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Procedures

CardiaStream specializes in the performance of outpatient cardiac and peripheral vascular procedures, including cardiac catheterization (coronary angiography), peripheral angiography, coronary angioplasty/stenting, peripheral angioplasty/stenting, pacemaker placement, defibrillator placement, and electrical cardioversion.

To learn more about a specific procedure performed at CardiaStream, select the appropriate link from the menu below.

Procedure List

A cardiac catheterization, also known as a coronary angiogram or heart cath, is a procedure performed to evaluate for abnormalities or blockages in the arteries that supply blood to the heart (coronary arteries). The procedure is typically performed in patients who have symptoms of coronary artery disease (known as “angina”), patients who are acutely having a heart attack, and patients who are planning to undergo a heart surgery for reasons unrelated to coronary artery disease (e.g. valvular disease).

Understanding the Cardiac Catheterization Procedure

A long, thin, flexible tube, called a catheter, is typically inserted into the leg or arm through a tiny incision (typically less than one-tenth of an inch) at the skin surface. These catheters travel through blood vessels to the heart. Contrast dye is then injected through the catheters and X-rays are taken of the heart. By visualizing the flow of (Iodine) contrast dye within heart arteries and/or heart chambers, detailed information about the heart and its blood supply is obtained (see Figure 1). Due to its minimally invasive approach (very small incision at the skin surface), a cardiac catheterization is usually very well-tolerated without significant discomfort to the patient. The patient is required to lay flat on his/her back for the duration of the procedure. Routinely, lidocaine is injected at the skin surface to numb the skin and tiny catheters are then inserted. Since there are no nerves inside the blood vessels, the patient does not feel the catheters inside the body once they have been inserted. Sedation medications typically are provided to the patient before and during the procedure, however, it is much safer for the patient to have this procedure performed while awake with minimal sedation as opposed to under general anesthesia with use of a breathing tube.

A cardiac electrophysiological study (EP study) is a minimally invasive procedure that is used to evaluate abnormal heart rhythm disturbances.

During an EP study, small, thin wire electrodes are inserted through a vein in the groin (or neck in some cases). The wire electrodes are threaded into the heart, using a special type of X-ray, called fluoroscopy. Once in the heart, electrical signals are measured. Electrical signals are sent through the catheter to stimulate the heart tissue to try to initiate the abnormal heart rhythm.

During the EP study, doctors may also map the spread of electrical impulses during each beat. This may be done to locate the source of an arrhythmia or abnormal heartbeat. If a location is found, an ablation (elimination of the area of heart tissue causing the abnormality) may be done.

The results of the study may also help the doctor determine further therapeutic measures, such as inserting a pacemaker or implantable defibrillator, adding or changing medications, performing additional ablation procedures, or providing other treatments.

Facts about Catheter Ablation

Also known as a cardiac ablation or radiofrequency ablation, this procedure guides a tube into your heart to destroy small areas of heart tissue that may be causing your abnormal heartbeat.

Not everyone with a heart arrhythmia needs a catheter ablation. It’s usually recommended for people with arrhythmias that can’t be controlled by medication.

The Procedure

Before the procedure begins, you will be given intravenous medications to help you relax; some people even fall asleep. After the medication has taken effect, your doctor will numb an area on your groin and make a small hole in your skin. Then, the doctor will guide a thin guide wire and 2 to 3 small catheters through blood vessels to your heart. In some cases, your doctor may place several catheters, which are used to help guide the procedures.

After the catheter has been placed correctly, electrodes at the end of the catheter are used to stimulate your heart and locate the problem areas that are causing the abnormal heart rhythm. Various measurements of the electrical system are performed. If a person is in normal rhythm at the time of the procedure, an attempt is made then to reproduce the abnormal rhythm by pacing the heart through the catheters. Occasionally an intravenous medicine called isoproterenol is required to “rev up” the heart in order to reproduce the abnormal rhythm. Then, the doctor will use mild radiofrequency heat energy to destroy or “ablate” the problem area. This area is usually quite small, about one-fifth of an inch. Once the tissue is destroyed, the abnormal electrical signals that created the arrhythmia can no longer be sent to the rest of the heart. These radiofrequency lesions have no long-term adverse consequences. Overall cure rates with catheter ablation is >90% and can be as high as 96-99% depending on the specific type of rhythm problem.

