Continuing Education Activity
Percutaneous transluminal coronary angioplasty (PTCA) also called percutaneous coronary intervention (PCI) is a minimally invasive procedure to open blocked or stenosed coronary arteries allowing unobstructed blood flow to the myocardium. The blockages occur because of lipid-rich plaque within the arteries, diminishing blood flow to the myocardium. The accumulation of lipid-rich plaque in the arteries is known as atherosclerosis. When atherosclerosis affects the coronary arteries, the disorder is known as coronary artery disease. This activity describes the indications, contraindications, complications of PTCA and highlights the role of the interprofessional team in the management of patients with CAD.
Identify the indications for PTCA.
Describe the contraindications for PTCA.
Review the complications of PTCA.
Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients undergoing PTCA.
Percutaneous transluminal coronary angioplasty (PTCA) also called percutaneous coronary intervention (PCI) is a minimally invasive procedure to open blocked or stenosed coronary arteries allowing unobstructed blood flow to the myocardium. The blockages occur because of lipid-rich plaque within the arteries, diminishing blood flow to the myocardium. The accumulationoflipid-richplaque in the arteriesis known as atherosclerosis. When atherosclerosis affects the coronary arteries, the disorder isknown as coronary artery disease. Patients with CADusually present with exertional chest pain, or with dyspnea with exertion. In acute myocardial infarction, there is plaque rupture with platelet aggregation, andacute thrombus formation, which results in a sudden occlusion of thecoronary artery. These patients present with acute chest heaviness, diaphoresis, and nausea. Urgent PTCA is often required to limit myocardial damage.
Andreas Gruentzigfirst developed PCTA in 1977, and the procedure was performed in Zurich, Switzerland that same year.By the mid-1980s many leading institutions adopted this procedure throughout the world as a treatment for coronary artery disease. PTCA is a hallmark procedure and basis of many other intracoronary interventions. It is one of the most common procedures performed in the United States making up 3.6% of all operating room procedures performed in 2011.
Anatomy and Physiology
The 2, main coronary arteries supplying the heart are the right and left coronary arteries. The left coronary artery (LCA) divides into left anterior descending (LAD) and left circumflex artery (LCX) branches. LCA supplies blood to the left ventricle of the heart. The right coronary artery (RCA) divides into theright posterior descending (PDA) and a (PL) posterolateral branch. RCA supplies blood to the ventricles, right atrium, and sinoatrial node. Coronary arteries are end-arteries supplying the myocardium and blockage can lead to serious adverse effects. Coronary artery disease occurs due to the buildup of plaque within the coronary arteries with subsequent narrowing and blockage reducing blood flow to the myocardium.
Indications of PTCA depend on various factors. Patients with stable angina symptoms unresponsive to maximal medical therapy will benefit fromPCI. It helps provide relief of persistent angina symptomsdespite maximal medical therapy.Emergency PTCAisindicatedfor acute ST-elevation myocardial infarction (STEMI)suggesting 100% occlusion of thecoronary artery. With acute STEMI, patients are taken directly to the cath lab immediately upon presentation to help prevent further myocardial muscle damage. In non-ST-elevation myocardial infarction (NSTEMI), or unstable angina, (known as acute coronary syndromes),patients are taken to the cardiac cath lab within 24 to 48 hours.
PTCA has limited contraindications. Patients with left main CAD are poor candidates for the procedure due to the risk of acute obstruction or spasm of the left main coronary artery during the procedure. It is also not recommended for patients with hemodynamically insignificant (less than 70%) stenosis of the coronary arteries.
Initially, PCI was performed using balloon catheters alone. However, due to subclinical outcomes and vessel re-stenosis, other devices were introducedincluding atherectomy devices and coronary stents.Atherectomy devices used alone resulted in poor outcomes. Coronary stents are the most widely used intracoronary devices in PTCA due to improved clinical outcomes. Various types of stents are available including traditional bare-metal stents (BMS) and drug-eluting stents (DES). DES has a polymer coating that prevents inflammation and endothelial cell proliferation. Most recent DES used in the United States use sirolimus, everolimus, and zotarolimus. The newer generation DES have reduced the incidence of late stent thrombosis.The use ofantiplatelet therapy is important during the first 12 monthsafter PTCA, allowing appropriate duration for endothelial cell formation over the metallic stent to prevent stent thrombosis.
