percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a non-surgical procedure used to treat obstructive coronary artery diseases, such as unstable angina, acute myocardial infarction (MI), and multivessel coronary artery disease (CAD).
This technique is used to open blocked heart arteries. Angioplasty is a procedure that involves inserting a thin balloon catheter into a clogged blood artery to assist expand it and enhancing blood flow to the heart
Indications for PCI include:
● Acute myocardial infarction with ST-elevation (STEMI)
● Acute coronary syndrome without ST elevation (NSTE-ACS)
● Unstable angina
● Anginal equivalents such as dyspnea, arrhythmia, or dizziness
● High-risk stress test findings
Another indication of PCI is the presence of objective evidence of a moderate to a large portion of viable myocardium or moderate to severe ischemia on noninvasive tests in an asymptomatic or slightly symptomatic patient.
Also, hemodynamically significant lesions in vessels serving viable myocardium (vessel diameter >1.5 mm) is a significant angiographic indication.
PCI procedures can be tailored to meet every patient’s needs. doctors choose the most appropriate technique for each individual. These techniques are:
Balloon angioplasty; the basic PCI method. A catheter with a small, foldable balloon on the tip is run into a blood vessel until it reaches the obstruction caused by plaque formation. The balloon is then inflated, compressing the plaque against the artery’s walls. The route is widened, and blood flow to the heart is restored. After that, the balloon is deflated and removed.
Angioplasty with stent; we usually insert a stent in the problem location as part of the balloon therapy to keep the artery open after the balloon is removed. A tiny wire is inserted into the blockage, and a balloon catheter with a stent is advanced to the blockage location over the wire. The stent expands when the balloon is inflated. The balloon is deflated and removed once the plaque is pushed against the arterial wall and the stent is in place. Most stents now include coatings that slowly release specific medications that prevent scar tissue from forming in the artery, guaranteeing better blood flow and lowering the need for future treatment.
Rotational atherectomy; doctors employ unique catheter-based equipment to drill out calcified plaque deposits in patients with very tough blockages.
Impella-supported PCI; a tiny device called the Impella heart pump can be temporarily inserted through the skin and into the heart to assist its pumping function during the procedure for patients at high risk of complications or with severe heart disease. Blood flow to vital organs is maintained as a result
The following are relative angiographic contraindications:
Arteries with a diameter of less than 1.5 mm
Diffusely diseased saphenous vein grafts
The other coronary anatomy that is not amenable for PCI
Although this is a less invasive procedure, it has some risks. The most common risks include:
Bleeding; a patient may have bleeding where the catheter was put in his leg or arm. It usually results in a bruise, although severe bleeding might occur and need a blood transfusion or surgical intervention.
Artery re-narrowing; in the case of using a drug-eluting stent combined with the angioplasty the treated artery has a slight chance of becoming blocked again.
When bare-metal stents are placed, the risk of re-narrowing the artery is increased.
Blood clotting; Even after the procedure, blood clots can develop within stents. These clots have the potential to block an artery, resulting in a heart attack. To lower the risk of clots forming in your stent, a patient should take aspirin along with clopidogrel, prasugrel, or another drug that helps prevent blood clots exactly as prescribed.
There are some rare risks of PCI, including heart attacks, coronary artery damage, kidney problems, abdominal heart rhythm, and strokes.
Before the procedure
Anesthesiologist will give your patient a sedative to help him relax before the procedure. Patients are sedated but not asleep during most PCIs.
In areas where a catheter will be put, such as the groin or wrist, the hair may be removed.
An intravenous (IV) line is inserted, allowing doctors to quickly provide patients with drugs as necessary.
A pulse oximeter will be clipped on a finger or ear to check the oxygen level in the patient’s blood, and electrodes will be implanted on his body to monitor his heart.
Depending on the complexity, a PCI might take from one to three hours.
On a procedure table, a patient will be lying on his back. At the place where the catheter will be implanted, a local anesthetic will be administered.
When the catheter reaches the heart, a contrast dye will be administered, to allow doctors to view the restricted portion of the artery on an X-ray. The physicians will next conduct the PCI that is most suitable for this condition.
The catheter will be removed after the procedure is completed, and pressure will be administered to the insertion site to stop the bleeding. If the catheter was put via your groin, you must lie flat on your back for many hours with your leg straight. The patient’s arm will be lifted on cushions and held straight with a stabilizing board if the catheter was put in his arm.
The medical team will transport the patient to a recovery room where he will be monitored for many hours. Depending on his health and the type of PCI he had, he’ll need to be in bed for two to six hours.
he may feel a little aching or pain in his chest. doctors can offer him pain killers if his pain is too much.
To help flush the contrast dye from the patient’s body, doctors should advise him to drink much water and other fluids.
Some patients are admitted to the hospital for observation and then go back home the next day.
After the procedure, the patient should follow some instructions to keep his heart healthy, they should:
Stop smoking
Follow a healthy diet
Exercise regularly
Maintain their cholesterol level
Control their blood glucose and blood pressure
Take their medications as prescribed
© 2023 Gulf Intervention Society. All Rights Reserved. PCO in charge ICOM
President, Gulf Intervention Society
Interventional Cardiologists
National Guard Hospital
Riyadh, Saudi Arabia
Vice President, Gulf Intervention Society
Professor of Cardiovascular Medicine
Chairman of Education, EMA
Editor Chief New Emirates Medical Journal
Alain, Abu Dhabi, UAE
General Secretary, Gulf Intervention Society
Head of Cardiology Unit, Al Sabah Hospital
Kuwait City, Kuwait