Cardioversion is a procedure that can restore a fast or irregular heartbeat to a normal rhythm. A fast or irregular heartbeat is called an arrhythmia (ah-RITH-me-ah). Arrhythmias can prevent your heart from pumping enough blood to your body.

Cardioversion is most commonly performed in symptomatic individuals with fast or irregular (e.g. atrial fibrillation) heart beats. Cardioversion generally can be accomplished either through the use of medication or electrical current. A standard approach, following patient sedation, involves delivering an electrical current to the heart through large stickers/pads attached to the chest wall.

Consult your physician for more detailed information about the procedure.

Coronary angioplasty, also known as percutaneous coronary intervention (PCI), is a procedure performed to open blockages formed from plaques in heart arteries and therefore improve blood flow to the heart. Plaques form as a result of coronary artery disease, an inflammatory process that eventually results in calcium deposits within the walls of blood vessels. If these plaques become severe enough, impairment in blood flow to the heart results. Angioplasty procedure is commonly performed in patients who have symptoms of coronary artery disease (angina) and in patients who are actively having a heart attack. The major benefit of this procedure is to reduce symptoms (e.g. chest pain, shortness of breath) related to coronary artery disease and in some instances, this procedure can reduce the incidence of myocardial infarction and death.

Understanding the Coronary Angioplasty / Stent Procedure

Coronary angioplasty, if necessary, is performed following a cardiac catheterization. A long, thin, flexible tube, called a catheter, is typically inserted into the leg or arm through a tiny incision (typically less than one-tenth of an inch) at the skin surface. These catheters travel through blood vessels to the heart. A wire is then advanced through the catheter and inserted into a coronary artery.

Usually, a balloon is advanced over the wire and the balloon is inflated at the location of the severe blockage or plaque. The balloon alone can be used to treat the blockage, but in most instances, a stent is required for best results. The stent, if needed, is initially located on the outside of a balloon. The stent and balloon are then advanced over the wire and the balloon is inflated. The balloon inflation expands the stent up against the wall of the artery, securing it in place.

The walls of the heart artery will eventually grow around the stent, much like ivy can grow and eventually cover a chain-link fence. While this healing process is occurring, certain medications are extremely important to take and your physician will discuss this with you. In most instances, aspirin is required life-long, and an additional anti-platelet medication (e.g. clopidogrel, prasugrel, or ticagrelor) is needed for months to years, depending on the type of stent and reason for its placement. Your doctor will discuss with you the specifics regarding necessary medications. If you recently have had a coronary angioplasty or stent procedure, and are taking medications prescribed by your physician, do not stop these medications for any reason without consulting your doctor.

A defibrillator is an implantable medical device that (1) acts as a pacemaker capable of delivering electricity to the heart to trigger it to beat, and (2) if necessary, shocks the heart out of life-threatening heart rhythms. It is this second feature, or the ability to shock the heart, that predominantly differentiates a defibrillator from a standard pacemaker.

Certain individuals (e.g. those with severe (CHF) congestive heart failure) are prone to have life-threatening heart rhythms and may be candidates for placement of a defibrillator, also known as an automatic implantable cardioverter defibrillator (ICD). All defibrillators, as explained above, serve a dual role, capable of being both a pacemaker and a defibrillator (shocking) device when needed.

Understanding the Defibrillator Placement Procedure

Defibrillator (ICD) PlacementFollowing patient sedation, a small incision (approximately 2-3 inches) is made beneath the collar bone. Electrodes (termed “leads”) are then inserted into the subclavian vein and passed inside this vein to the heart (see image on the right). Electrodes have small screw-like coils on their tips that enable them to be secured into place within the heart muscle. The electrodes are then attached to the defibrillator generator which is placed underneath the skin. The skin surface is closed with sutures.

Following implantation, defibrillator function is closely monitored on follow-up visits. During device checks, which may be performed in the physician’s office or even at home with telephonic monitoring, detailed information about both the defibrillator (e.g. battery life or frequency of pacing) and the intrinsic heart (e.g. underlying rhythm) is able to be obtained and helps with ongoing management.

A cardiac electrophysiological study (EP study) is a minimally invasive procedure that is used to evaluate abnormal heart rhythm disturbances.

During an EP study, small, thin wire electrodes are inserted through a vein in the groin (or neck in some cases). The wire electrodes are threaded into the heart, using a special type of X-ray, called fluoroscopy. Once in the heart, electrical signals are measured. Electrical signals are sent through the catheter to stimulate the heart tissue to try to initiate the abnormal heart rhythm.

