Interventional Cardiology

At Liv Hospital Coronary Angiography and Heart Catheterization Laboratory; Interventional procedures such as angiography, balloon and stent are performed with modern treatment methods.

Procedures Performed in the Interventional Cardiology Clinic

• Coronary angiography
• Peripheral angiography
• Right and left heart catheterization
• Vascular resistance measurement for pulmonary hypertension
• Diagnostic procedures such as renal angiography
• Complex percutaneous coronary interventions
• Carotid interventions
• renal stent
• Alcohol septal ablation in hypertrophic obstructive cardiomyopathy
• Percutaneous closure of atrial and ventricular septal defects
• Renal denervation in resistant hypertension
• TAVI (Transcatheter aortic valve implantation) in patients whose surgery is risky

The Risk of Bleeding Decreases with Angiography from the Wrist

The risk of bleeding is significantly reduced after angiography procedures performed on the wrist. While this rate is observed to be around 5 percent in the world for interventions performed through the femoral artery; The risk rate in radial artery interventions is 0.2 percent. In procedures and percutaneous interventions performed at Liv Hospital Interventional Cardiology Clinic, the radial artery (wrist) is preferred as the entry site in 95 percent of the patients. This rate is above world standards. No bleeding complications due to angiography entry site have been observed in clinical practice. After diagnostic procedures, patients using radial artery access can be discharged after 2-3 hours. On the other hand, in patients for whom femoral access is preferred, the duration of immobilization from 6-12 hours is reduced to 2 hours with groin closure devices, and there is no need to use applications such as sandbags.

At Liv Hospital Coronary Angiography and Heart Catheterization Laboratory; Interventional procedures such as angiography, balloon and stent are performed with modern treatment methods.

Why is Angiography Performed on the Wrist?

Angiography performed through the leg vein makes the patient bedridden for 6 hours and may cause the patient to face the risk of bleeding. At Liv Hospital Interventional Cardiology Clinic, balloon and stent procedures are performed through the pulse artery in the wrist. Thus, patients can stand up in a very short time after wrist angiography and be discharged without the risk of bleeding.

What is the use of drug-eluting stents?

In our laboratory; The usage rate of drug-eluting stents and resorbable stents is 90 percent. This rate is well above the general standards of 60 percent. The drug-eluting stents used are FDA approved and provide significant advantages in reducing the formation of new stenosis in the vessel.

Accurate Diagnosis with Intravascular Ultrasound and OCT

In addition to advanced intracoronary imaging techniques such as intravascular ultrasound (IVUS) and OCT (Optical coherencetomography), FFR measurements can be routinely performed with the first and only wirelesspressure-wire application in our country, integrated into the existing angiography system and always ready for use. In this way, the correct coronary lesion can be decided more precisely for stent application. The laboratory is organized in accordance with the safety and quality standards set by SCAI. Intra-aortic balloon pump support is available in the catheterization laboratory at all times for patients admitted to the laboratory with cardiogenic shock. The set-up is suitable for complex interventions such as TAVI and has been approved by teams from abroad.

What is Coronary Angiography?

Coronary angiography is the visualization of the vessels that bleed and feed the heart (coronary vessels) by administering a dyed liquid. Angiographic procedures can be performed for all vessels of the body. Eye, brain, heart and leg vessels are generally the most frequently investigated vascular systems. The procedure performed to examine the heart vessels is called coronary angiography.

Coronary angiography, also called cardiac catheterization or angiography, is an invasive imaging method performed to evaluate heart vessels and function.

Diseases Where Cardiac Catheterization is Used for Diagnosis and Treatment Purposes

• Coronary artery, heart valve or aortic disease
• Assessing heart muscle function
• Determining advanced treatment methods such as coronary balloon angioplasty and stent, coronary bypass surgery, heart valve interventional or surgical intervention

How is Coronary Angiography Done?

During coronary angiography, a thin, soft, plastic sheath is placed in the artery in the groin or arm. It is advanced through this sheath to the exit point of the cardiac vessels through soft and thin plastic hollow catheters. The catheter is directed to the coronary arteries with the help of a special x-ray machine.

Contrast material (angio dye) is injected through the catheter and moving x-rays are recorded digitally. This part of the procedure is called coronary angiography. In addition to these images, in some special cases, it may be necessary to perform advanced imaging and evaluation methods such as intravascular ultrasound (IVUS), optical coherence tomography (OCT) or fractional flow reserve (FFR) measurements. IVUS allows more detailed images to be obtained with ultrasound within the coronary artery. OCT provides detailed information about the inner wall of the vessel with a special light source. If FFR; It determines the characteristics of blood flow and provides information about the severity of the observed narrowing. These advanced evaluation methods should be performed in centers with experienced operators.

What is a Coronary Interventional Procedure?

Coronary interventional procedure is a non-surgical treatment performed to open narrowed coronary arteries to increase blood flow to the heart. When narrowed or occluded coronary arteries are detected during coronary angiography, they can be treated with angioplasty and stent methods in the same session or in a separate planned session, with the joint decision of the physician and the patient. Making this decision may vary depending on the clinical condition of the patient. A coronary interventional procedure begins in the same way as a coronary angiography. Balloon angioplasty and stenting are done to open the coronary arteries after the catheter is placed where the coronary arteries originate.

What is Balloon Angioplasty Procedure?

By inflating a liquid, expanding balloon at the tip of a thin catheter, narrowed heart vessels can be opened. Balloon angioplasty is technically called percutaneous coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). When the balloon is inflated; The fatty plaque is compressed against the clogged artery walls and blood flow is increased.

How is Balloon Angioplasty Done?

In most cases, stent placement is performed in combination with a balloon angioplasty procedure. A stent is a small, metal mesh tube that acts like a skeleton to provide support within the coronary artery. A balloon catheter is used to place a stent in a narrowed artery, which is advanced over a guide wire. When the stent reaches the narrowed area, the balloon is inflated and the stent expands according to the diameter of the artery and attaches to the vessel wall. After the balloon is deflated, the stent remains permanently at the point where it was placed. Within a few weeks, the stent is covered with normal vascular cells (endothelium). Angioplasty with stent is generally applied to patients with narrowing or occlusion in 1-2 coronary arteries. If there is blockage in more than two coronary arteries, coronary artery bypass surgery may be required.

What are Drug-Eluting Stents (DSP)?

Drug-eluting stents are released for a certain period of time in the area where the stent is placed and contain drugs that reduce re-narrowing of the vessel. Drug-eluting stents also have a metal stent skeleton structure. However, there is a thin and controlled release medicated layer on their surface.

Many studies show that the likelihood of restenosis is lower in drug-eluting stents than in non-drug-eluting stents. Drug-eluting stents have distinct advantages, especially in thin-structured vessels, in cases where the diseased area is long, in completely occluded vessels, and at the points where the vessels divide into two (bifurcation). Since the applicability of the drug-eluting stent may vary depending on the patient’s clinical condition and vascular structure, it is recommended that you discuss this situation with your interventional cardiologist. It is extremely important for patients who receive drug-eluting stents to use dual anticoagulants as long as their cardiologist recommends and not to take a break without their doctor’s permission.

Cardiac catheterization and interventional procedures are not considered surgical procedures because the chest is not surgically opened and therefore no wound occurs. The procedure time is shorter than surgery. In some cases, depending on the results of the surgical procedure, the patient may be recommended a coronary interventional procedure.