Percutaneous coronary intervention (PCI)

Overview

A percutaneous coronary intervention (PCI), formerly known as coronary angioplasty with stenting or simply angioplasty, is a minimally invasive technique designed to unblock coronary arteries, which carry oxygen-rich blood from the heart throughout the body. During the PCI procedure, a small balloon is utilized to widen a narrowed artery, enhancing blood flow.

Following the balloon inflation, an interventional cardiologist typically implants a permanent tube, known as a stent, to maintain the openness of the artery over the long term. This stent often incorporates medication that is released directly into the artery (drug-eluting stent), aiming to minimize the risk of re-narrowing within the stent.

Reasons for undergoing the procedure.

A PCI may be essential for addressing the accumulation of atherosclerotic plaque, a dense fatty substance, in the arteries. This condition, known as atherosclerosis, heightens the risk of cardiovascular disease and hinders the smooth flow of blood through the heart, potentially causing chest pain or angina due to inefficient pumping. Additionally, PCI functions as a critical medical intervention for the treatment of acute myocardial infarction, promptly restoring blood vessel patency to minimize the risk of myocardial damage.

Risk

PCI procedures, while generally safe, entail certain risks, including bleeding or infection at the catheter insertion site, blood clot formation in the heart stent, artery re-narrowing, and the potential for stroke. Notably, when a drug-eluting stent is utilized in PCI, the risk of artery re-closure is minimized to less than 5%.

Before the procedure

In preparation for a non-emergency PCI, it is typically necessary to undergo a fasting period, abstaining from both food and drink for several hours prior to the procedure. If you are taking anticoagulant medications, it may be required to temporarily discontinue them, as these drugs can elevate the risk of bleeding during the intervention. It is crucial to adhere closely to the specific instructions provided by your healthcare provider regarding dietary restrictions and medication adjustments to ensure a safe and successful PCI.

During the procedure

An interventional cardiologist, specializing in the heart, blood vessels, and circulatory system, conducts a PCI. A sedative is administered for relaxation, allowing you to stay awake but not feel anything during the procedure.

The process involves:

• Inserting a small hollow tube (sheath) through a blood vessel in your arm or at the top of your thigh.
• Guiding a small, hollow tube (catheter) through the sheath to reach your heart.
• Injecting contrast dye and using X-rays to observe the catheter in real time.
• Opening the blocked artery by inflating a balloon at the catheter’s tip.
• Placing a stent if necessary to maintain the openness of the artery.
• Removing the catheter and closing the insertion site with a compression bandage (for the arm), a small stitch (for the thigh), or a collagen plug (for the thigh).

The procedure typically lasts between 30 minutes and two hours, with the duration depending on factors like the extent of plaque buildup.

After the procedure

Following a PCI, it is customary to spend several hours in a recovery area. Bruising or soreness at the catheter insertion site may be experienced. Depending on the circumstances, you could be discharged on the same day or may require an overnight stay in the hospital.

Outcome

Typically, individuals undergoing a PCI can resume their normal activities within a week. However, those with physically demanding jobs may need to wait longer before returning to work.

As part of the recovery process following PCI, your cardiologist might prescribe blood-thinning medications like clopidogrel, prasugrel, or ticagrelor to reduce the risk of blood clots. It’s crucial to adhere to the prescribed medication regimen provided by your healthcare provider.

In the post-PCI period, promptly contact your healthcare provider if you experience:

• Bleeding or discharge at the catheter insertion site.
• Chest pain (angina).
• Chills or fever.
• Coolness or numbness at the catheter insertion site.
• Dizziness or fainting (syncope).
• Shortness of breath (dyspnea).
• Persistent swelling or pain that does not subside.