About Cardiac Catheterisation, Angioplasty and Stent Insertion

In cases of suspected angina, heart attack or heart muscle dysfunction of unknown cause it may be necessary to image the coronary arteries to ascertain whether a reduction in the blood supply the heart is the cause of these symptoms.

The commonest cause of reduced blood supply is narrowing of the coronary arteries.

Coronary catheterisation requires puncture of the femoral or radial artery to allow insertion of a catheter and access to the heart.

In general three catheters are used one to access the right coronary artery, one to access the left coronary artery and one to allow measurement of pressure within the heart.


Once the arteries had been engaged with the specific catheter and iodine-containing contrast is inserted into the artery and the images digitally acquired. This is repeated for each artery this the left and right coronary arteries. After this, the specially designed pigtail artery is inserted directly into the heart through the aortic valve pressures recorded and a set quantity of contrast injected into the heart and again the images digitally acquired to allow for later analysis. Both the pressures acquired and the digital images allow a full analysis of the cardiac function and blood supply.

The images are analysed and if narrowed arteries are found it is usual that these are corrected immediately as part of the procedure. If they are more complex they may require more detailed discussion and analysis with colleagues prior to embarking on revascularisation. This may include complex interventions such as Rotablator or multiple stent insertions in a highly technical fashion. Such cases are often referred to super specialists to allow better outcome for patients. Often this decision is made during the original procedure and patients may not have met the super specialist as it’s difficult to predict who would need their help.

Some people require coronary artery bypass grafting and this would be done electively or in some cases immediately if it proves that the patient would benefit from immediate intervention. This procedure is done by cardiovascular surgeons who practice a dark at the Sunninghill clinic. We have four cardiothoracic surgeons here who form a skilled team to perform these operations.

In the event that the cardiac catheterisation was done to assess a valvular lesion, it may be necessary to follow this with a valve replacement or repair. Each case assessed on merit and a decision to make whether this can be done percutaneously or requires open heart surgery.

The percutaneous option is done very much like an angiogram with the valve being delivered through a large catheter inserted into the femoral artery in the groin. This procedure is known as a TAVI (transcatheter aortic valve insertion). This again is done by super-specialists located in the Sunninghill hospital.

There are a variety of other more specialised catheter driven procedures which allow the treatment of a variety of cardiac conditions which previously required open heart surgery for example closure of patent foramen ovale, atrial septal defects and ventricular septal defects.

There are procedures which reduce the risk of clot formation in the heart in patients with atrial fibrillation and removed the necessity for such people to be on anticoagulation.

The Cardiologist - Dr Anthony Stanley Logo


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