Stanford's Interventional Cardiology clinical services include procedures for the diagnosis and treatment of heart disease. Most patients scheduled for coronary intervention are admitted for same-day procedures. 

Stanford Leading-Edge Treatments

Alcohol Septal Ablation

During this procedure, Stanford Hospital & Clinic cardiologists use an ethanol (alcohol) injection to decrease thickened heart muscle which obstructs the outflow of blood from the heart in a condition known as hypertrophic obstructive cardiomyopathy.

Atrial Septal Defect (ASD) Closure

Involves the use of specialized devices to close a defect in the wall between the upper chambers of the heart. This can relieve ASD-related symptoms such as shortness of breath and palpitations, as well as prevent any future complications related to the ASD.

Patent Foramen Ovale (PFO) Closure

Involves the use of a specialized device to close a common small tunnel in the heart called a PFO, which has been linked to strokes. This procedure is done to prevent a subsequent stroke. Research into the possible connection between migraine headaches and PFO is continuing.

Balloon Mitral Valvuloplasty 
Patients who have been diagnosed with mitral valve stenosis, high-risk aortic stenosis or certain blockages of the plumonic valve may benefit from balloon valvuloplasty. These valvular obstructions are relieved using highly specialized balloon catheters. A balloon is threaded into the heart through the vein (femoral) in the groin and temporarily expanded across the narrowed valve. The goal of this procedure is to enhance blood flow across the mitral valve.

Brachytherapy
Following intracoronary stenting, renarrowing of the artery may occur. Brachytherapy is a form of radiation used to treat this recurrence. 

Additional Treatments to Re-establish Blood Flow to the Heart
(Percutaneous coronary revascularization)

• Coronary Artery Balloon Angioplasty
   Each year, our team of interventional cardiologists performs more than 800 balloon angioplasties. In this procedure, a specially designed catheter with a tiny balloon is carefully guided through the coronary artery to the point of a blockage, then inflated to relieve the blockage and increase blood flow to the heart.
• Coronary Artery Stenting
  Very often, balloon angioplasties also involve the placing of a stent - a small, hollow stainless steel mesh tube - at the site of coronary artery narrowing. Virtually all stenting procedures today involve the use of a drug-eluting stent, which have drugs coated onto the surface to limit regrowth of scar tissue with the stent. The Stanford team is actively involved in the studies of next-generation drug-eluting agent. 
• Rotational Atherectomy
  Stanford's intervventional cardiologists are highly skilled in performing complex angioplasties that require physical removal of plaque. Dr. Simon Stertzer, Stanford's Director of Experimental Angioplasty, performed the first rotational atherectomy in the world. Rotational atherectomy, performed using a high-speed, diamond-tipped drill, is generally reserved for patients with calcified plaque.

See  Catheter-Based Procedures  for more information on these procedures as well as the following diagnostic procedures:

Diagnostic Procedures

• Right- and Left-heart Catheterizations
  
  Used to diagnose:
  • valvular and congenital defects
  • cardiomyopathies including pre- and post-transplant
• Endomyocardial biopsy
  This cellular analysis of heart tissue looks for the presence of disease in pre-transplant patients and is used to monitor post-transplant patients for indications of rejection.
  
  
• Coronary Angiography
  Is an x-ray examination of the blood vessels or chambers of the heart. A very small tube (catheter) is inserted into a blood vessel of either the patient's groin or arm. The tip of the tube is positioned either in the heart or at the beginning of the arteries supplying the heart, and a special fluid or dye is injected. This fluid is visible by X-ray, and the pictures obtained are called angiograms.

Intracoronary Diagnostics

Patients with normal appearing coronary arteries sometimes develop symptoms because of episodes of coronary spasm.  Spasm refers to temporary constriction of an artery which results in decreased blood flow to the heart.  Spasm can occur if the lining of the artery, called the endothelium, is not functioning properly.  Acetylcholine is a medicine which temporarily triggers spasm in patients who have abnormal endothelium.  It can be given safely in the cardiac catheterization laboratory to help determine if spasm is the cause of a patient’s symptoms.

Intravascular Ultrasound (IVUS)

This is one of many examples of interventional techniques pioneered by Stanford researchers. IVUS is an imaging technique that has become the international gold standard for detection and evaluation of coronary artery disease. Designed to provide data about lesion characteristics, IVUS is used to improve decision-making regarding coronary intervention for patients. IVUS refers to a catheter or tube which has an ultrasound probe near its tip. An IVUS catheter can be placed in a coronary artery to look from the inside at the artery. It provides very detailed pictures of the inside of the artery and often provides more information than a standard angiogram alone.

Fractional Flow Reserve (FFR)

FFR is an index that can be measured with a coronary pressure wire in a patient with a moderate narrowing of unclear significance.  The coronary pressure wire is a small wire with a pressure sensor near its tip that can be placed beyond the moderate narrowing.  FFR is the ratio of the coronary pressure beyond the narrowing compared to the pressure before the narrowing.  Measuring FFR provides more information than a standard angiogram alone about the significance of moderate coronary narrowings.

Coronary Flow Reserve (CFR)

CFR is an index that can be measured to determine the status of the small branches of vessels that supply blood to the heart, but which are poorly visualized by the standard coronary angiogram.  CFR is determined by using a small wire which can measure the flow of blood into the small vessels.  Patients who have chest pain, but normal appearing coronary arteries and no evidence of coronary spasm, may have abnormal flow in the small vessels (abnormal CFR).

Specialty Diagnostic Procedures

Nipride Study
Performed in the Cath Lab, this pre-transplant diagnostic procedure measures pressures within the heart in response to a nipride infusion.