Interventional cardiology and radiology use minimally invasive techniques guided by imaging to diagnose and treat diseases. Some common procedures include radiofrequency ablation to treat cancers, coronary angioplasty and stent placement to open blocked arteries, transjugular intrahepatic portosystemic shunt placement to reduce portal hypertension, and coronary angiography to image heart arteries using contrast dye. These procedures use catheters and stents along with imaging like fluoroscopy to precisely deliver treatments to diseased areas while minimizing patient trauma.

2. Introduction
• Interventional Radiology is a medical subspecialty of
radiology.
• It provides minimally invasive diagnosis and/or treatment
using imaging to target and show the results of the
intervention.
• Interventional Cardiology is the subspecialty of cardiology
that uses intravascular catheter-based techniques with
fluoroscopy to treat various heart diseases.

3. Interventional Cardiology and
Radiology Procedures
1. Radiofrequency ablation
2. Coronary artery angioplasty and stent placement
3. Transjugular intrahepatic portosystemic shunt
(TIPS) placement
4. Coronary angiography

4. Cardiac Radiofrequency Ablation
• Radiofrequency ablation (RF ablation) is a minimally
invasive treatment for cancer that is approved by the FDA.
• It is used to treat primary lung cancers, liver and kidney
cancer and to manage pain resulting from small bone
cancers.
• RFA utilizes frictional energy transmitted by oscillating
ions within tissue to heat and treat tumors.

5. PRINCIPLE:
 Cells undergo coagulation necrosis when heated to more
than 50°C for more than 5 minutes.
 At temperatures above 60°C, intracellular proteins are
denatured (killed) rapidly.
 The AC current (350-500 kHz) of RF waves passing down
from an un-insulated electrode tip into the surrounding
tissues generates changes in the direction of ions and
creates ionic agitation and frictional heating.

6.  The tissue heating then
dehydrates the tissue, resulting
in tissue destruction by
coagulative necrosis .
 Cell membranes are destroyed
through dissolution and the
melting of lipid bilayers, and
lastly, cell death is inevitable.

7. EQUIPMENT:
• The RF ablation setup is a simple electrical circuit wherein
the current loop comprises a generator, cabling, electrodes
and tissue as the resistive element.
a) Catheter:
– Single (monopolar) electrode radiofrequency catheters emit
radiofrequency energy from a single point at the catheter tip.

8. • Multi electrode radiofrequency
catheters have several electrodes, each of
which can deliver radiofrequency energy.
• These catheters can ablate a larger area of
tissue than single point radiofrequency
energy catheters, which could decrease
procedure time.
• These catheters can also deliver superficial
bipolar radiofrequency energy, which my
reduce injury to deeper tissues in certain
areas of the heart.

9. • Irrigated tip catheters:
– Closed Irrigation: Saline is perfused via a
pump mechanism through the catheter tip,
turns around within the catheter tip, and
returns back to the pump.
– Open Irrigation: Open irrigation overcomes
the limitations of non-irrigated ablation by
lowering electrode and tissue surface
temperature.
– The efficacy of power delivery is increased
along with the safety of reduced char
formation.

10.  Three types of RF electrodes are currently available
commercially:
– Two brands of Multi polar retractable needle electrodes:
1. RITA Medical Systems, Mountain View, CA;
2. LeVeen needle electrode, Boston Scientific, Boston, MA
– Internally cooled electrode:
1. Cool-Tip RF electrode; Radionics, Burlington, MA

11. Generator and ground pads:
• The RF ablation generator provides three essential
functions: power generation, control, and user interface.
• The ground pad closes the electrical current path and is
designed to disperse energy over a large surface area to
reduce the likelihood of thermal injury to the skin.

12. WORKING:
• The procedure can be done in a variety of ways.
• RFA can be performed percutaneously.
• In this technique, under ultrasound guidance the LeVeen®
Electrode is inserted through a small puncture in the
chest and positioned within the tumor and opened
allowing the multiple tines to spread out.

13. • Then, the generator is turned on and the radiofrequency
energy is passed from the tines of the electrode into the
tumor.
• The energy creates heat which destroys the cells in the area.
• The result is destruction (ablation) of the tumor.

14. APPLICATIONS:
• RF ablation is used in recurrent atrial flutter (AFL), atrial
fibrillation (AF), Supraventricular Tachycardia (SVT).
• It is used in the treatment of varicose veins.
• RFA is used to treat severe chronic pain the lower (lumbar) back.
• RFA is also used in radio frequency lesioning, for vein closure in
areas where intrusive surgery is contraindicated by trauma.
• RFA is used in liver resection to control bleeding (homeostasis)
and facilitate the transaction process.
• RFA is also used to ablate tumors in patients where surgery is
not possible due to health condition.

16. Coronary Angioplasty And
Stent Placement
• Coronary angioplasty is a procedure used to open blocked
coronary arteries (caused by coronary artery disease).
• It restores blood flow to the heart muscle without open-heart-
surgery.
• Coronary angioplasty is also known as Percutaneous
transluminal coronary angioplasty (PICA).
• The combination of coronary angioplasty with stenting is
usually referred to as Percutaneous Coronary Intervention
(PCI).

17. EQUIPMENT:
• The most commonly used
PCI equipment consists of
four basic elements:
1. a guiding catheter,
2. a balloon catheter,
3. a coronary guidewire,
4. a stent.

