I'm Dr. Eric Cohen and I want to talk about
coronary angiogram for information of patients who might undergo this procedure.
First of all, coronary angiogram is a type of x-ray
picture of the arteries of the heart. You can see on our model of the heart right
here
these these red
lines are the arteries. They're the tubes that take blood to the heart muscle itself.
As you probably know these are prone to getting narrowed or blocked
and the angiogram is about looking for those narrowings or blockages. What we do in an
angiogram is insert a tube
through an artery in the wrist or sometimes at the top of the leg
thread it up to the heart
and then inject x-ray dye into these arteries here.
The x-ray dye
then outlines for us where the arteries are blocked.
Based on what we find on
those pictures
we then decide what - together with the
patient of course - what the best treatment might be.
Various treatments include medications alone,
sometimes bypass surgery,
and sometimes the balloon procedure with the stent, which we called angioplasty or
these days we call it
PCI.
On the day we do the procedure, many patients come from home that
morning. If we're just doing the angiogram procedure, they
usually go home the same day. It's an outpatient procedure,
often home within a few hours.
We usually ask you to not have anything to eat in the morning if
your procedure scheduled early in the day. If it's scheduled later you can have
a light breakfast before showing up.
Here you see Mr. Nezim coming into the procedure room.
He's being
led to the procedure table.
The nurses will do some prep of the skin on the hand and at the top of
the leg.
Then we usually
insert some local anesthetic - a very small amount. A little bit of
discomfort with that but once it's numbed up, you
usually don't feel anything else.
You are awake during this procedure. We often use a mild sedation
so you're a bit relaxed, but we
do not need
general anaesthetic. You don't need to be asleep for this.
In fact, many patients can watch on the monitor
exactly what's going on.
Following this, we proceed to insert what we call them introduce
tube.
The introducer tube is in place now.
We advance the catheter towards the heart and we are guided by the x-ray
during this.
You can see the people in the room wear x-ray protection in the form of
a lead apron and there are x-ray shields. This is mainly to protect the staff
who are exposed to the x-rays constantly in their job.
Here you can see how we are actually injecting the x-ray dye and taking the
pictures.
The images are shown in real time on the monitor. We are observing the monitor.
We take multiple pictures from different angles that's why you see the camera
being moved around
to different projections. Once we've seen the images sometimes we will
proceed with the angioplasty procedure, that's the balloon and stent,
right then and there at the same time.
In other situations, it requires further discussion, thinking about it
and as I said before, possibly other types of treatment.
After the procedure you're taken off the procedure table,
wheeled back to the room usually on a stretcher, sometimes in a wheelchair.
Then we usually keep an eye on things and observe
for three to four hours, sometimes a bit less if it's an uncomplicated
procedure.
As i said you go home the same day. We always ask you to take it easy that
evening when you go home,
but one of the advantages of this kind of procedure is that you can get back to your usual
activities very quickly.
If we do the angioplasty procedure either at the same time or even if you
come back on a separate day
that takes a bit longer for the procedure itself and that depends on how
complex your particular arteries and situation might be.
We've completed taking the pictures and we're reviewing them now
and discussing with Mr. Nezim what the best treatment option would be.
We'll put at least one, maybe two stents there
and that will probably make your chest discomfort feel better.
In this case, we all felt that an attempt to open that narrowed artery
right away
would be the best treatment option.
So we're getting set up at this point to proceed with what we call
angioplasty or a stent procedure.
We started working on the angioplasty at this point. We use a very fine
guidewire which is threaded through the narrowed area of
the artery and then we insert a
small balloon.
Everything is very small here. They are only two or three
millimeters in diameter
We insert the balloon and then we inflate it to stretch the artery a bit. That makes
room to bring the stent in. In this case, it requires more than one stent to
fully open
the narrow portion of the artery.
At this point we've completed the procedure, the stents are in
place and it might be quite obvious from the images that the arteries are
now wide open where it was severely narrowed before.
At this point, we just have to remove the tube -
the introducer sheath -
from the wrist.
We apply pressure over the site until the bleeding stops. You can
see that there really is very little blood loss and the only incision made is
about a quarter of an inch
in length. Do you wanna see the picture before and after?
As you can see, it's almost completely blocked.
There's no blood getting through.
Afterwards it's wide open. Lots of blood getting through.
That's called the right coronary artery.
The whole bottom part of your heart
was not getting very much blood supply.
So I think your angina is going to feel better.
Once we're all done with removing
all the equipment, the patient is taken off the procedure table. He's
getting back onto a
stretcher here and will be returned do what we call the short stay unit.
He may go home later in the same day or in this case because it
was later in the day already, he'll probably stay overnight and go home the
following morning. We usually arrange or ask that you arrange follow-up with your own
cardiologist who might be someone here at Sunnybrook or might be somewhere else.
We make sure that you have all the information about prescriptions because
some of the medications after these procedures are quite important.