Peripheral Interventional Procedures
Other heart procedures
Successful heart treatment depends on the right diagnosis.
With fully accredited lab and diagnostic imaging services, The Mat Gaberty Heart Center offers the technology and certified staff to assess the problem and offer the best solution.
In addition, the cardiac team is able to perform many life-saving cardiac treatments without surgery, right in the catheterization lab. These include cardiac and peripheral interventional procedures, such as the use of stents or balloon angioplasty to open blocked arteries.
The Mat Gaberty Heart Center offers a comprehensive range of diagnostic tests and procedures.
Screening and diagnosis
Echocardiography- This type of testing, also called adult transthoracic echocardiography (TTE), is used to study the heart and surrounding structures and to detect life-threatening cardiovascular disorders.
An echocardiogram is an ultrasound of your heart. It measures blood flow through the heart and also enables physicians to view the heart valve structure and heart wall function. It is a non-invasive procedure which is helpful in determining heart size and ventricular function. Echocardiography can also detect heart clots and damage after a heart attack. It is often used in conjunction with Doppler ultrasounds.
The Mat Gaberty Heart Center is fully accredited for echocardiography testing by the Intersocietal Commission of Accreditation of Echocardiography Laboratories (ICAEL). The ICAEL “seal of approval” means the facility’s testing labs have met rigorous national standards.
About the procedure: You will be asked to lie on an exam table while a technologist moves a transducer over your chest and heart region. A small amount of gel is applied during this procedure. You will be asked to lay still, change positions or hold your breath. Most exams take approximately 30 to 45 minutes.
Transesophageal Echocardiogram (TEE)-This test is like standard echocardiography (high-frequency sound waves are used to produce an image of the heart), but the sound waves travel through a tube-like device put into the mouth and passed down the throat into the esophagus.
The TEE provides greater detail about the size and movement of the heart muscle, the condition of aorta and how the heart valves are working. The TEE is used when physicians cannot get a clear picture of the heart using standard echocardiography.
About the procedure: The patient should not eat at least 4 hours before the test. Talk to your doctor about any medications you are taking because they may also need to be stopped before the test.
Before the procedure, the staff will spray the patient’s throat with an anesthetic to numb it and the patient will typically get an IV line to administer a mild sedative. The staff will place metal disks, called electrodes, on the patient’s chest, which connect to an electrocardiogram machine to monitor the heart rhythm during the test.
Then a small, flexible tube will be placed in the throat and the cardiologist will ask the patient to swallow as he or she moves the tube gently down the throat. The tube has a transducer on the end of it, which takes pictures of the heart.
After the test, the tube and IV line are removed. The patient may feel a little sleepy until the sedative wears off. The patient may also experience a sore throat that typically goes away in a day or so.
Other Non-Invasive Tests
Exercise Stress Test– During this test, specialists monitor the heart while the patient exercises on a treadmill. Small disks, called electrodes, are applied to the patient’s chest and are connected to wires called leads. The leads are connected to a monitor that records the electrical activity of the patient’s heart (EKG). The level of exercise is gradually increased to see how the patient’s heart responds to exercise.
Pharmacologic Stress Tests– If a patient is physically unable to exercise, the staff can give the patient a medication that has the same effect on the heart as exercise. The patient wears the same electrodes for the EKG as described above so that doctors can monitor the way the heart performs under the conditions of the drug.
Nuclear Stress Test– This is similar to the exercise stress test, but here doctors may also inject a radioisotope into the patient’s bloodstream. This helps doctors to see more clearly the structure and blood flow of the heart.
Stress Test with Echocardiology– This type of testing typically combines the exercise stress test with an echocardiogram (a non-invasive ultrasound of the heart).
Preparation for testing: Once your physician has ordered the test and received authorization from your insurance carrier, you will be notified of some additional preparation.
Please note: For all these types of stress tests, it is required that patients should have nothing by mouth (food or fluid) for a minimum of 4 hours before the test.
It is also very important that you do not eat or drink items containing caffeine (coffee, tea, chocolate, cola) for at least 12 hours before the test. Caffeine can interfere with test results. This includes decaffeinated coffee or tea, since they do contain small amounts of caffeine. You may also need to stop taking some medications before the test, so be sure to let your doctor know in advance about any medications you are taking.
PET/CT Scanning- McLaren Macomb is the only hospital in Macomb County to offer Myocardial Viability testing to determine heart muscle health. The test combines two sophisticated imaging techniques, positron emission tomography (PET) and computed tomography (CT), to help doctors identify blood flow and viable muscle within areas of the heart. Cardiac PET/CT scans are painless and noninvasive, performed by a doctor on an outpatient basis.
The highly sensitive scans help cardiologists and surgeons evaluate high-risk cardiac patients with a great degree of accuracy, prior to potentially serious cardiac procedures and surgeries. Physicians who are considering these procedures can refer patients to McLaren-Macomb and get results within 72 hours.