A team made up of an interventional cardiologist, nurse, and radiology technologistperforms PTCA. All team members must have specialized and extensive training in the procedure.
An interprofessional team evaluates the patients and performs pre-procedural testing to determine candidacy for the procedure. The inquiry related to the pasthistory of allergy to seafood or contrast agents is vital. Important pre-procedure laboratory tests include PT and PTT, serum electrolytes, BUN, and creatinine. The patientis required to be well hydrated. Medication review is essential including cessation of anticoagulants if possible. Also, common medications including NSAIDs, or ACEIs can be held to prevent worsening renal insufficiency. The diabetes medication metformin is held prior to cardiac catheterization to avoid worsening renal insufficiencyand lactic acidosis.Fluids and food are restricted 6 to 8 hours before the procedure. When cases are performed via radial artery access, patients are often givenintra-arterial calcium channel blocker, nitroglycerin, and heparin to prevent vasospasm. The health care provider should thoroughly explain the procedure and its associated risks and complications to the patient to obtain a signed informed consent.
The procedure is performed under local anesthesia. Conscious sedation is routinely given to avoid stress and calm the patient. The most commonly used approach is the percutaneous femoral (Judkins) approach. Once the patient isanesthetizedwith a superficial injection of lidocaine to the skin, and subcutaneous tissues over the right femoral artery,a needleis inserted into the femoral artery (percutaneous access). Successful insertion of the needle is followed by insertion of a guidewire through the needle into the lumen of the blood vessel. The needle is thenremoved with the guidewire remaining in the vessel lumen. A sheath with an introducer is placed over the guidewire and into the femoral artery. Next, the guidewireandintroducer is removed, leaving the sheath in the vessel lumen. This provides easy access to the femoral artery lumen. Next, a long narrow tube, knownas the "diagnostic catheter," is advanced through the sheath with a longguidewire in the catheter lumen. The diagnostic catheter follows the guidewire and is passedretrograde through the femoral artery, iliac artery, descending aorta, over the aortic arch to the proximal ascending aorta.The guidewire is removed leaving the tip of the diagnostic catheter in the ascending aorta.The diagnostic catheteris attached to a manifold with asyringe. The manifold allows the ability to inject contrast, check inter-arterial pressure, and administermedications.
The diagnosticcatheteris then manipulated intothe ostium of the left main coronary artery, or right coronary artery.Contrast dyeis injected, and cineangiographyimages areobtained in multiple views of both arteries. If severe stenosis exists in one of the arteries, PTCA can be performed. The diagnostic catheteris removed and exchanged fora similar guide catheter. Guide catheters have a larger luminal diameter for ease of passage of wires and balloons during angioplasty.After theguide catheter is placed in the ostium of the respective artery, a PTCAguidewireis advancedthrough the catheter and across the stenosis. Once the PTCA guidewire is passed across the stenosis, itis left in place until the end of the procedure.A balloon wirecan be placed over the PTCAguidewire and advanced until the balloon is directly over the stenosis. The cardiologist controls the direction and movement of the PTCA guidewire, and balloon wire by twisting the part of guide wires that sit outside the patient. The balloon is then inflated and deflated repeatedly until the artery is patent. In most instances, a stent is required. The balloon wire is removed and exchanged for a stent. A stent is a latticed metal scaffold that isdelivered crimped over a balloon of a balloon wire. The stent is then placed in the position of the stenosis, and the balloon is expanded. Once the stent is expanded, it cannot be removed from the artery.The balloonis deflated,and the stent remains in place.Thestent can maintainlong-termpatency.Repeated injections of contrast mediaare utilizedto check for patency of the artery.
Upon successful insertion of the stent and expansion of the vessel, the balloonwireis removed. Lastly, the PTCA guidewire is removed. During the procedure, anticoagulationis administered to prevent the formation of clots. The entire procedure can take from 30 minutes to 3 hours depending upon the technical difficulties of the case.
PTCA is widely practiced and has risks, but major procedural complications are rare. The mortality rate during angioplasty is 1.2%. People older than the age of 65, with kidney disease or diabetes, women, and those with massive heart disease are at a higher risk for complications. Possible complications include hematoma at the femoral artery insertion site, pseudoaneurysm of the femoral artery, infection of skin over femoral artery, embolism, stroke, kidney injury from contrast dye, hypersensitivity to dye, vessel rupture, coronary artery dissection, bleeding, vasospasm, thrombus formation, and acute MI. There is a long-termrisk of re-stenosis of the stented vessel.
