200139.vtt
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WEBVTT
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DCA, or directional coronary atherectomy is a
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minimally invasive procedure to remove
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blockage from coronary arteries
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to improve blood flow to the
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heart muscle and ease pain.
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First, a local anesthesia numbs the groin area.
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Then the doctor puts a needle into the
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femoral artery, the artery
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that runs down the leg.
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The doctor inserts a guide wire through
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the needle
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and then removes the needle.
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He replaces it with an introducer,
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a tubular instrument with two ports used to
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insert flexible devices such as a
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catheter into a blood vessel.
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Once the introducer is in place,
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the original guidewire is replaced by a finer wire.
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This new wire is used to
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insert a diagnostic catheter,
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a long flexible tube, into the artery
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and guide it to the heart.
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The doctor then removes the second wire.
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With the catheter at the opening of one of the coronary arteries,
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the doctor injects dye and takes an X-ray.
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If it shows a treatable blockage,
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the doctor uses another guide wire to remove
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the first catheter and replace it with a guiding catheter.
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Then the wire that was used to do this is removed
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and replaced by a finer wire that is advanced across the blockage.
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Another catheter designed for lesion
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cutting is also advanced across the blockage site.
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A low-pressure balloon attached next to the cutter,
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is inflated, exposing lesion material to the cutter.
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A drive unit is turned on, causing the cutter to spin.
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The doctor advances a lever on the drive unit that in turn advances the cutter.
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The pieces of blockage it cuts away are stored in a section
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of the catheter called a nosecone until they are removed at the end of the procedure.
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Rotating the catheter while inflating and deflating the balloon makes it possible
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to cut the blockage in any direction, leading to uniform debulking.
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A stent may also be placed.
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This is a latticed metal scaffold put inside the coronary artery to keep the vessel open.
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After the procedure, the doctor injects dye and takes
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an X-ray to check for change in the arteries.
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Then the catheter is removed and the procedure is over.