Scan results are interpreted by a board-certified specialist with extensive experience in cardiac PET imaging.
About the procedure: Patients having the Myocardial Viability test lie on an exam table, while a technologist injects a safe, radioactive substance called a tracer into a vein. The tracer travels through the body to the heart and releases energy. The PET/CT scanner detects this energy and, with the help of a computer, produces extremely detailed pictures of the heart and how it's working.
Invasive Testing Procedures
Cardiac catheterization– Many tests for diagnosing and treating coronary artery disease (angiography and electrophysiology studies) are performed during a process called cardiac catheterization. These tests are done in the hospital’s cardiac catheterization labs, located within the Mat Gaberty Heart Center. They are administered by our specially trained cardiologists.
About the procedure: During the procedure, cardiologists thread a long, thin tube (catheter) through an artery or vein in the leg, arm or wrist (transradial procedure) and into the heart. Dye is injected through the catheter to see the heart and its arteries. This test is called a coronary angiograph. In another type of test, electrical impulses may be sent through the catheter to study irregular heartbeats. These tests are called electrophysiology studies (EPS).
Prior to the procedure, the area where the catheter will be inserted is numbed using an anesthetic agent. The cardiologist locates the artery then gently threads the catheter through the artery and into the heart.
Once the catheter is in place, dye is injected and the catheterization team will take pictures of the coronary arteries (a coronary angiograph). This allows the cardiologist to see if there is blockage in the arteries and to determine the location of the blockage.
Transradial catheterization- Increasingly, specialists are using the transradial method to view the coronary arteries. This approach involves threading a small catheter through the radial artery of the wrist.
Cardiologists at the Mat Gaberty Heart Center are routinely using the transradial catheterization method because it has several benefits for the patient.
Radial artery access allows the patient to regain mobility faster after the procedure and has a lower risk of bleeding than the more traditional method of using an artery in the groin area. Not all patients are candidates for this procedure. The cardiologist will determine if the patient is able to undergo this type of catheterization.
Interventional Procedures
Coronary artery disease (the most common form of heart disease) results when the arteries that lead to the heart become blocked with a waxy substance, called plaque. The substance is made up of cholesterol, fatty compounds and a blood-clotting material called fibrin. When plaque builds up, it makes the artery narrow, which makes it difficult for blood to flow to the heart. This can lead to pain and pressure from a condition called angina pectoris, and serious blockages can result in a heart attack.
Sometimes the pain of angina can be treated with medications, but the medications will not actually clear the blockages. Specialists may treat this condition with surgery (coronary artery bypass graft), or by performing a percutaneous coronary intervention (PCI), such as a balloon angioplasty or stent.
Angioplasty– In the catheterization lab, physicians use a thin tube called a catheter with a small balloon on its tip. They gently thread the catheter through an artery and may perform an angiogram (described above in the cardiac catheterization information) using dye to allow them to take pictures of the arteries and locate the location and size of the blockage inside the artery.
About the procedure: Once the cardiologists know the location of the blockage, they thread a guide wire through that same artery and advance it across the blockage. This allows them to slip the balloon-tipped catheter over the guide wire and advance it to the blockage. Then they inflate the balloon at the site of the blockage inside the artery. This flattens or compresses the plaque against the artery wall and opens up the artery. Doctors may inflate and deflate the balloon a number of times. At the end of the procedure, they remove the catheter, wire and deflated balloon.
Stents– About 80 percent of the time, patients who have balloon angioplasty will also have a stent placed in the artery. A stent is a small, mesh-like device made of metal. It is placed inside the artery (again through a small catheter tube) to act as a support and keep the vessel open. This improves the flow of blood to the heart muscle.
About the procedure: To insert the stent, the cardiologist places it at the tip of the catheter, over the balloon. When the catheter is positioned at the site of the blockage, inside the artery, the balloon is inflated, which expands the stent. Once the stent is open, the balloon is deflated. The cardiologist removes the catheter, guide wire and deflated balloon, but leaves behind the stent to hold open the artery.
The procedure usually takes 90 minutes to a little more than 2 hours and the patient may or may not spend the night in the hospital. Patients will feel sleepy until the sedative wears off.
Coated stents- Recently new types of stents have been introduced to help reduce the possibility of restenosis, the development of more blockages in the treated area. Some stents are coated with drugs that can help to keep the vessel from re-closing. The coated stents (also called drug eluting stents) release their medicine into the tissue around the stent, which can slow down or stop restenosis.
Your cardiologist will determine the best type of stent to be used for your particular situation.
Peripheral Procedures
Peripheral vascular diseasecan cause blocked or narrowed arteries in the neck, arms, legs and abdomen (peripheral arteries). This condition can cause strokes, leg pain, kidney problems and high blood pressure.
Peripheral catheterization
Just as the catheterization method is used to see inside the coronary arteries, the process also can be used (along with angiography) to see the vessels in the rest of the body (the peripheral arteries, or those outside of the heart).