18. Guiding Catheter:
• A special large lumen catheter is used to
deliver the coronary balloon catheter and
other interventional devices to the vessel
that contains the lesion to be dilated.
 Function:
• A guiding catheter serves three major
functions during angioplasty:
– Balloon/Stent catheter delivery and guidance
– Backup support for balloon/Stent
advancement
– Pressure monitoring and contrast injections
(1)Stiffer body (2)variable
softer primary curve (3) wire
braiding (4)atraumatic tip (5)
large lumen(6) lubrious
coating

19. Balloon Dilatation Catheter System:
 When a stent is placed inside of a coronary artery, it acts as a
support or scaffold, keeping the vessel open.
 Stent procedures are usually used along with balloon
catheters.
 There are three types of PCI balloon catheters:
Over-the-wire (OTW)
Monorail
Fixed-wire

20. Stents:
• A Stent is a tiny, expandable, metal mesh coil that is put
into the newly-opened area of the artery to help keep the
artery from narrowing or closing again.
• It helps re-narrowing of the blood vessel.

21. PROCEDURE:
• PCI uses fluoroscope to find the
blockages in the coronary arteries as a
contrast dye moves through the arteries.
• The step by step procedure of
percutaneous coronary intervention:
1. The artery is filled with atherosclerotic
material, compromising the lumen.
2. A guidewire is positioned past the
stenosis through the lumen
3. A balloon catheter is advanced over the
guidewire

22. 4. The balloon is inflated
5. The balloon catheter is exchanged
for a stent (on a balloon)
6. The stent is expanded
7. The expanded stent remains in
place after the deflated balloon is
withdrawn.

23. APPLICATIONS:
Percutaneous coronary intervention (PCI) is used to treat
narrowing (stenosis) of the coronary arteries of the heart
found in coronary artery disease.

25. Transjugular Intrahepatic
Portosystemic Shunt (TIPS)
• Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a
procedure that uses imaging guidance (fluoroscopy) to
percutaneously create connection between the portal and
systemic circulations within the liver .
• A TIPS is placed to reduce portal pressure in patients with
complications related to portal hypertension.
• TIPS connects the vein which brings blood from the gastro-
intestinal tract and intra abdominal organs to the liver, and the
vein from the liver to the right part of heart.[

26. EQUIPMENT:
• In this procedure, x-ray or ultrasound equipment, a stent,
and a balloon-tipped catheter are used.
• The equipment used for this examination consists of
– Radiographic table,
– one or two x-ray tubes and
– a television like monitor that is located in the
examining room.
• Fluoroscopy, which converts x-rays into video images, is
used to watch and guide progress of the procedure.

27. • A catheter is a long, thin, plastic tube that is approximately
1/8 inch in diameter.
• The Stent used in this procedure is a small wire mesh
tube, often covered with a fabric made of GORE-TEX®.
• Other equipment that may be used during the procedure
includes an intravenous line (IV), ultrasound machine
and devices that monitor heart beat and blood pressure

28. PROCEDURE:
• With the use of Fluoroscopy guidance
and an injection of contrast material
containing iodine, the location of the
hepatic vein is identified.
• From the hepatic vein, a connection
through the liver is made into the
portal vein using guiding catheter.
• Once the connection is made to the
portal vein, fluoroscopy guidance is
utilized to dilate the connection and
place a stent

30. APPLICATION:
• The TIPS procedure is
usually performed in
patients with liver
cirrhosis.
• The TIPS may successfully
reduce internal bleeding
in the stomach and
esophagus in patients with
cirrhosis.

31. Coronary Angiography
• An angiogram is an x-ray image of blood vessels after they
are filled with a contrast material.
• An angiogram of the heart, a coronary angiogram, is the
“Gold Standard” for the evaluation of coronary artery
disease (CAD).
• A coronary angiogram can be used to identify the exact
location and severity of CAD.

32. EQUIPMENT:
The equipments needed for coronary angiogram are
 Angiogram needle,
 vascular sheath,
 Guidewires,
 Catheters,
 Fluoroscopic machine,
 Power injector
The catheter inserted into
angiogram needle.

33. PROCEDURE:
• Coronary angiography is
performed with the use of local
anesthesia and IV sedation, and is
generally not significantly
uncomfortable.
• In performing a coronary
angiogram, a small catheter is
inserted through the skin into an
artery in either the groin or the
arm.

34. • Under fluoroscopy guidance, the
catheter is then advanced to the
opening of the coronary arteries.
• A small amount of radiographic
contrast, is injected into each
coronary artery.
• The images that are produced are
called angiogram
• After the procedure, the catheter is
removed and the artery in the leg or
arm is sutured, sealed to prevent
bleeding

35. APPLICATION:
Coronary Angiography procedure is used to diagnose coronary
heart disease and coronary micro-vascular disease after
chest pain, sudden cardiac arrest, or abnormal results from
tests such as an electrocardiogram (EKG) of the heart or an
exercise stress test.

37. Bibbliography
• Yasunori Minami and Masatoshi Kudo, “Radiofrequency Ablation of
Hepatocellular Carcinoma: A Literature Review,” International
Journal of Hepatology, vol. 2011, Article ID 104685, 9 pages, 2011.
doi:10.4061/2011/104685
• http://www.rfalung.com/rfa_brochure.pdf

38. THANK YOU!