Q: What is an angiogram? How is it done?
A: An angiogram is a picture of your arteries obtained under x-ray using a contrast agent. Angiograms of the heart arteries (coronaries) are obtained by a procedure called cardiac catheterization (click here for more information about it). A large artery either in the leg at the groin or the wrist is entered with a small catheter similar to an IV. Catheters (thin hollow tubes) are then passed up the large aorta to the heart, and pictures of the heart arteries are obtained by administering contrast under x-ray.
Q: Will I be asleep during the angiogram procedure? Is it painful?
A: Mild to moderate sedation is given to patients, taking in mind the patient and procedure risks, to alleviate pain and anxiety. Local anesthesia is given at the site of the artery in the groin or wrist to minimize pain. Once the artery has been accessed, the procedure after this is usually without discomfort.
Q: How are blockages in arteries treated?
A: If a blockage is determined to be the cause of symptoms, then through the catheterization procedure a small balloon and a stent can be delivered into the artery to push the blockage out of the way to allow unobstructed blood flow. Some blockages, depending on the site, severity, and extent might require an evaluation for a surgical procedure called a coronary bypass that re-routes blood around the blockage using bypass graft veins or arteries .
Q: Do all blockages need to be treated invasively?
A: No. But all blockages need to be treated with medical management that includes appropriate risk factor modification, such smoking cessation, diet, weight management, exercise, stress reduction, and treatment of hypertension, high cholesterol, and diabetes. Medications prescribed, such as aspirin and cholesterol-reducing agents like statins, help to minimize the occurrence of heart attacks, and reduce progression of blockages as well.
Q: What are stents? Do stents collapse?
A: Stents are fine metal tube-like mesh-wire scaffolds delivered into the artery over a balloon that pushes the blockage outward and holds the artery open (scaffold) once the balloon in removed. Over time a lining forms over the stent and the stent becomes part of the artery. Stents do not collapse. However, in a small percentage of patients, the same lining that forms can growing like scar tissue and block the flow of blood that might require repeat treatment. Stents have been found to be safer and more durable than other invasive artery-opening methods available.
Q: What are drug-coated stents?
A: Drug-coated stents are similar to regular stents but have a drug coating on their surface. This drug will be delivered to the wall of the artery to prevent the development of scar tissue buildup and the need for repeat artery-opening procedures. There are different types of such stents, and this is constantly improving with newer developments.
Q: Why do I need to take Plavix (clopidogrel) after getting a stent?
A: Stents being metal are foreign to the body. Until they get a lining that covers them, they are exposed to blood. This lining might take a month to develop with regular stents or 6-12 months with drug-coated stents. Platelets are blood cells that can clump together on the stents, form a clot, and abruptly and dangerously block the stents. Like aspirin and Effient (prasugrel), Plavix (clopidogrel) belongs to a group of anti-platelet drugs that can prevent this clumping from happening, and as such are extremely important to take diligently once a stent is placed. Do not stop taking these medications without speaking to your cardiologist.
Q: Can stents be placed in other arteries?
A: Yes. Stents can be placed in other arteries for symptomatic blockages, such as the arteries that provide blood flow to the brain (carotid arteries), the kidneys (for severe uncontrolled hypertension and kidney failure), or the legs (for incapacitating pain while walking or non-healing wounds). A careful discussion with your doctor is needed of risks, benefits, and alternatives before such treatment is undertaken.
Q: Can I have an MRI exam after a stent is placed in either my coronary arteries or my aorta?
A: These stents are MRI compatible up to 3 teslas. The magnet in an MRI machine is rated using a unit of measure known as a tesla. Some of today's MRI machines are stronger than 3 teslas. The various stent companies have laid out certain conditions in their user instructions. The main concern is not a generally assumed movement, but heat production. Adjacent organs (brain, spine, joints) are deemed safe after 3 months following implantation of a stent. But be aware that many freestanding MRI facilities don't know this information. Therefore, carry the manufacturer's implant card with you, so that the MRI staff can look it up on the manufacturer's website, or call the Stony Brook Heart Institute for guidance at 631-44-Heart.