What is Interventional Cardiology?
Interventional cardiology deals specifically with the catheter-based treatment of heart diseases. Interventional cardiologists are board-certified cardiologists who perform interventional cardiology procedures, most often in a cardiac catheterization lab at a hospital.
The majority of interventional cardiology procedures are performed in the cardiovascular (heart, veins and arteries) system. Most interventional cardiology procedures are considered to be minimally invasive because they do not require an instrument to enter the body or large incisions – most incisions are approximately one inch. These procedures usually involve the insertion of a catheter (hollow tube) into the femoral artery in the upper leg. The catheter is guided toward the heart or vascular area through the use of real-time X-ray.
Some of the advantages of minimally invasive interventional cardiology are decreased pain, less risk of infection, avoidance of large scars, and shorter postoperative recovery times. In many instances, patients are awake during the procedure, requiring only a local anesthetic. Additionally, many procedures are performed on an outpatient basis, allowing patients to go home within hours of the procedure.
Interventional Cardiology procedures can include:
• Balloon Angioplasty creates a space in a blocked artery by inserting and inflating a tiny balloon. The balloon compresses the plaque against the wall of the artery, so blood can flow more freely. The balloon does not remain in the body.
• Carotid Stents and Stroke Intervention involves the insertion of a stent to expand the carotid arteries located on each side of the neck, extending from the aorta to the base of the skull to supply blood to the brain. If a clot or plaque blocks the blood flow to the brain, it can cause a stroke, resulting in brain damage or death.
• Congenital Heart Defect Correction can be employed to correct atrial septal and ventricular septal defects, closure of a patent ductus arteriosus and angioplasty of the great vessels.
• Fractional Flow Reserve (FFR) can accurately measure blood pressure and flow through a specific part of the coronary artery. The measurement of FFR has been shown useful in assessing whether or not to perform angioplasty or stenting on intermediate blockages.
• Intracoronary Stenting requires the permanent insertion of a tiny stainless steel wire-mesh tube called a stent to keep arteries open following a balloon angioplasty. Both bare-metal and drug-eluting (medication-releasing) stents are available.
• Intravascular Ultrasound involves a small catheter in the coronary artery to emit sound waves that produce an image of the blockage, providing the cardiologist with needed information to best manage the blockage.
• Implantable Cardioverter Defibrillators (ICDs) help treat patients at high risk for sudden cardiac arrest. Implanted through a small incision near the shoulder, ICDs use electrical pulses or shocks to help control life-threatening and irregular heartbeats.
• Pacemaker Insertion is for patients with abnormally slow heart rhythms, congestive heart failure and those at risk for sudden death. Pacemakers help coordinate the pumping action of the heart by sending electrical signals, allowing the heart to pump more effectively.
• Peripheral Arterial Disease (PAD) Intervention involves the evaluation of diseases of the blood vessels outside the heart. Balloon angioplasty and stenting may be used similarly to heart procedures to treat PAD.
• Peripheral Atherectomy cuts through plaque in the blood vessels outside the heart. The plaque is reduced to particles smaller than red blood cells, resulting in a smoother inner surface of the vessel that allows for increased blood flow.
Dr. Eric Cohen, interventional cardiologist, is the medical director of Peripheral Vascular Intervention at the Heart & Vascular Center of Northern Arizona. Dr. Cohen specializes in vascular care and the treatment of peripheral arterial disease and limb salvage.