Percutaneous coronary intervention is an interventional procedure, used to open up narrowed segments of coronary arteries in cases of Coronary artery disease (CAD). These segments are stenosed due to the accumulation of cholesterol laden plaques, resulting in atherosclerosis. Percutaneous coronary intervention can be performed to reduce or eliminate the symptoms of coronary artery disease (CAD), including chest pain, shortness of breath on exertion, and heart failure. PCI is also used to abort an acute myocardial infarction (Heart attack). PCI is less invasive than coronary artery bypass surgery (CABG).
PCI is used for different procedures such as balloon angioplasty, implantation of stent, Laser artherectomy, brachytherapy(Use of radioactive source to inhibit restenosis).
- Patient is prepared and brought to the procedure room.
- Local anesthesia is provide at the site of insertion of the catheter (a slender balloon-tipped tube).
- PCI is performed by threading the guide wire – a long, flexible, soft plastic tube, which allows for radiopaque dyes (usually iodine based) to be injected into the coronary artery, so that the disease state and location can be readily assessed using real time x-ray visualization, from femoral artery in the groin to a trouble spot in an artery of the heart, under radiographic guidance.
- While visualizing again by real-time x-ray imaging, the cardiologist guides the wire through the coronary artery to the site of the stenosis or blockage. The tip of the wire is then passed across the blockage
- The balloon catheter is threaded through the guide wire to reach the spot. This is referred to as Percutaneous transluminal coronary angioplasty (PTCA), coronary artery balloon dilation or balloon angioplasty. The balloon is then inflated, compressing the plaque and widening the narrowed coronary artery so that blood can flow more easily. This is often accompanied by inserting an expandable metal stent. Stents are wire mesh tubes used to prop open arteries after PTCA. These can either be a bare metal stent or a drug eluting stent.
- The catheter is withdrawn, the same way it was advanced.
- Incision is sutured.
During the procedure the patient is awake and may feel chest discomfort indicating ischemia. More serious risks such as heart attack, stroke or dissection may occur during the procedure. Less than 2 percent mortality is reported during the procedure.