Percutaneous coronary intervention (also known as angioplasty with stent) is a minimally invasive procedure to open clogged heart arteries. A thin tube called a catheter is inserted into an artery and moved into the blocked blood vessel of the heart. Contrast is used to visualize the path of the catheter. The narrowed or blocked artery is then expanded using a balloon. For better results, a stent, which is a small wire mesh tube, may be placed or other medical equipment may be used.
Percutaneous coronary intervention (PCI) is a non-surgical, invasive procedure with a goal to relieve the narrowing or occlusion of the coronary artery and improve blood supply to the ischemic tissue . This is usually achieved by different methods, most common being ballooning of the narrow segment or deployment of a stent to keep the artery open. PCI may be the best option to re-establish blood flow as well as prevent angina (chest pain), myocardial infarctions (heart attacks) and death.
-The purpose of expanding a blocked blood vessel and placing a stent is to allow for better blood flow. The plaque causing the narrowing or blockage is pushed into the walls of the artery. When the blood flow improves, the patient will experience less chest pain and breathe more easily. Furthermore, it is a procedure that produces immediate results, prevents tearing of the blood vessel, reduces the risk of recurrence, and prevents heart attack.
-Can treat multiple narrowed arteries at once
-Can sometimes be done at the same appointment/same time as angiography
-Involves sedation (you will be conscious but feel no pain)
-Recovery time may take up to 1 day.
You will be given an anticoagulant to prevent blood clots. Medications/fluids will be given through intravenous lines. A local anesthetic will be injected to numb the area of your body that is used (the groin, the wrist, or the inside of the elbow). A thin tube with a small, deflated balloon at the tip will be guided into the narrowed or blocked artery. Once the balloon-tipped catheter is at the site of the blockage, the balloon is inflated. This compresses the plaque against the artery wall, widening the blood vessel. In most cases, a stent will be placed to help decrease the chance of the artery narrowing again. The stent stays in place permanently. The procedure will take approximately 60-120 minutes to complete.
To allow for the most effective treatment, the patient’s health and disease must be assessed. The patient’s medical history is also important. The doctor will explain your medical condition, the reason for the procedure, and the risks and benefits of treatment. Other recommendations include: Before the procedure you will undergo a physical examination as well as several laboratory tests. Please let your medical team know if you have any allergies to medication, food, and other substances. Patients who take anticoagulants, such as aspirin, clopidogrel, prasugrel, etc., do not need to stop their medication, but those taking other blood thinners or certain diabetes medication, such as Metformin, will need to speak to the doctor for specific instructions. Fast for at least four hours before the procedure. Avoid drinking alcohol and smoking cigarettes for at least one week. On the day of the procedure, please bring all current medication with you to the hospital. The doctor may prescribe medication to help you relax and to prevent allergies to contrast.
After the procedure, you will be taken to a recovery area for observation and monitoring. If the procedure was done at the groin, it is important to lie flat for several hours to avoid bleeding. Pressure may be placed at the site to prevent bleeding. If the catheter was inserted through the wrist, after the procedure you will be able to get up. A bandage will be placed at the insertion site. Depending on your condition, you will remain in the hospital for one or more days. Ask your health care team when you can shower, return to work, and resume other normal activities. Your puncture site will remain tender for a while. It may be slightly bruised and have a small bump. Your doctor will likely prescribe medications to prevent blood clots. It is important to follow your doctor’s instructions regarding the blood thinning medications. While this procedure will open blocked arteries, it will not cure coronary artery disease. It is up to you to be committed to living a heart-healthy lifestyle. You can make dietary changes, quit smoking, exercise regularly, keep your appointments, and be an active member in your treatment.
