Percutaneous coronary intervention (PCI) is a useful procedure for treating some forms of heart disease.

It is a minimally invasive technique that doctors use to remove blockages in arteries and widen narrowed arteries.

This article discusses what to expect during a PCI, the risks, benefits, results, and more.

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PCI is a surgical procedure that widens narrowed arteries and improves blood supply. A doctor may perform the procedure using several different methods.

The most common method of PCI involves inflating a balloon in the narrowed portion of the artery. It may also involve using a small piece of mesh tubing called a stent to keep the artery open.

Doctors use PCI to treat heart conditions where one or more coronary arteries develop a narrowing or blockage. These conditions include:

  • Coronary artery disease (CAD): CAD is a condition where a fatty substance called plaque builds up against the artery walls, causing them to narrow or harden.
  • Acute coronary syndrome: Acute coronary syndrome is a group of conditions that cause blood flow to the heart to become suddenly interrupted. This includes heart attacks and unstable angina, but sometimes a doctor will treat these with medication or a different procedure.
  • Angina: According to the American Heart Association (AHA), angina refers to a type of chest pain due to a lack of blood flow to the heart. It is not a disease or condition but a symptom of another condition, generally CAD.

Doctors may use PCI to treat people with new or unchanging symptoms. They may also use the procedure to treat individuals during a heart attack.

Doctors generally perform PCI in a cardiac catheterization laboratory.

During the procedure, a healthcare professional inserts a small plastic tube into a blood vessel in the wrist or groin. Most more experienced doctors will insert the tube through the wrist to reduce the risk of bleeding at the site.

The doctor will then insert a smaller tube, known as a catheter, through this first tube and guide it to the heart. Live X-ray images allow them to guide the tube as they move it through the blood vessels to the affected artery.

Once they place the catheter into the affected artery, they will inject a contrast dye into the artery. The contrast dye will help highlight the areas where the artery narrows or becomes blocked on the imaging. This allows them to use a tool to remove the blockage or open up the narrow part of the artery.

After this, the doctor may insert another smaller catheter attached to a deflated balloon and position it in the affected part of the artery.

Once in position, they will inflate the balloon to open the artery so that blood can reach the heart. If a person has a particularly tough blockage, the doctor may use a small drill to break up the plaque.

Sometimes, they will also insert a small mesh tube known as a stent into the affected area of the artery. The stent will stay in place after the procedure to hold the artery open and help prevent or slow narrowing.

Not everyone may be a suitable candidate for PCI.

Current guidelines indicate suitable candidates for the procedure include people with:

  • acute coronary syndrome
  • stable ischemic heart disease (SIHD) and a stress test that suggests a blockage.
  • people with SIHD and noncomplex stenosis of the left main coronary artery who are not candidates for coronary artery bypass surgery
  • people with SIHD and coronary stenosis greater than 70% or fractional flow reserve (FFR) less than 0.8 with disruptive angina

FFR is a diagnostic test to measure the pressure of blood in the coronary artery.

Other people with SIHD that do not fall into these categories should aim to treat their heart disease with medical and lifestyle interventions.

Complications of PCI can include:

  • coronary artery or aortic injury
  • bleeding at the access site
  • infection
  • kidney injury or failure from the contrast dye
  • stroke
  • heart attack

Complications are more likely to occur in the following groups of people:

  • those over 65 years of age
  • females
  • those with kidney disease or diabetes
  • people with systolic heart disease or severe coronary disease
  • people with a lower body mass index

A PCI can improve outcomes for people with CAD and other types of cardiac disease. The overall PCI complication rate is 4.5% in those who have not had an ST-segment elevation myocardial infarction, a type of serious heart attack.

After a PCI, a person needs to rest and avoid strenuous activities for about a week. At this time, a doctor may clear them to resume activities and encourage exercise. They may also recommend a cardiac rehabilitation program or special exercise plan that aims to strengthen the heart muscle.

Before the procedure, a medical professional may prepare the access area by removing some of the individual’s hair and cleaning the site of the operation. They will then place electrodes on the person to monitor them.

A member of the surgical team will place an intravenous line to deliver medication, including the sedative they will administer to help the person relax. During most PCIs, doctors provide sedative and local pain relief but do not put an individual to sleep.

Below is what occurs during the procedure:

  1. A person will lie on their back on the table. A medical professional will inject them with a local anesthetic at the catheter insertion site.
  2. The doctor will then work the catheter through the blood vessels to the blockage and inject the contrast dye to allow them to see the narrowed area. They will then open the blockage using one of the methods above.
  3. After the doctor opens the blockage, they will withdraw the catheter. A medical professional will apply pressure to the insertion site to stop the bleeding.
  4. If the doctor inserts the catheter through the groin, the person needs to remain flat on their back with their leg straight. If the doctor inserts the catheter through the wrist, the individual should keep their arm elevated and straight.
  5. After the procedure, a person will spend time in the recovery room for observation. During this time, they may experience mild pain. After several hours, doctors may discharge people who had the procedure on an elective basis.

Data indicates a person who had the procedure done urgently, emergently, or as a salvage procedure will then move to another hospital room for observation or become discharged to go home. If doctors discharge someone on the same day as the procedure, they will need another individual to drive them home.

A doctor will perform a PCI on a person with certain types of heart disease. The procedure involves threading a special tool through the blood vessels using X-ray guidance until it reaches the blockage.

Once it reaches the blockage, a doctor will widen the artery and may use a balloon or a stent.

After a PCI, a person will need time to recover before resuming regular, more strenuous activities, including a potential cardiac rehabilitation plan.