What is Percutaneous Coronary Intervention (PCI) – Coronary Stenting Procedure?
Percutaneous Coronary Intervention (PCI), also known as coronary angioplasty, coronary stent placement or balloon angioplasty, is a minimally invasive procedure used to open narrowed or blocked coronary arteries. These arteries supply oxygen-rich blood to the heart, and when they become narrowed due to a buildup of plaque (atherosclerosis), it can lead to chest pain (angina), shortness of breath, or even a heart attack.
PCI involves inserting a thin catheter with a small balloon at its tip into the blocked artery. The balloon is then inflated to push the fatty deposit against the artery walls, restoring normal blood flow. In most cases, a small metal mesh tube called a coronary stent also placed to keep the artery open and reduce the risk of it narrowing again.
Why do patients need PCI – Coronary stents?
Dr Amin may recommend PCI if you have:
• Angina (chest pain) that does not improve with medication
• Significant narrowing of the coronary arteries seen on a diagnostic angiogram
• A heart attack, where a blocked artery needs to be quickly opened to restore blood flow
• Shortness of breath or other symptoms of reduced blood supply to the heart
• High risk plaque disease identified on noninvasive tests particularly CT coronary angiogram
PCI (Coronary stent placement) is often preferred over open-heart surgery (coronary artery bypass grafting, CABG) for many patients because it is less invasive, has a shorter recovery time, and is highly effective in relieving symptoms. There are certain cases however who would benefit from CABG rather than stenting procedure. This depends on the complexity of disease and associated medical condition particularly diabetes mellitus.
Preparing for the procedure
Before undergoing PCI, Dr Amin will provide you with detailed instructions. Some general preparations include:
• Consenting: Dr Amin will provide you a detailed discussion regarding the procedure steps, benefits and risks of the procedure. This can be done in a face to face consultation or over the phone if you have been referred for the procedure. You will need to sign a formal consent form on the day before attempting the procedure. If you have any questions, Dr Amin would be happy to discuss at any point before the day.
• Fasting: This is not indicated in most of cases unless there would be an indication for deep sedation or anaesthetics requirements. You may need to stop eating and drinking for a few hours before the procedure.
• Medications: Inform Dr Amin about all medications you are taking, especially blood thinners, diabetes medications, or any drugs that affect kidney function. Dr Amin might give you instructions to stop some medications particularly strong blood thinners such as Apixaban, Rivaroxaban or Edoxaban only on the day of the procedures. If you are diabetic, metformin might need to be stopped in certain cases.
• Allergies: If you have allergies to iodine, shellfish, or contrast dye, let your doctor know.
• Kidney Function: Since the contrast dye is filtered through the kidneys, patients with kidney disease may need additional precautions. Dr Amin or the admin team at the Great Western Hospitals Private Healthcare in Swindon might arrange for kidney function test ahead of the procedure. If the procedure is arranged at a short notice, bloods can be taken on the day.
What happens during the procedure?
PCI is performed in a specialized room called a catheterization laboratory (cath lab). The procedure typically takes 30 minutes to an hour, although it may take longer in complex cases.
You will be asked to attend the Cardiac Cath Lab suite at the Great Western Hospital in Swindon early on the day usually 08:00. You will be met by our friendly nursing team who will guide you regarding preparation and will fill in a questionnaire for the procedure including medical history and medications. A cannula will be inserted in one of your veins in case you need medications to be given.
Dr Amin will meet you to discuss if you have any questions and to go briefly through the details of the procedure for recap. You will be asked to sign a consent form if you have not done earlier. There would be an opportunity to discuss any concerns and ask questions regarding the procedure and possible outcomes.
1. Preparation and Catheter Insertion
• You will be given a mild sedative to help you relax.
• A local anesthetic is applied to numb the area where the catheter will be inserted, usually the wrist (radial artery) or groin (femoral artery) in some cases.
• A small incision is made, and a thin, flexible tube (catheter) is guided through the blood vessels to the blocked coronary artery.
