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Percutaneous coronary intervention (PCI)
Percutaneous coronary intervention (PCI) or Balloon Angioplasty, also known as coronary angioplasty, is a commonly performed procedure to treat blocked arteries. PCI can be necessary if you have plaque, build-up of fatty substances, calcium, or cholesterol in the arteries. PCI is also a helpful treatment to use after a heart attack occurs.
What is percutaneous coronary intervention?
A percutaneous coronary intervention (PCI) or Balloon Angioplasty is a minimally invasive treatment for clogged arteries. Coronary arteries are blood vessels that carry oxygenated blood to the heart muscles. When build-ups of fat, cholesterol, or calcium block an artery, diminishing blood flow and causing symptoms such as dyspnea and angina. PCI can help reopen a blocked artery and relieve the symptoms. Usually, an interventional cardiologist performs the PCI. The procedure involves inserting, through a small incision made on the wrist or groin, a catheter with a stent and balloon at the tip and navigating to the blocked coronary artery.
When plaque build-up happens in the arteries, it is called Atherosclerosis, which could lead to an increased risk of cardiovascular disease and reduced blood flow to the heart and other organs. When atherosclerosis significantly compromises a coronary artery, an imbalance of myocardial oxygen demand and supply can lead to symptoms like angina. PCI is the go-to procedure for people who need correction of the narrowed coronary artery due to atherosclerosis. In addition, it is a lifesaving measure after an acute heart attack. To determine whether PCI is appropriate for patients, a cardiologist will take into consideration the number of blockages, muscle function, the age of patients, and preexisting cardiac or non-cardiac health conditions.
What to expect?
Before the procedure
You will receive instructions about the preparatory steps before the procedure.
A fasting period is necessary and should be at least 4-6 hours before undergoing the procedure. In addition, if you are on anticoagulants, you need to stop taking them for a prescribed duration since anticoagulants may result in an increased risk of bleeding during the procedure. You will be sedated (not asleep) just before the start of the PCI and will be unaware during the procedure. Placement of an IV line provides a route for medication administration, if necessary. In addition, electrodes will be used to monitor your heart, with a pulse oximeter on your ear lobe or fingertip to measure the oxygen saturation level in your blood.
During the procedure
During a PCI, your cardiologist will insert a catheter, tipped with a deflated balloon, through a small incision and guide it to the heart. After inserting a catheter, injection of a contrast dye allows the cardiologist to visualize a blocked artery with X-ray fluoroscopy. Then, the interventionist will inflate the balloon at the tip of the catheter to dilate the blocked artery to increase blood flow. Cardiologists typically deploy stents to prop the artery open. Finally, the incision is closed after removing the catheter with the balloon deflated. The process usually takes about half an hour and may be up to two hours in complex cases.
After the procedure
After PCI, you will be transferred to a recovery room for observation. How long you will stay in the recovery room depends on your condition, usually 2 – 6 hours. You may have bruises around the area of the catheter insertion site and may experience a mild ache in your chest. In addition, you may need to have a companion drive you home since you should not drive or operate any vehicle within 24 hours after PCI.
The benefits and risks of PCI
Benefits of PCI include:
- Improved blood flow to the heart
- Improved symptoms of a blocked artery (chest pain and shortness of breath)
Potential risks of PCI include:
- Bleeding, bruising, or infection at the catheter site.
- Blood clots in the heart stent can lead to a heart attack.
- Stroke from a blood clot or emboli
- Restenosis.
- Injury to the coronary arteries, such as tear or rupture.
Recovery
You should shower within one or two days after the procedure. A week after a PCI, you can resume moderate-intensity activities. These activities, which include walking, swimming, and riding a stationary bike, are advisable as they can strengthen your heart. However, avoid activities that involve lifting or pulling with the wrist and avoid strenuous exercise or physical tasks such as playing sports and vacuuming. In addition, your doctor may prescribe antithrombotics to lower the risk of blood clots during your recovery. You should adhere to the medications accordingly.
When to see a doctor
If the following symptoms occur after a PCI, seek medical attention immediately:
- Bleeding, discharge, coolness, or numbness at the catheter site.
- Shortness of breath.
- Chest pain.
- Fever or chills.
- Syncope.
- Increased pain in the wrist or groin area.
- Swelling that does not go away.
