• Interventional Cardiology

    Overview

    The following procedures fall under the category of “interventional cardiology,” which describes procedures performed using tiny tubes (catheters) that are threaded through the blood vessels to sites of blockage or disease. Interventional cardiology procedures are less invasive than open heart surgery, as they allow physicians to access the coronary arteries or other arteries in the body through arteries or veins in the leg or arm.

    Cardiac Catheterization (angiogram) 

    Nurse in cath lab views resultsCommonly known as an angiogram, cardiac catheterization involves passing a catheter through blood vessels and injecting contrast dye to detect blockages. The contrast dye makes it possible for physicians to view the coronary arteries on X-ray, allowing them to see the exact site where the artery is narrowed or blocked. Catheterization is sometimes performed for diagnostic purposes only, and other times, it is the first step in opening a narrowed artery.

    Transradial Catheterizations

    Lahey is also a leading center in New England for radial artery catheterizations, an increasingly popular option for people requiring catheterization. This approach uses the radial artery in the wrist as the point of entry rather than the femoral artery in the groin. Although the procedures are performed in the same manner, the radial approach offers benefits for some patients, particularly those patients at a higher risk of bleeding. The radial approach also allows patients to sit up immediately after the procedure, rather than have to lie flat for six hours. Patients with difficult anatomical issues often benefit from the radial approach as well. To learn more, talk to your cardiologist.

    Angioplasty

    Sergio Waxman, MD, looks at images in Lahey's Cardiac Catheterization LabAngioplasty is performed to open blockages in the coronary arteries and restore blood flow to the heart. During this procedure, a tiny balloon is inserted into the coronary artery through a catheter. The balloon is then inflated, opening the narrowed area of the artery. One or more stents – small, wire, mesh-like-tubes – may be placed to keep the artery open.

    Five Steps of Angioplasty

    What is a Stent?  

    Peripheral Vascular Interventions

    Peripheral vascular intervention procedures help to open blockages in peripheral arteries and restore blood flow to the lower body, legs or kidneys. If it is determined that a blockage is causing an obstruction, angioplasty is performed. Angioplasty involves inflating a tiny balloon within the obstructed artery in order to open the narrowed area. After angioplasty, one or more stents may be placed to keep the artery open.

    Cerebrovascular Interventions

    Cerebrovascular interventions are conducted to open blockages in cerebral arteries (arteries to the brain). These procedures help to restore blood flow in the brain, thus reducing the risk of major stroke. During cerebrovascular intervention, a team of physicians – including an interventional cardiologist, interventional neuroradiologist, neurologist, and vascular surgeon – direct patient care. The actual procedure is performed jointly by the interventional cardiologist and interventional neuroradiologist. If an obstructive blockage is found, angioplasty is performed using a tiny balloon to open it. Following angioplasty, a stent may be used to keep the artery open.

    Patent Foramen Ovale (PFO) and Atrial Septal Defect (ASD) Closures

    Patent Foramen Ovale (PFO) and Atrial Septal Defects (ASD) are holes in the wall (septum) between the heart's left and right upper chambers (atria). Often a harmless heart defect, PFO is an opening that failed to close after birth, as it normally should. In most cases, this does not cause any problems. However, sometimes clots in the vein can find their way to the left side of the heart through the hole, and proceed to travel through the arteries to the brain or other organs. In the case of ASD, the hole allows blood to seep from the left atrium into the right atrium. This results in too much blood flow to the right side of the heart and lungs. The more blood that is diverted to the right side of the heart, the harder the lungs and right ventricle must work to compensate for the problem.

    PFO and ASD closures are less invasive treatment alternatives to open heart surgery. During these procedures, a small patch is placed across the hole with the aid of fluoroscopy and ultrasound. Tiny catheters are used to implant a special device that closes the hole in the heart and remains in the body.

    Lahey Clinic is one of the busiest and most experienced hospitals in New England with regard to closing PFOs in stroke patients. In addition, Lahey is currently participating in a national trial to determine if PFO device closure is superior to coumadin therapy for treating these patients.

    Valvuloplasty

    This procedure uses balloon angioplasty to dilate diseased heart valves in order to improve blood flow between the heart chambers. A catheter with a collapsed balloon at the tip can be inserted into an artery or vein in the leg under a local anesthetic and conscious sedation. This catheter is then advanced into the heart and across the narrowed valve, and the balloon is expanded to open the valve. Valvuloplasty may be performed on either the mitral valve or the aortic valve.

    Symptoms including shortness of breath or chest discomfort may lead your physician to investigate the possibility of performing valvuloplasty on you. Following the procedure, patients are generally discharged by the following day.

    Drug-eluting Stents

    Drug-eluting stents help prevent narrowing of the artery within the stent (in-stent restenosis), which occurs due to an overgrowth of tissue during the healing process. A stent consists of a stainless steel mesh scaffold with a thin drug coating on its surface. The stent provides mechanical support for the artery while the drug is slowly released. 

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    An innovative procedure to replace the aortic valve without traditional surgery.