Coronary catheterization is an invasive diagnostic and therapeutic technique that involves inserting a catheter into blood vessels to directly observe the heart's structure and blood flow. Its primary uses include assessing the degree of coronary artery obstruction, measuring intracardiac pressures, diagnosing congenital heart defects, and performing interventional treatments such as angioplasty. This technique combines real-time imaging with functional assessment, allowing precise localization of lesions and immediate treatment execution.
The procedure is usually performed in a catheterization laboratory under local anesthesia, guided by X-ray or ultrasound. Its advantages include simultaneous diagnosis and treatment, such as immediate stent placement upon detecting arterial blockages, significantly reducing treatment time. Patients must strictly follow preoperative preparations, including fasting and anticoagulant management.
Coronary catheterization is divided into diagnostic and therapeutic categories. Diagnostic procedures involve measuring ventricular pressures, blood oxygen levels, and injecting contrast agents for coronary angiography. Therapeutic procedures include balloon angioplasty, stent placement, or radiofrequency ablation to correct arrhythmias. Catheters are typically made of flexible polymer materials, with diameters of only 2-3 millimeters, allowing smooth passage through blood vessels.
The mechanisms vary according to treatment goals: in stenotic coronary arteries, balloon inflation dilates the arterial wall; radiofrequency ablation destroys abnormal electrical circuits using electromagnetic energy. Sensors at the catheter tip can provide real-time data on cardiac function, such as cardiac output and valve opening and closing, aiding immediate clinical decision-making.
Mainly indicated for suspected coronary artery disease, myocardial infarction, or patients with recurrent chest pain of unclear origin. Congenital heart diseases such as patent ductus arteriosus or Tetralogy of Fallot are also often corrected using this technique. For patients with hypertension poorly controlled by medication and with aortic stenosis, transcatheter aortic valve replacement (TAVR) is a common option.
Other indications include evaluating cardiac function before and after heart transplantation, diagnosing pulmonary hypertension, or sampling for infective endocarditis. Physicians will determine whether to perform this procedure based on symptom severity and imaging results. For example, in acute myocardial infarction, if thrombolytic therapy fails, immediate catheter thrombectomy is a critical treatment step.
The procedure typically lasts 1-3 hours, with the patient awake but under local anesthesia. The catheter is inserted via the femoral or radial artery, guided by fluoroscopic angiography. Contrast agent dosage is adjusted based on body weight, usually about 50-100 c.c. for adults, with special consideration for those with renal impairment to prevent acute kidney injury.
For therapeutic interventions like stent placement, the physician selects appropriate balloon and stent sizes based on the degree of vessel stenosis. Complex cases may require staged treatments, such as initial balloon dilation followed by drug-eluting stent placement. All procedures are performed under digital subtraction angiography to ensure precise positioning.
The main advantages include the combination of accurate diagnosis and immediate treatment, such as stent placement upon detecting blockages, avoiding secondary surgeries. Compared to traditional open-heart surgery, it involves less trauma and shorter recovery time, typically 1-2 days. The diagnostic accuracy exceeds 95%, especially in evaluating complex anatomical structures, outperforming non-invasive tests.
This is particularly important for elderly or high-risk patients, as complex treatments can be completed without general anesthesia. The development of transcatheter aortic valve replacement (TAVR) has replaced some open surgeries.
Common risks include puncture site hematoma (incidence about 5-10%), contrast-induced nephropathy (especially in diabetic patients), and bleeding due to anticoagulant therapy. Serious complications such as cardiac tamponade or stroke are rare, with an overall risk of about 1-2%.
Emergency situations may include arrhythmias, vascular embolism, or catheter rupture. Long-term follow-up shows that about 3-5% of patients may experience in-stent restenosis or thrombosis after treatment. Physicians will assess the risk-benefit ratio based on patient age and medical history, such as adjusting contrast agent use in patients with severe renal impairment.