PTCA is performed under local anesthesia and serves as an alternative to coronary artery bypass surgery (CABG). In comparison to CABG,PTCA is associated with lower morbidity and mortality, shorter convalescence, and lower cost. It can significantly improve blood flow through the coronary arteries in about 90% of patients with relief of anginal symptoms and improvement in exercise capacity. It effectivelyeliminates arterial narrowing in most cases. Different modeling studies presented different conclusions regarding the cost-effectiveness of PTCA and CABG in patients with myocardial ischemia that do not respond to medical therapy.
Enhancing Healthcare Team Outcomes
PTCA is not an easy procedure, and despite the advances in technology, it has risks and complications. All patients need to be educated about the procedure and its potential complications. Maintaining a healthy diet, exercising, and reducing stress are important post-procedural measures to reduce the risk of recurrences and complications. The heart team illustrates an excellent example of patient-centered care. Experts from different fields of medicine come together to provide the best solution for each patient.
Figure 2. Coronary angiogram showing normal epicardial left (A) and right (B) coronary arteries. Contributed by Nelson Telles
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Percutaneous transluminal coronary angioplasty (PTCA) also called percutaneous coronary intervention (PCI) is a minimally invasive procedure to open blocked or stenosed coronary arteries allowing unobstructed blood flow to the myocardium.When do you use percutaneous transluminal coronary angioplasty? ›
Percutaneous transluminal coronary angioplasty (PTCA) is performed to open blocked coronary arteries caused by coronary artery disease (CAD) and to restore arterial blood flow to the heart tissue without open-heart surgery.What is the CPT code for percutaneous transluminal coronary angioplasty with stent? ›
CPT code 92944 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately ...What are the steps for angioplasty? ›
An angioplasty has three major steps: placement of the angioplasty catheter into the blocked artery, inflation of the balloon to open the blocked artery, and removal of the catheter. Local anesthetic is used so that you will only feel some pressure during the procedure.Where is percutaneous transluminal coronary angioplasty? ›
Percutaneous transluminal coronary angioplasty is commonly called PTCA, or just angioplasty. A catheter is inserted into an artery—usually in the groin—but sometimes in the arm or wrist.What is primary percutaneous angioplasty treatment? ›
Primary Percutaneous Coronary Intervention (PPCI), also known as angioplasty or coronary angioplasty, is a procedure used to treat the narrowed coronary arteries of the heart and angina in patients. Therefore it is sometimes used as an emergency treatment for patients who have had a heart attack.How is percutaneous transluminal coronary angioplasty done? ›
Percutaneous transluminal angioplasty (PTA) is a procedure that can open up a blocked blood vessel using a small, flexible plastic tube, or catheter, with a "balloon" at the end of it. When the tube is in place, it inflates to open the blood vessel, or artery, so that normal blood flow is restored.What are the indications for percutaneous transluminal angioplasty? ›
The main indications for angioplasty include coronary artery disease and peripheral arterial disease. Following angioplasty, stents are often placed to relieve obstructive stenosis.Why is percutaneous transluminal coronary angioplasty important? ›
Widening of narrowed arteries to restore blood flow to the heart. Coronary angioplasty or percutaneous transluminal coronary angioplasty is a treatment for atherosclerosis (narrowing or hardening of arteries), which you may need if diet and lifestyle changes aren't enough to improve blood circulation to the heart.What is the ICD-10 code for CAD with percutaneous coronary angioplasty? ›
ICD-10 code Z98. 61 for Coronary angioplasty status is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
The angioplasty code is found in the CPT® Index under Percutaneous Transluminal Angioplasty/Artery/Coronary, 92920-92921.What is it called when they clean out your arteries? ›
Atherectomy is a catheter-based procedure used to remove plaque buildup in the arteries.What is the difference between a stent and angioplasty? ›
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary arteries. A coronary artery stent is a small, metal mesh tube that expands inside a coronary artery.Is angioplasty the same as a stent? ›
The term "angioplasty" means using a balloon to stretch open a narrowed or blocked artery. However, most modern angioplasty procedures also involve inserting a short wire mesh tube, called a stent, into the artery during the procedure. The stent is left in place permanently to allow blood to flow more freely.How many blockage requires angioplasty? ›
An artery should be clogged at least 70% before a stent should be placed in it.What is the difference between PTCA and angioplasty? ›
An angioplasty is called a PTCA when used to treat a coronary artery obstruction and a PTA when treating other arteries. The "P" stands for the work percutaneous which means through the skin. The "T" is trans-luminal which means inside the middle of the artery. The "C" in PTCA identifies the treated artery as coronary.Does PTCA use a balloon? ›
PTCA relieves symptoms of CAD by improving blood flow to your heart. During PTCA, a catheter (a thin, soft, flexible tube) with a balloon at the tip is inserted into your artery to widen the passageway. Then, the catheter is removed. After the procedure, you may need to stay in the hospital for a day or more.What is the difference between angioplasty and percutaneous coronary intervention? ›
Coronary angioplasty and stenting (also known as percutaneous coronary intervention or PCI) is a procedure where a blocked or narrowed coronary is opened or widened with balloons or stents. The widened artery improves the flow of oxygen-rich blood to the heart muscle, which keeps the muscle alive and decreases angina.What are the two types of angioplasty? ›
- Balloon angioplasty, which involves using the pressure of an inflating balloon to clear plaque that is blocking an artery. ...
