CORONARY ANGIOPLASTY (PCI)

(BARTS HEART CENTRE)

A coronary angioplasty is a procedure used to widen blocked or narrowed coronary arteries (the main blood vessels supplying the heart). The term "angioplasty" means using a balloon to stretch open a narrowed or blocked artery.

Supplies: 

- ANGIO-pack (KIMAL)

- Spike for saline bag

- 2 chloraprep

- 500ml NSS (sterile bag)

- Tegaderm dressing (to secure radial sheath)

- 6F Terumo radial sheath (Radial Approach) or 6F Cordis femoral sheath (Femoral approach)

- Inflator device

-short hemostasis valve extension

-Contrast balloon mixture (50mL contrast: 50mL Saline)

-30mL luerlock syringe

-Angioplasty wire (operator preference) or ASAHI Sion Blue (commonly used workhorse wire)

-Angioplasty balloon (size depending on the vessel diameter)

-Semi-compliant (for predilation)

-Non-Compliant (for postdilation)

-Drug-eluting stent (size depending on the vessel diameter)

For IV drug line

- 500 mL saline bag

- Extension line (long)

- 3-way tap

- 20mL luerlock syringe

- 2ml or 5 ml luerlock syringe (labeled, for midazolam)

- blunt needle for aspirating drugs

- giving set

Diagnostic Catheters: (used for check shots)

LCA (for left coronaries)

- 6F JL 3.5 catheter if radial

- 6F JL4 if femoral

- Others : JL 3,5,6 AR, MPA

RCA (for right coronaries)

- 6F JR4 catheter 

- Others: WR, AL1,2, AR 1,2,3, MP

Single catheter technique: 5F TIG (for RCA and LCA)

If tortuous vessel or if there’s spasm: 

- 0.35 Terumo glide wire 150cm

- 0.35 Exchange wire 260cm

- 0.014 BMW wire

Guidecatheter Catheters: (used for coronary intervention)

LCA (for left coronaries)

- 6F EBU 3.5 guidecatheter

RCA (for right coronaries)

- 6F JR4 catheter 

Medications (Scrub Nurse): 

- Lidocaine 1% 5ml amp if radial (20ml if femoral) 

- Heparin 10,000iu/10mL

- 1 amp Isosorbide Dinitrate 10mg/10ml (Dilution: ISDN 2mg/2mL add with 8mL NSS to make 2mg/10mL or 200mcg/mL dilution)

- 1 amp Verapamil 2.5mg/2ml (Dilution: Verapamil 2.5mg/mL add with 4mL NSS to make 2.5mg/5mL)

SEDATION: (Managed by Circulating Nurse)

Midazolam 2mg/2mL (give in 0.5mg increments)

PAIN RELIEF:

Morphine 10mg/2mL (give in 2.5mg increments)

If taking aortogram or femoral angiogram

- 6F pigtail catheter

- High pressure tubing 

- High pressure Contrast syringe 

- High power injector 

- Forcep (for tapping tubes to remove air and secure tube connections)

Closure devices: 

- Angioseal (6F or 8F) for femoral access 

- TR band or Helix (regular or large) for radial access

PROCEDURE STEPS

RADIAL APPROACH:

Operator injects 2-3 mL of Lidociane 1% subcutaneously

Inserts the sheath using Seldinger Technique

Aspirates blood from sheath to confirm patency of the puncture

Verapamil 2.5mg/5mL through the sheath (spasm prevention)

Then introduce catheter with guidewire (JR4 first for RRA, JL4 for RFA)

Introduction of Angioplasty wire (usually Sion Blue) and park the wire distal to the coronary lesion

Predilation of the lesion with Semi-compliant balloon

Deployment of coronary stent

Post-dilation with Non-Compliant (NC) balloon, if necessary

Closure of radial/femoral access.

For RCA:

1. LAO 30

2. LAO 20 CRAN 20 / PA CRAN 30

3. RAO 30

For LCA:

1. PA CAUDAL 40

2. LAO 40 CAUDAL 40

3. LAO 10 CRAN 40

4. RAO 40 CRAN 40

5. RAO 30 CAUD 30