During the EP study, doctors may also map the spread of electrical impulses during each beat. This may be done to locate the source of an arrhythmia or abnormal heartbeat. If a location is found, an ablation (elimination of the area of heart tissue causing the abnormality) may be done.

The results of the study may also help the doctor determine further therapeutic measures, such as inserting a pacemaker or implantable defibrillator, adding or changing medications, performing additional ablation procedures, or providing other treatments.

Facts about Catheter Ablation

Also known as a cardiac ablation or radiofrequency ablation, this procedure guides a tube into your heart to destroy small areas of heart tissue that may be causing your abnormal heartbeat.

Not everyone with a heart arrhythmia needs a catheter ablation. It’s usually recommended for people with arrhythmias that can’t be controlled by medication.

The Procedure

Before the procedure begins, you will be given intravenous medications to help you relax; some people even fall asleep. After the medication has taken effect, your doctor will numb an area on your groin and make a small hole in your skin. Then, the doctor will guide a thin guide wire and 2 to 3 small catheters through blood vessels to your heart. In some cases, your doctor may place several catheters, which are used to help guide the procedures.

After the catheter has been placed correctly, electrodes at the end of the catheter are used to stimulate your heart and locate the problem areas that are causing the abnormal heart rhythm. Various measurements of the electrical system are performed. If a person is in normal rhythm at the time of the procedure, an attempt is made then to reproduce the abnormal rhythm by pacing the heart through the catheters. Occasionally an intravenous medicine called isoproterenol is required to “rev up” the heart in order to reproduce the abnormal rhythm. Then, the doctor will use mild radiofrequency heat energy to destroy or “ablate” the problem area. This area is usually quite small, about one-fifth of an inch. Once the tissue is destroyed, the abnormal electrical signals that created the arrhythmia can no longer be sent to the rest of the heart. These radiofrequency lesions have no long-term adverse consequences. Overall cure rates with catheter ablation is >90% and can be as high as 96-99% depending on the specific type of rhythm problem.

An implantable loop recorder (ILR) is a small implantable, easily removable, medical device, placed under the skin in your chest that is used to monitor for abnormal heart rhythms.

Many individuals can undergo external heart monitoring (devices and/or stickers worn underneath clothing and attached to the chest wall) to detect abnormal heart rhythms. However, certain individuals with very infrequent and severe spells consistent with heart rhythm abnormalities may benefit from temporary placement of an implantable loop recorder to assist in diagnosing the problem. Ask your physician if you think that you may be a candidate for an ILR device.

Understanding the Implantable Loop Recorder Procedure

Following patient sedation and local anesthetic, a small incision (less than 2 inches) is made in the chest wall adjacent to the sternum. The implantable loop recorder is then slid underneath the skin surface and secured into place. The skin surface is appropriately closed with medical glue or sutures. The device can subsequently be removed at any time once the appropriate information necessary to diagnose the heart rhythm abnormality has been obtained.

Following implantation, the loop recorder is closely monitored on follow-up visits. Information obtained from the device is able to be downloaded/retrieved by your physician and is used to assist in diagnosing your medical condition.

A pacemaker is a medical device that delivers electricity to the heart via small electrodes, triggering the heart to beat. A normal human heart contains an intrinsic pacemaker, termed the sinoatrial (SA) node. This group of cells within the heart generates an electrical impulse usually 60 to 100 times per minute that stimulates the heart muscle to contract. In certain illnesses, or with age, these cells may become diseased or unable to perform their duty on a consistent basis. This results in bradycardia (or slow heartbeats) which can be treated with the placement of an artificial pacemaker (see image).

Understanding the Pacemaker Placement Procedure

Pacemaker Placement

Following patient sedation, a small incision (approximately 2-3 inches) is made beneath the collarbone. Electrodes (termed “leads”) are then inserted into the subclavian vein and passed inside this vein to the heart (see image). Electrodes have small screw-like coils on their tips that enable them to be secured into place within the heart muscle. The electrodes are then attached to the pacemaker generator which is placed underneath the skin. The skin surface is closed with sutures.

Following implantation, pacemaker function is closely monitored on follow-up visits. During device checks, which may be performed in the physician’s office or even at home with telephonic monitoring, detailed information about both the pacemaker (e.g. battery life or frequency of pacing) and the intrinsic heart (e.g. underlying rhythm) is able to be obtained and helps with ongoing management.

