becomes painful, blue, cold, numb, tingly, swollen, or increasingly bruised
  • الغثيان و/أو القيء
  • ألم لا يمكنك السيطرة عليه بالأدوية التي أعطيت لك
  • السعال، ضيق التنفس، أو ألم في الصدر
  • آلام المفاصل ، والتعب ، والتصلب ، والطفح الجلدي ، أو غيرها من الأعراض الجديدة

في حالة الطوارئ ، اتصل على المساعدة الطبية على الفور.

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