Hospital-Based Procedures

Cardiac and peripheral extremity vascular angiography

Catheters usually from the groin (sometimes from the arms) are used to visualize the inside of coronary arteries and other arteries of the extremities using radiopaque dye.

Coronary stent placement/percutaneous coronary intervention (PCI)

This is a therapeutic procedure involving the placement of catheters, balloons, and stents, bare-metal or drug-eluting, in order to open coronary obstructions.  This procedure usually does not require surgery and usually is able to be done with a small hole in the groin.  Most of the time, the patients are able to go home the next day.  Newer drug-eluting stents are coated with a medication which markedly reduces the chances of scar tissue formation and chances of restenosis.

Peripheral vascular intervention

This procedure involves the placement of stents, balloons to open obstructed arteries in legs or arms.  New techniques such as cryoplasty and atherectomy are also used to treat disease.  A special subset of patients called critical limb ischemia requires procedure in leg arteries below the knee by new techniques such as atherectomy and cryoplasty.

Carotid angiography and carotid stent placement

These procedures involve visualization of the arteries supplying blood flow to the brain in the neck.  Nowadays, certain patients can be treated by stent placement, particularly those who are high-risk patients, for open surgery (carotid endarterectomy).

Pacemaker insertion

The pacemaker is a small metallic device which is usually used to correct slow rhythms of the heart which are making the patients pass out.  With newer models the life of a pacemaker generator can be up to ten years.  Usually the hospitalization is for one day.

Transesophageal echo (TEE)

This test involves patients swallowing an ultrasound probe to get dramatically improved imaging of the heart from the esophagus (food pipe).  This test is able to detect subtle abnormalities of heart valves and other tissues of the heart which a surface echo is not able to uncover.  The patient is usually pre-medicated by before the test is done.

Tilt-table testing

Tilt-table testing is a procedure used to investigate patients who have sudden passing out spells and lightheadedness spells (syncope).  The patient rests on a table which is inclined at an angle of usually 70 degrees.  Drops in heart rate or blood pressure, or both, may be detected by the test. 

Implantable loop recorder

These are small implantable devices which are inserted by a small incision on the skin and is usually used to diagnose rare episodic arrhythmias which are making the patient pass out and which have not been able to be detected by the Holter or event monitor.  This has a much higher diagnostic yield as compared to an event recorder.  Usually the procedure is a very simple outpatient procedure.