What is a percutaneous coronary intervention?
A percutaneous coronary intervention, usually called PCI or simply angioplasty and stenting, is the treatment of a narrowed or blocked coronary artery from the inside, through a small puncture in the wrist or groin, without opening the chest. A balloon is used to open the narrowing and in almost all cases a stent, a small metal mesh tube coated with medication, is left behind to hold the artery open and keep it from closing again.
Why is it done?
PCI is done for two main reasons: to save heart muscle and life during a heart attack, when the blocked artery must be opened as quickly as possible, and to relieve chest pain or breathlessness caused by a significant narrowing when medication alone is not enough. It treats the narrowing that is causing trouble, but it does not cure the underlying disease, so tablets, exercise, stopping smoking and control of cholesterol, blood pressure and diabetes remain essential.
What happens on the day?
You will be asked not to eat for a few hours and will be told which medications to take; usually you receive antiplatelet tablets beforehand. In the catheterisation laboratory a drip is placed, the wrist or groin is numbed with local anaesthetic and you stay awake but relaxed. A catheter is guided to the heart and dye is injected to show the artery. A fine wire is passed across the narrowing, a balloon is inflated for a few seconds, which may cause brief chest discomfort, and a stent is then positioned and expanded. Extra tools such as intravascular ultrasound, pressure wires or lithotripsy may be used to guide and prepare the treatment. A straightforward case takes about forty-five to ninety minutes.
What to expect afterwards
If the wrist was used, a tight band is left on for a few hours and you can walk soon afterwards; if the groin was used you lie flat for several hours. Most planned patients go home the next morning, while patients treated for a heart attack stay longer. Bruising at the puncture site is normal, and you should avoid heavy lifting and strenuous exercise for about a week. You will be given dual antiplatelet therapy, usually aspirin with a second tablet, and you must not stop these without speaking to your cardiologist, as stopping early can cause the stent to clot suddenly. Most people can drive after about a week and return to work within one to two weeks, and cardiac rehabilitation is strongly encouraged. Report any return of chest pain immediately.
Possible complications
PCI is performed many thousands of times a day worldwide and is generally safe, but it is a procedure on the heart. Common and minor: bruising, bleeding or tenderness at the puncture site, and brief chest discomfort during balloon inflation. Less common: significant bleeding, damage to the artery, an allergic reaction to the dye, or temporary strain on the kidneys. Uncommon but serious: heart attack during the procedure, a tear or perforation of the artery, a dangerous rhythm disturbance, stroke, the need for emergency bypass surgery, or death; these occur in well under one percent of planned cases but are more likely in emergencies and in very unwell patients. In the longer term the stent can narrow again or, rarely, clot, which is why the antiplatelet tablets matter so much. Your cardiologist will discuss your own risk profile with you beforehand.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.