Risks that are involved with this procedure include; -Bleeding, infection, and pain at the catheter site -Blood clots causing heart attack or stroke -Re-narrowing of the artery -Damage to blood vessels -Allergic reaction to the dye used -Kidney problems caused by the dye -Fluid around the heart -Arrhythmias (irregular heartbeat) -Death Let your doctor know if you experience any symptoms such as: -Dizziness -Shortness of breath -Nausea -Back Pain -Chest discomfort -Bleeding, new bruising, or swelling at the catheter site -Signs of infection such as redness, drainage, or fever
Are there any travel restrictions pertaining to this procedure?
Before the procedure:
You should plan to stay in Thailand for at least one week through the duration of your treatment. It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure or from the day of the procedure to the day of your follow-up appointment.
After the procedure:
At your follow-up appointment you will undergo a physical examination and your wound will be checked. You will receive documentation regarding your surgery or procedure and all other relevant documentation for traveling. You will receive information about caring for yourself when you return home and be given the document “Discharge Instructions for Percutaneous Transluminal Coronary Angioplasty (PTCA)/Stent.” Please read all information you are given carefully and follow your medical team’s instructions. Keep the injection site at the wrist or groin dry and clean until it is fully healed. Please let the doctor know if you experience redness, swelling, and/or severe pain. If there is bleeding from the injection site, place pressure on the site for at least 10 minutes. If the bleeding doesn’t stop, please talk to your doctor immediately.
When traveling by air, if you are seated in Economy Class, please choose an exit row or bulkhead seat for convenience in getting up and moving around every 15-30 minutes. Flex your ankles regularly to prevent deep vein thrombosis. Please take all medication prescribed by your doctor. Carry the appropriate dosage of mediation in your carry-on luggage when you travel as well as a few extra doses in case of an emergency. Carry the prescription for all your medication to avoid problems at the airport.
What are other alternative procedures to PCI?
Laser angioplasty - The laser angioplasty procedure is similar to angioplasty; however, in this procedure, the catheter has a laser tip that is used to open up the artery. Pulses of light beams then vaporize the build-up of plaque.
Atherectomy - The atherectomy procedure is also similar to angioplasty; however, in this procedure, the catheter includes a shaver at its tip which rotates to cut away plaque.
Coronary Artery Bypass Graft [CABG] - A CABG is the most commonly performed but most invasive procedure available for treating patients with an obstructed coronary artery. The procedure involves bypassing the blocked part of the artery by attaching a segment of a blood vessel, or graft, that has been obtained from another part of the body to the coronary artery, either on the blocked or narrowed side of the artery. This can permanently restore blood flow by redirecting the blood around the blockage and through the newly placed graft. CABG is an open-heart surgery and therefore requires the surgeon to make a large incision in the middle or side of the chest to expose the heart. This procedure can take up to six hours and patients need to stay in the hospital for at least three days to recover once the CABG has been completed. Patient recovery time is around 4 to 6 weeks and most people can return to work within one or two months of the surgery.
Cardiomyoplasty - A cardiomyoplasty is an experimental procedure that involves the use of skeletal muscles that have been taken from the abdomen or back. These muscles are then wrapped around the heart to provide extra muscle that is stimulated by a device to boost the organ’s pumping motion. Heart transplant - In a heart transplant, the diseased and irreversibly damaged heart is removed and replaced with a donated healthy heart.
Port-access coronary artery bypass - A port-access coronary artery bypass procedure is an alternative to CABG and requires only small incisions or “ports” to be made in the chest. Through these ports, instruments are passed to perform the bypass. The heart is stopped during the procedure and an oxygenator or “heart-lung” machine is used to pump blood. Arteries from the chest or veins from the leg are used to bypass the obstructed artery.
What are some common types of stents used?
Currently, stents are implanted in nearly all patients undergoing PCI because the stent gives various advantages over simple balloon dilatation. The two main types are: 1. Bare metal stent (BMS) - usually stainless steel. 2. Drug-eluting stent (DES) - metal struts are coated with a growth-inhibiting agent that inhibits smooth muscle cell proliferation. This reduces the frequency of restenosis (by about 50%). However, it also slows the process of re-endothelialisation, thus prolonging the risk of stent thrombosis.