This procedure, which typically includes "angiography" is designed to obtain precise images of the blood vessels that supply the heart muscle-- the coronary arteries.  Your cardiologist guides a small plastic catheter through an artery or vein in the arm or leg and into the heart structures. This test measures blood pressure in the heart chambers and often includes an injection of dye into the main pumping chamber, the left ventricle.  This allows your doctor to visualize the heart's pumping ability (ejection fraction), determine whether any injury has been suffered by the heart muscle, and evaluate the function of heart valves. 

A coronary angiogram specifies the nature and severity of coronary artery stenoses, or blockages. 

The procedure itself takes about an hour, during which time the patient is sedated and comfortable.  A local anaesthetic is given to numb the area of catheter insertion, which is usually  adjacent to the crease of the groin.  After the catheter is removed,  the small incision can be closed using devices that allow more rapid recovery and ambulation-- often within two hours.  When not feasible to use such a device,   pressure is applied manually to prevent bleeding and patients may be instructed to rest on their backs for up to six hours.   Most patients can return to typical activities within 24 to 48 hours. 

Percutaneous transluminal coronary angioplasty is also known as PTCA or balloon angioplasty. It's an established and effective therapy for many patients with coronary artery disease and is known to reduce symptoms of chest pain, improve quality of life, and prevent future cardiac events such as heart attacks. About 80 percent of angioplasty procedures also involve the placement of a stent.  During angioplasty, or PTCA, the cardiologist guides and inflates a non-distensible balloon into the area of blockage, compressing the atheromatous plaque and enlarging the inner diameter of the artery-- helping blood to flow more easily.   Depending on the initial result and on the characteristics of the lesion, a metallic stent may be inserted into the area of blockage and expanded to achieve a more desirable outcome.  This mesh cylinder holds the artery open, remaining in place after the procedure is completed. 

PTCA and stenting as treatment for severe coronary artery disease are less invasive and traumatic than traditional coronary bypass surgery.  Serious complications from the procedure are unusual.  However,  coronary angioplasty techniques remain challenged by the problem of restenosis.  This describes a recurrence of blockage in the treated artery segment, often resulting in a return of pre-procedural symptoms such as chest pain and breathlessness. It can occur within six months in up to 25 percent of patients undergoing angioplasty,  and is typically less common with the use of primary stenting.  Therapy for restenosis includes repeat angioplasty, stenting, and coronary bypass surgery.  Newer techniques including intracoronary radiation therapy are emerging as promising future therapies for the problem of restenosis.

Cardiologists at Heart Care Centers have made available this new device, which looks like a tiny "Pacman".  First, the device is threaded through a leg artery up to the heart blockage. Then, when the jaws open, they split the hardened plaque apart. "After the pathway has been established, you can put a wire down the pathway and use conventional angioplasty once the 'cement' blockage has been cleared," Stella explained.