- Stent placement in the artery, which involves a tube, or stent, made out of wire mesh.
A coronary angioplasty usually takes between 30 minutes and 2 hours, although it can take longer.
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary arteries. A coronary artery stent is a small, metal mesh tube that expands inside a coronary artery.How do you prepare for a coronary angioplasty? ›
Usually, you'll need to stop eating or drinking six to eight hours before an angiography. Take approved medications with only small sips of water on the morning of your procedure. Gather all of your medications to take to the hospital with you, including nitroglycerin, if you take it. Arrange for transportation home.What are 3 indications for percutaneous coronary intervention PCI? ›
- Acute ST-elevation myocardial infarction (STEMI)
- Non–ST-elevation acute coronary syndrome (NSTE-ACS)
- Unstable angina.
- Stable angina.
- Anginal equivalent (eg, dyspnea, arrhythmia, or dizziness or syncope)
- High risk stress test findings.
PCI is used to treat heart conditions in which one or more of the coronary arteries is narrowed or blocked. It may be used to treat people with stable symptoms, new onset of symptoms, or during a heart attack.What is the success rate of percutaneous transluminal coronary angioplasty? ›
Complete success was achieved in 95.2% and partial success in 0.9%. PTCA was considered to be “failed” in 3.9%. Within 24 hours of PTCA, 2 patients (0.5%) died. MI occurred and emergency CABG was performed in 2.7% and 1.4% of patients, respectively.What are the risks of PTCA? ›
Possible risks associated with PTCA, atherectomy, and/or stent include, but are not limited to, the following: Bleeding at the catheter insertion site (usually the groin, but the arm may be used in certain circumstances) Blood clot or damage to the blood vessel at the insertion site.What is the ICD-10 code for angioplasty stent of the right coronary artery? ›
ICD-10 code: Z95. 5 Presence of coronary angioplasty implant and graft.What is the ICD-10 for status post angioplasty with stent? ›
Peripheral vascular angioplasty status with implants and grafts. Z95. 820 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2023 edition of ICD-10-CM Z95.What is the ICD for stented coronary artery? ›
ICD-10 Code for Stenosis of coronary artery stent- T82. 855- Codify by AAPC.What is the ICD 10 PCS code for PTCA? ›
Dilation of Coronary Artery, One Artery, Percutaneous Approach. ICD-10-PCS 02703ZZ is a specific/billable code that can be used to indicate a procedure.
