The Interventional Procedure

05/25/23 22:38
Types of Interventional Procedures

• POBA - Plain Ol’ Balloon Angioplasty

• Stents - Balloon & Self-expandable systems
• Rotational Athrectomy
• Directional Athrectomy
• Laser
• Radiation
• Thrombectomy
Factors in determining what type of
Intervention to use

• Single, Double or Triple vessel disease

• Presence of Thrombus / Clot
• Presence of Calcium
• Dissection / Plaque Rupture
• Last remaining vessel
• SVG or native vessel
Single, Double or Triple vessel disease

• Severity of the disease

– Diffuse or Focal Lesions?

• Is the patient a candidate for bypass surgery

or not
– Dependant upon age and whether the
patient wishes to have the CABG operation
or not

• Has the patient had previous bypass surgery?

– Does the patient wish to have another
CABG operation or... is the patient now not
a candidate for surgery
 Presence of Thrombus / Clot
• Acute Thrombus / Clot formation
– Usually indicative of an acute MI or Heart
Attack
– Treatable with PTCA &/or Stents
– Use of thrombolytics is sometime applicable
• Thrombus / Clot formation in a SVG
– Treatable with PTCA &/or Stents
– Thrombolytics
• Significance & location of the Thrombus / Clot
formation
– How much area does the Thrombus / Clot
cover?
– Does the Thrombus / Clot occlude flow
to/from the vessel?
 Presence of Calcium

• Significance & location of the Calcium

– Proximal, mid or distal location / Mild or heavy
concentration of Calcium
• Concentric or Eccentric formation
– Single sided or “Napkin Ring” formation?
• Short or long segment
– The longer the calcific area, the more difficult to treat
• Ostial disease
– Left Main / Right Main
 Dissection / Plaque Rupture

• Significance & location of the dissection /

plaque rupture
– Proximal, mid or distal location
• Length of the dissection / plaque rupture
– Short or long segment - The longer the
segment, the more difficult to treat
• Involvement of other vessels or side branches
– Can be disastrous
 Last Remaining Vessel
• Native or SVG
– Native vessels are more “forgiving” than
that of SVG’s. SVG’s tend to be more
friable and need more TLC than native
vessels
• Significance & location of stenosis
– The more difficult the stenosis, the lower
the success rate
• Surgical options
– Is the patient a surgical candidate?
– Do they wish not to have CABG surgery
– Is CABG surgery their only viable option?
 Saphenous Vein Grafts (SVG’s)

• Which vessel does the graft supply

– The LAD, Circumflex or RCA & does the
patient have a Right or Left Dominant
coronary system?
• Significance of the graft to the vessel
– Is the graft supplying blood to a dominant
vessel
• Type of stenosis on the SVG
– Soft, mixed, hard or calcific plaque
– Thrombus / clot
• Location of the stenosis
– Proximal, mid or distal
Equipment of the Cath Lab

What makes things tick?

X-ray Equipment

Single or Biplane systems

• Provide the “Live Imaging”

fluoroscopy needed to
complete the diagnostic &
interventional procedures
• Can be used in
combination with one
another to reduce the
patients exposure to X-
ray’s and X-ray Contrast
load
Monitors
Fluoroscopy
• Allows the cath
lab members to
observe what
they're doing
when they're
doing it
Playback
• Allows the cath
lab members to
review any of the
previous images
they have taken
EKG & Arterial
Pressures
Accessory Equipment

Power Injector
• Used to deliver the X-
ray dye (contrast)
• Can be directly shot
into the patient or
bypassed into a “hand
syringe” which the
physician will use to
inject dye
• Used specifically with
the LV gram injection
Accessory Equipment

Defibrillator
• Used in situations
where the patients
heart goes into a
irregular rhythm &
needs a “jump start”
Oximeter
• Used to measure the
patients oxygen levels
Blood Pressure Cuff
• Used to measure the
patients current B/P.
Accessory Equipment

Intra Aortic Balloon Pump (IABP)

• Used primarily with patients

that have a very low or poor
left ventricular function
• Can be used in conjunction
with a interventional or
surgical procedure
• Helps decrease the stress on
the heart by taking some of
its work
The Sterile Field

The Sterile Field

• A.k.a. “Death Valley” in
some institutions. This is
the area where the
physicians & cath lab
staff work with our
products

The Sterile Tray

• Contains all the
necessary items to
perform the diagnostic &
interventional procedures
“If it’s Blue, don’t touch it!”

The Sterile Field and

Tray can be considered
“sacred” areas within
the cath lab, it’s best
to stay away from
them
Scrub Tech

Duties & Responsibilities

• To assist the Cardiologist

with the diagnostic &
interventional procedures
(essentially become their
“Right Hand Person”
• Preparation of all the wires,
catheters & other items used
during a procedure
• Assist with any patient care
needs
Circulating Nurse

Duties & Responsibilities

• Assisting & assessment
of all patient care &
needs
• Administration of
medications & fluids
• Obtaining products and
information for the
physician and scrub
tech
• Report of patients
procedure(s) to next
unit or nurse receiving
the patient
The Interventional Procedure
Sheath(s) Placed
• Arterial
• Venous in some cases
Guide Catheter
• Conduit for the delivery
of all Interventional
Modalities
Guide Wire
• The “Track which
delivers the trains”
• Placed past the stenosis
in order to deliver the
Interventional Devices
Delivery of the Interventional Device

Prep of the device

• Scrub Tech prepares the

Balloon, Stent, etc.
• Placed on Guide Wire
• Advanced to target
lesion site
• Positioned
• Intervention delivered
Monitoring during the Interventional
Procedure
Assess for changes in the patients

• EKG, Blood Pressure & Oxygen saturation

• Level of anticoagulation in the patients blood
(ACT Level)
• Angiographic appearance of the patients
coronary artery and lesion site during and after
the Interventional Procedure
• Ask the patient if they are having any tightness
or pain within their chest, tingling / numbness in
their fingertips or pain in their jaw
• Or... ask the patient if the pain or discomfort
that they are experiencing is similar to that
which brought them into the Cath Lab
Completion of the Interventional
Procedure
Happens when

• Patients pain or level of discomfort diminishes

• Patients EKG & Blood Pressure return to
normal
• Angiographic appearance of the target lesion
demonstrates a residual stenosis < 30%
• TIMI 3 flow is re-established through the
vessel
• Major Adverse Cardiac Event (MACE) occurs,
requiring surgical intervention
The Interventional Procedure

The End