Atherosclerosis is a ch ronic problem leading to gradual thickening of the arterial walls. The main target arte ries that are i nvolved by this process are the coronary arteries (heart), carotid arteries (brain), the renal arte ries (kidney), the aorta and the leg arteries. The activity of the invasive cardiovascular unit is centered on diagnosis and treatment of coronary artery disease, peripheral vascular disease, as well as cardiac valve problems and congenital heart disease. Each year ca. 1500 diagnostic examinations (coronary and other a ngiograms) and 550 therapeutic interventions (angioplasty, stents, etc.) are done at La Tour in two digital angiographie rooms.
When a coronary artery is severely narrowed, the blood flow feeding the heart muscle becomes insufficient, and the patient may feel chest pain: these symptoms are referred to as angina. Following appropriate non invasive evaluation, coronary angiogra phy allows to confirm the diagnosis and localise the problem. When the anatomy is suitable, one can then proceed to percutaneous coronary intervention (PCI) using balloon dilatation of the narrowed segment to reesta blish a normal blood flow. This is generally completed by implanting a coronary stent, with or without a drug fixed at its surface, in order to improve the early result, and decrease the likeli hood of a recurrence. The length of the hospital stay for such an intervention is typically 12-24 hrs. In addition to the balloon and stent approach, the catheterization laboratory currently also has available intravascular ultrasound equipment, rotational atherectomy (rotablator), distal protection devices, intra-aortic balloon counterpulsation and a left ventricular assist system. Besides stable
angina caused by a fixed narrowing of a coronary artery, it is also possible for an atherosclerotic plaque within a coronary artery to rupture, causing a sudden complete occlusion of the artery, and leading to myocardial infarction. In order to li mit the size of the infarction, very early intervention is mandatory. With our emergency room equipped to receive urgent admissions, whether transported by helicopter or by ambulance, and thanks to the permanent availability of the catheterization laboratory, 24 hrs a day, 7 days a week, we are able to intervene within an hour following admission to mechanically open the blocked artery and re-establish normal blood flow. After such an intervention, the patient generally remains in the Intensive Care Unit for 48 h rs, and his overall hospital stay lasts for 3-7 days.
Similar techniques make it possible to recanalise most of the arteries in the body. This is most often done in the legs to treat intermittent claudication or more severe forms of ischemia, in the kidneys to treat and/or prevent hypertension and renal failure, and the carotids, to prevent strokes and transient cerebral ischemic attacks. Many aortic aneurysms (abnormal dilatation of the aorta) can also be treated by the percutaneous insertion of a prosthesis, th us avoiding the need for a full surgical intervention. When necessary, narrowed or com pressed veins can also be re-opened by stent im plantation.
Valvular heart disease is characterised by either a narrowing or a leakage of one of the four cardiac valves. In certain situations, it is possible to dilate a narrowed valve (valvuloplasty) using a balloon that is introduced th rough the skin. This is most often done for the mitral and the pulmonary valves. Finally, cer tain congenital cardiac malformations involve abnormal communications between the heart chambers (patent foramen ovale, atrial septal defect, fistulas, etc.). It is usually possible to correct such defects by the implantation of a prosthesis that occludes the abnormal communication in a permanent fashion.
The new Siemens Artis Q catheterization lab allows to perform coronary angiography with a reduction of the radiation dose in the range of 30-50%. This is a benefit for patients but also for staff, daily exposed to X-rays
On the other hand, it has a large flat screen that can display images from the ongoing exam and all other previous images carried out on the same patient, such as echocardiography, CT-scan or intracoronary ultrasound. The doctor will benefit, during the intervention of all the patient information on a single screen.
Image processing software is also included, allowing to see the structures of stents in order to ensure that they are properly deployed and that the overlap is minimal during complex interventions.
Finally, another benefit for the patient is a thermal mattress that adapts to the shape of the body, increasing therefore patient comfort.
Last modified on June 20th, 2016
Unless specified otherwise, this text has been written by the editorial team.