A peripheral catheterization, also known as a peripheral angiogram, is a procedure performed to evaluate for abnormalities or blockages in the blood vessels outside of the heart, such as the arms, legs, or neck. The procedure is typically performed in patients who have symptoms of peripheral artery disease (known as “claudication”) resulting from poor circulation and/or abnormal wound healing.

Understanding the Peripheral Angiography Procedure

A long, thin, flexible tube, called a catheter, is typically inserted into the leg or arm through a tiny incision (approximately less than one-tenth of an inch) at the skin surface. These catheters are then positioned into the blood vessels of interest. Contrast dye is injected through the catheters and X-rays are taken of the blood vessels. By visualizing the flow of contrast dye within these blood vessels, detailed information is obtained.

Due to its minimally invasive approach (very small incision at the skin surface), a peripheral catheterization is usually very well-tolerated without significant discomfort to the patient. The patient is required to lay flat on his/her back for the duration of the procedure. Routinely, lidocaine is injected at the skin surface to numb the skin and tiny catheters are then inserted. Since there are no nerves inside the blood vessels, the patient normally does not feel the catheters inside the body once they have been inserted. Sedation medications typically are provided to the patient before and during the procedure, however, it is much safer for the patient to have this procedure performed while awake with minimal sedation as opposed to under general anesthesia with use of a breathing tube.

There are many different treatment options used to treat peripheral artery disease (PAD). The percutaneous revascularization of diseased arteries can be performed using balloons and stents or by removing the plaque with atherectomy devices. There are 4 types of atherectomy devices: orbital, rotational, laser and directional atherectomy. Tyler Cardiac & Endovascular Center provides comprehensive state-of-the-art technology and equipment for its patients, some of which cannot be found at any other facility in East Texas.

Groundbreaking Procedure at Tyler Cardiac & Endovascular Center

Treatment Options

  • Atherectomy
  • Drug Coated Balloons
  • Intra-vessel Ultrasound Imaging
  • OCT Guided Directional Atherectomy
  • Balloons/Stents
  • CO2 Angiography
  • Medication

At Tyler Cardiac & Endovascular Center we offer an alternate to (iodine) contrast dye for our patients that have renal impairment and are at risk for complications from the use of contrast. This option is to use CO2 instead of contrast containing iodine to displace the blood in the artery to help visualize any blockages in the peripheral vascular bed.

Critical Limb Ischemia

Many people suffer with peripheral artery disease (PAD). Left untreated, PAD can be associated with non-healing wounds which may lead to amputation. If you have a history of diabetes, tobacco abuse, heart disease, high cholesterol, or kidney disease you are at risk for PAD. Ischemia is defined as inadequate blood flow to the tissue. When this occurs, the tissue begins to die. By improving blood flow to the tissue, this can be corrected. Evidence shows that in most cases these minimally invasive interventions can help increase the blood flow to these critical wounds. Our goal at CardiaStream is to improve the quality of life for our patients. By increasing the blood flow to a wound, the wound has a better chance to heal. These vascular interventions aim to minimize the degree of amputation and may prevent amputation altogether.

Atherectomy

When plaque builds up in an artery, blood flow can be blocked and leads to leg pain (claudication) or non-healing wounds. Atherectomy is a procedure that can be performed to remove plaque from the arteries. There are several treatment options that utilize minimally invasive devices. One option is to grind away calcium that narrows the artery. Another option is a small cutting tool that can be advanced to the plaque where it shaves it away. This technique removes the plaque entirely from the body through a small catheter. A third option would be to utilize a laser to dissolve the plaque. Atherectomy is an excellent treatment option that allows our patients to obtain a better quality of life and reduces their lower extremity pain. These treatment options can also be very beneficial in the treatment of non-healing wounds which decreases the need for amputation.

Balloon AngioplastyPeripheral Angioplasty / Stent

Balloon angioplasty is another type of procedure that can be performed to increase the natural blood flow within an artery. During this procedure, a balloon is advanced to the site of the narrowing and inflated in order to push the plaque towards the wall of the artery. Balloon angioplasty can be performed independently or in addition to atherectomy and/or stenting.

Stents

A stent is a very small cylindrical metal tube that can be placed in the artery to help prevent the artery from narrowing again in the future. It can be used alone, or in conjunction with atherectomy or balloon angioplasty. Stents are particularly successful in the larger arteries found in the legs.

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