What is the CPT code for percutaneous transluminal angioplasty of the left anterior descending artery? ›
Report 92920 Percutaneous transluminal coronary angioplasty; single major coronary artery or branch for the left anterior descending artery angioplasty. For the right coronary artery angioplasty, report 92920 again and append modifier 59 Distinct procedural service.What three sections are often used to report codes for cardiology services? ›
The cardiovascular codes can be found in three sections in the CPT Manual. The sections are Surgery, Medicine, and Radiology.What vitamin removes plaque from arteries? ›
Optimal Vitamin K2 intake is crucial to avoid the calcium plaque buildup of atherosclerosis, thus keeping the risk and rate of calcification as low as possible.Which artery is the most common to have blockage? ›
Although blockages can occur in other arteries leading to the heart, the LAD artery is where most blockages occur. The extent of the blockage can vary widely from 1% to 100%.Can oatmeal unclog arteries? ›
Oats are an excellent choice for those who have atherosclerosis or are trying to prevent clogged arteries. Eating oats can help significantly reduce atherosclerosis risk factors, including high levels of total and LDL (bad) cholesterol ( 39 ).What is the risk age for angioplasty? ›
Background: Coronary angioplasty is an alternative revascularization strategy for patients with medically refractory rest angina and a high risk of adverse outcomes with CABG. Patients > or = 70 years old are a specific high risk subset.What happens to stents after 10 years? ›
Stents are made to be permanent and will continue to keep your artery open once they've been placed. However, stents don't cure the underlying condition that caused the buildup in your artery (atherosclerosis). You'll still need treatment to prevent future artery narrowing.How do you clear blocked arteries without surgery? ›
Through angioplasty, our cardiologists are able to treat patients with blocked or clogged coronary arteries quickly without surgery. During the procedure, a cardiologist threads a balloon-tipped catheter to the site of the narrowed or blocked artery and then inflates the balloon to open the vessel.Why are you awake during stent surgery? ›
Typically, you're awake during your stent placement because it's a minimally invasive procedure. Medicine helps you relax, and a local anesthetic numbs the area of insertion, but you're able to hear your doctor and you're aware of what's going on around you.Why do you have to lay flat after angioplasty? ›
During your recovery after angioplasty, you may lie flat for several hours to make sure your blood vessel heals all the way. In most cases, you'll stay in the hospital overnight.
“A 100% blocked artery does not mean a patient has to undergo a bypass surgery. Most of these blocks can be safely removed by performing an Angioplasty and the long term results are as good or are better than surgery.What is the most serious coronary artery to have a blockage in? ›
A heart attack is particularly dangerous when it's caused by blockage in the left anterior descending artery, which supplies blood to the larger, front part of the heart, earning it this scary-sounding nickname.What artery is 70% blockage? ›
If a carotid artery is narrowed from 50% to 69%, you may need more aggressive treatment, especially if you have symptoms. Surgery is usually advised for carotid narrowing of more than 70%. Surgical treatment decreases the risk for stroke after symptoms such as TIA or minor stroke.What percentage of angioplasty is risky? ›
Applying the evidence
Within the moderate-risk group, the expected range for risk of complications is greater than 5 percent to 10 percent, with an observed rate of procedure complications of 6.2 percent, or about 1 in 16. Given these risks, the patient would likely choose to go ahead with the procedure.
The stent is left in place permanently to allow blood to flow more freely. Coronary angioplasty is sometimes known as percutaneous transluminal coronary angioplasty (PTCA). The combination of coronary angioplasty with stenting is usually referred to as percutaneous coronary intervention (PCI).What is the difference between stent and percutaneous coronary intervention? ›
Coronary angioplasty and stenting (also known as percutaneous coronary intervention or PCI) is a procedure where a blocked or narrowed coronary is opened or widened with balloons or stents. The widened artery improves the flow of oxygen-rich blood to the heart muscle, which keeps the muscle alive and decreases angina.What are the two major types of stents used in cardiac patients? ›
- Bare metal stents (BMS)
- Drug-eluting stents (DES)
- Bioresorbable scaffold system (BRS)
- Drug-eluting balloons (DEB)
- Balloon angioplasty.
- Carotid artery angioplasty.
- Cerebral angioplasty.
- Coronary artery stent.
- Laser angioplasty.
- PTA of the Femoral Artery.
Coronary angioplasty with stenting (also known as percutaneous coronary intervention or PCI) is a treatment that helps improve the blood supply to your heart.Does PCI always mean stent? ›
Percutaneous Coronary Intervention (PCI, formerly known as angioplasty with stent) is a non-surgical procedure that uses a catheter (a thin flexible tube) to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup, a condition known as atherosclerosis.
Cardiac catheterization or “cardiac cath” and percutaneous coronary intervention (PCI) are minimally-invasive medical procedures used to help diagnose and treat conditions of the heart and blood vessels. You may need a cardiac cath or PCI to: Determine if you have a disease of the heart, blood vessels or heart valves.