Endovascular therapy—the treatment of cardiovascular disease from inside the blood vessel—has changed the way heart attacks, stroke and other cardiovascular conditions are being treated. Many heart and vascular problems that once required invasive surgery can now be treated from inside the body. Because endovascular procedures are less invasive, patients spend less time in the hospital, less time recovering and often have less pain.
Endovascular therapy uses minimally invasive, catheter-based procedures and specialized equipment and techniques. These procedures are often performed in a cardiac catheterization labs. Cardiac catheterization labs are located at Froedtert Hospital and Community Memorial Hospital.
These procedures require only a small incision, through which a thin catheter is inserted. Using advanced imaging technology, the catheter is guided through a blood vessel to remove blockages and/or open narrowed areas. Today, even smaller, more flexible catheters and stents (small tubes) are being used to treat even the smallest blood vessels.
To open blocked coronary arteries, the following catheterization procedures may be performed. These non-surgical procedures are also known as percutaneous coronary interventions (PCI).
Balloon angioplasty, also called percutaneous transluminal coronary angioplasty (PTCA), is one of the most common procedures for opening obstructed coronary arteries.
- Percutaneous refers to accessing the blood vessel through the skin.
- Transluminal means the procedure is performed through the blood vessel.
- Coronary refers to the coronary arteries, the vessels that supply the heart with blood.
- Angioplasty is the enlarging of a narrowed blood vessel.
PTCA is performed by advancing a slender, balloon-tipped catheter from an artery in the groin to an artery of the heart. The balloon at the tip of the catheter is then inflated, compressing the plaque in the coronary artery and widening the artery so that blood can flow more easily.
Angioplasty With Stent Placement
During an angioplasty procedure, a flexible, wire mesh tube (stent) is placed in an artery after it is opened by the balloon. The stent is left in place to keep the artery open. Stents may have medication embedded on the surface to keep the blockade from returning.
Drug-Eluting Stents (DES)
Also called “coated” or “medicated” stent, a drug-eluting stent is a standard metal stent that has been coated with a drug that minimizes restenosis (reblocking) of the artery. Types of coated stents vary for use with appropriate patients, including those with diabetes.
Renal Artery Angioplasty and Stenting
The renal arteries that supply blood to the kidneys can become narrowed by a build-up of plaque, which can cause kidney damage. To relieve a blockage in the renal artery without surgery a catheter can be inserted through an artery. Once inserted a balloon on the catheter is inflated to open up the blockage and allow more blood to flow through it. Kidney arteries often require the insertion of a stent to keep the arteries open after the procedure. This procedure is performed by a vascular and interventional radiologist.
Carotid Artery Stenting
Carotid artery stenting provides an alternative to patients considered high-risk for a carotid endarterectomy (open surgical procedure). A stent is a metallic mesh device that remains permanently in place to help keep the carotid artery open. The body’s two carotid arteries, located in the front of the neck, provide blood from the heart to the brain. When the carotid artery narrows due to a buildup of plaque, blood flow to the brain is reduced and a stroke can occur. Depending on a patient’s risk factors and anatomy there are two options available.
- Transfemoral Carotid Artery Stenting
This procedure involves placing a stent in a blocked carotid artery to push plaque out of the way and restore blood flow. During the procedure, a tiny catheter is inserted through the femoral artery at the top of the leg and threaded to the carotid artery. The catheter dilates the artery with a balloon and the stent is inserted. The stent is specifically designed for the carotid artery and includes filters that act as a “safety net” and prevent plaque from breaking off and going to the brain — and potentially causing a stroke — while the stent procedure is being performed.
- Transcarotid Artery Revascularization
Transcarotid artery revascularization, or TCAR, is an innovative option for patients with carotid arterial disease who are at high risk for a traditional carotid endarterectomy due to age, medical condition or anatomical issues. This minimally invasive endovascular procedure, involves a small incision at the base of the neck providing a vascular surgeon direct access to the carotid artery. During the delivery of the stent to open the carotid artery, a neuroprotective system is used to temporarily reverse blood flow to protect the brain from stroke while delivering and implanting the stent.
Intravascular brachytherapy (IVBT) can benefit patients who are more likely to experience scar tissue reforming over the stents during the healing process. The goal of this advanced treatment, which adds about 10 minutes to the procedure, is to limit the regrowth of tissue during the healing process, keep the arteries open and reduce the need for future surgery. The radiation therapy is given to patients right after angioplasty treatment for narrowed coronary arteries. After completing the angioplasty procedure, a physician threads a catheter with a ribbon of radioactive particles to the blockage, leaves it in place for a few minutes, and then removes the catheter with no radiation being left in the body.
A procedure that opens an artery by removing the plaque produced from the build-up of cholesterol and other fatty substances inside an artery (atherosclerosis) (“hardening of the arteries”). A catheter is inserted into the artery and, using special devices placed inside of a catheter, the physician is able to cut, grind, ablate or vaporize plaque from inside arteries or veins.
The catheter may have a laser that vaporizes the plaque, a rotating shaver on the end of the catheter, or a device that shaves off the plaque. Balloon angioplasty or stenting may then be done after the atherectomy. If atherectomy cannot be done as a catheterization procedure, a vessel can be opened as a surgical procedure in an operating room.
Thrombolysis is a catheter-based treatment that removes abnormal blood clots that restrict blood flow. Thrombolytic therapy dissolves blood clots using medication given directly into the clot through a catheter. Mechanical thrombolysis breaks up a blood clot using various mechanical devices. An interventional radiologist can use either of these methods to dissolve and remove blood clots.
Structural Heart Problem Procedures
For structural problems of the heart, the following catheterization procedures may be used.
A procedure to widen a narrowed heart valve; a catheter is advanced through a blood vessel through the aorta and into the heart; the catheter is placed in the valve to be opened, and a large balloon at the tip of the catheter is inflated until the flaps of the valve open (performed by an interventional cardiologist).
- PFO and ASD Closures
Patent foramen ovale (PFO) and atrial septal defect or (ASD) are holes or defects in the wall (septum) between the atria, the two upper chambers of the heart; to guide the closure of these defects with a special device, transesophageal echocardiography (TEE) is performed in the cardiac catheterization lab.
- Transseptal Catheterization
Procedure that extends or are performed through or across the septum — the wall between the right and left sides of the heart.