2. Balloon Inflation and Stent Placement
• A contrast dye is injected to highlight the blockage on X-ray imaging.
• A tiny balloon at the tip of the catheter is inflated to widen the narrowed artery.
• In most cases, a stent is placed to keep the artery open. The stent remains in place permanently, while the balloon is deflated and removed.
3. Completion of the Procedure
• Once blood flow is restored, the catheter is carefully removed.
• Pressure is applied to the insertion site to prevent bleeding. A small closure device or bandage is usually used.
What happens after the procedure?
Immediate Recovery
• You will be provided with a detailed Coronary Angiogram and PCI report which includes the details of your coronary anatomy, medications and equipments used as well as the contrast volume and radiation dose. The report will also include the conclusions and recommendations for management plan. Some reports will include captured images for your coronary vessels and stents placed.
• You will be monitored in a recovery area for a few hours to check for complications.
• If the catheter was inserted through the wrist, you may be able to sit up sooner. If the groin was used, you may need to lie flat for a while.
• You may be advised to drink fluids to help flush the contrast dye from your system.
Going Home and Recovery
• Most patients can go home the same day or the next day, depending on their condition.
• You should avoid strenuous activities, heavy lifting, and driving for a few days.
• It is normal to experience some bruising or mild discomfort at the catheter insertion site. If you notice excessive bleeding, swelling, or severe pain at the puncture site, contact Dr Amin immediately via the provided contact number. You may be asked to come back for checking by the Cath Lab team.
Long-Term Care and Medications
• Blood Thinners: You will need to take antiplatelet medications (such as aspirin and clopidogrel or ticagrelor) to prevent blood clots from forming inside the stent. Duration of anti platelet regimen will be determined by Dr Amin after the procedure.
• Lifestyle Changes: A healthy diet, regular exercise, smoking cessation, and stress management are crucial for preventing further heart disease.
• Follow-Up Appointments: Dr Amin will monitor your recovery and check for any signs of restenosis (re-narrowing of the artery).
What are the benefits of PCI – Coronary stenting procedure?
• Relieves chest pain (angina) and improves quality of life
• Restores normal blood flow to the heart
• Minimally invasive, with a shorter hospital stay and faster recovery compared to open-heart surgery
• Can be life-saving in the case of a heart attack
What are the risks of the procedure?
While PCI is a safe and effective procedure, it does carry some risks, including:
• Bleeding or bruising at the catheter insertion site. The risk is higher if the groin access is used rather than the forearm.
• Allergic reaction to the contrast dye. This is rare complication and previous allergy to contrast should be notified before the procedure. If allergy is known, Dr Amin may still go ahead with the necessary precautions including administration of some medications to mitigate the risk.
• Blood vessel damage during catheter insertion
• Irregular heart rhythms (arrhythmias)
• Re-narrowing of the artery (restenosis), which may require another procedure
• Rare complications such as heart attack, stroke, or kidney problems
Death is a very rare scenario in diagnostic coronary angiography and the quoted risk is almost 1 in 4000 cases.
Dr Amin will discuss these risks with you and take steps to minimize them.
How effective is PCI procedure?
PCI is highly effective in relieving symptoms and restoring blood flow. However, it does not cure coronary artery disease. Without lifestyle changes and proper medical management, new blockages can develop over time.
Studies show that:
• Stents significantly reduce the chance of restenosis, especially modern drug-eluting stents.
• Patients who maintain a healthy lifestyle and take prescribed medications have the best long-term outcomes.
• In some cases, bypass surgery (CABG) may be a better option for patients with multiple blockages or more complex heart disease.
Conclusion
Percutaneous Coronary Angioplasty (PCI) is a safe, effective, and minimally invasive procedure for treating coronary artery disease. It provides immediate relief from symptoms, improves quality of life, and reduces the risk of serious heart events.
If you have been advised to undergo PCI, it is important to follow Dr Amin’s recommendations and commit to heart-healthy habits for long-term success.
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