Peripheral vascular specialists often use angiography to detect any problems in the vessels of the legs (peripheral angiogram) or kidneys (renal angiography). The angiography procedure for peripheral arteries is performed in a similar way as described above for cardiac catheterization.
Peripheral angiogram
This test is done to help the peripheral vascular specialist find narrowed or blocked areas in one or more of the arteries that supply blood to the legs. It can help to determine if the patient has peripheral artery disease or PAD. The procedure uses a catheter and the injection of dye into the leg artery so that X-ray images can be taken of the artery. The procedure is similar to the cardiac catheterization procedure described above.
Peripheral angiography can help determine if the patient requires an interventional treatment, such as peripheral angioplasty or the placement of a stent in the peripheral artery.
Renal angiography- This test is done to look at the blood vessels that feed the kidney. With this procedure, the specialist inserts a catheter, usually near the groin, to allow a dye to be injected. The dye flows through the catheter into the kidney artery so the specialist can take special X-ray images of the vessel. (The dye helps the arteries to show up better on the X-ray).
The test may show the presence of tumors, narrowing of the artery or aneurysms (widening of the artery), blood clots, fistulas or bleeding in the kidney.
Other peripheral diagnostic tests
Doctors also perform a test called carotid arteriography to look inside the vessels leading to the brain.
Intravascular Ultrasound is also used to look inside the arteries and determine the blood flow within the vessel.
Peripheral Interventional Procedures
Peripheral angioplasty– Doctors may also use balloon angioplasty or stenting to open narrowed vessels in other (peripheral) parts of the body, such as the legs, arms or the carotid arteries in the neck that lead to the brain. Opening blocked carotid arteries can help prevent a stroke.
A peripheral vascular specialist can also use stents to repair blockages in the peripheral arteries in the legs. To help relieve the pain involved with Peripheral Arterial Disease (PAD), doctors may use balloon angioplasty and stenting in methods that are similar to the interventional heart procedures described above.
For these interventional procedures, the patient usually receives a local anesthetic (injected at the site where the catheter is inserted) so he or she will not feel any pain.
Peripheral Atherectomy– This procedure helps cut through plaque in the blood vessels outside of the heart (peripheral vessels). The plaque is reduced to particles smaller than red blood cells, which leaves the inner surface of the vessel smoother and more open so that blood can flow more freely through the vessel.
Other heart procedures
Cardioversion– This procedure is done to convert an abnormal heartbeat (arrhythmia) to a normal rhythm. The technique is most often done by sending electrical shocks to the heart through electrodes placed on the patient’s chest.
Cardioversion can correct a heartbeat that’s too fast (tachycardia) or irregular (fibrillation). It is usually used to treat people who have atrial fibrillation or atrial flutter.
Occasionally, cardiologists may perform cardioversion using only medications to restore the heart’s rhythm. For most people, cardioversion quickly restores a normal heart rhythm.
About the procedure: Electric cardioversion is usually done on an outpatient basis and the patient will be asleep under sedation. The patient should not eat or drink anything for 12 hours before the procedure. Ask your doctor beforehand whether you should take any of your regular medications before the procedure.
Pacemaker Surgery– Sometimes patients with abnormally slow heart rhythms, or congestive heart failure require the use of a pacemaker. This device helps to coordinate the pumping action of the heart by sending electrical signals, allowing the heart to pump more effectively.
Pacemakers may also be used to stop the heart from triggering impulses or from sending extra impulses.
A pacemaker is a small, implantable device. It is made up of two parts – a pulse generator, which includes the battery and several electronic circuits, and leads, which are wires that are attached to the heart wall. Depending on the type of pacemaker to be used, there may be one, two or three leads.
About the procedure: Most pacemaker surgery is done under anesthesia. The patient is typically asleep during the procedure, which usually takes between one and three hours.
AICD Procedures– When patients have abnormal heart beats (arrhythmias), a cardiologist may recommend implantation of an AICD system. An AICD is a device that monitors a person’s heart rate. It can be used to monitor and treat tachycardia (when the heart beats too fast), brachycardia (when the heart beats too slowly), or atrial fibrillation (an irregular heart beat).
The device is programmed to either speed up or slow down the heart, depending on the patient’s heart rate. The AICD gives the heart a shock if the patient starts having life-threatening arrhythmias (abnormal heart beat) or an abnormally high heart rate.
There are different kinds of AICD systems, but they all have two parts – electrodes (thin, flexible wires) and a generator. The electrodes, or leads, monitor or sense the heart’s electrical activity. The generator is the battery power source. It is a small metal can about the size of a deck of cards.
The generator stores information about any arrhythmias the patient may have, and tracks how often a shock is needed.
About the procedure: Surgical implantation of an AICD system is done while the patient is asleep under anesthesia. The surgery usually takes between 1 and two hours.