Preoperative preparations include discontinuing anticoagulants like warfarin at least 5 days prior, and strict blood glucose control in diabetic patients. Contraindications include uncontrolled bleeding tendencies, infections at the puncture site, or severe iodine allergy. Patients with severe coagulopathy or systemic infections should not undergo the procedure.
Postoperative care involves compressing the puncture site for 2-4 hours and bed rest for 6 hours, monitoring for bleeding signs. For contraindicated patients, non-invasive alternatives may be considered, but in emergencies such as acute myocardial infarction, the physician may weigh risks and proceed under close monitoring.
Interactions with antiplatelet drugs require special attention; post-procedure, dual antiplatelet therapy is usually prescribed for at least six months to prevent stent thrombosis. Compatibility with MRI depends on stent material; some metal stents may affect imaging quality.
If the patient is undergoing chemotherapy, bone marrow suppression and bleeding risks should be evaluated. When combined with oral anticoagulants, dosage adjustments and extended monitoring are necessary. Compared to cardiac surgery, this technique avoids sternotomy, but complex cases may require conversion to open surgery.
Coronary intervention has an immediate success rate of over 90%, with a lumen patency rate of about 85-90% after one year. In patients with acute myocardial infarction, it can reduce mortality by 30% compared to traditional treatments. Structural correction after congenital heart disease repair reaches a 95% improvement rate, significantly better than medication alone.
Long-term follow-up shows that patients treated with drug-eluting stents have a restenosis rate below 10% within three years. In electrophysiology, radiofrequency ablation achieves over 90% cure rate for arrhythmias. These data from multicenter clinical trials confirm its central role in cardiovascular treatment.
Non-invasive alternatives include coronary CTA (coronary computed tomography angiography) and nuclear cardiology scans, which can preliminarily assess vascular obstruction. Stress tests (such as exercise ECG) assist in diagnosing angina but do not provide immediate treatment.
Surgical options like coronary artery bypass grafting (CABG) are suitable for multi-vessel disease but involve longer recovery. Pharmacological treatments (e.g., antiplatelet therapy) can delay disease progression but do not address acute occlusions. The choice of treatment depends on lesion location, patient age, and overall health status.
Patients should undergo blood tests, ECG, and imaging studies in advance, and inform the doctor of current medications (e.g., anticoagulants should be temporarily stopped). Fasting for about 8 hours before surgery is usually required, but water intake is allowed. The doctor will adjust preoperative instructions based on the patient's cardiac condition, such as insulin dosage in diabetic patients.
Can I remove the pressure bandage at the puncture site myself after surgery?The puncture site will be secured with a special bandage, which generally needs to remain for 24 hours. Patients should lie flat for 6 to 8 hours to prevent bleeding; after 24 hours, nursing staff will evaluate and remove it. If swelling, subcutaneous hematoma, or increasing pain occurs at the puncture site, notify medical personnel immediately.
How soon can I resume normal activities after surgery?Generally, light activities such as walking can gradually resume after 24 hours, but lifting heavy objects or bending over should be avoided for two weeks. If a vascular stent was placed, the doctor may recommend antiplatelet medication and a longer recovery period. High-intensity exercise should wait 4 to 6 weeks, depending on individual recovery.
Will my heart condition completely disappear after successful catheterization?The procedure can improve blood flow in stenotic arteries and relieve symptoms like chest pain or shortness of breath, but it cannot reverse existing myocardial damage. Patients still need to adhere to medication therapy, low-salt and low-fat diets, and regular exercise to control hypertension, hyperlipidemia, and other underlying conditions to prolong vessel patency.
How often should follow-up examinations be conducted?Doctors typically schedule a follow-up at one month post-procedure, with regular checks of blood lipids, blood sugar, and cardiac function. For stent placement, antiplatelet therapy is usually continued for at least one year, with vascular assessments every 6 to 12 months, and treatment plans adjusted based on the condition.
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