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 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?
In the catheterisation laboratory a drip is placed and the wrist or groin is numbed with local anaesthetic. 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.
What to expect afterwards
If the wrist was used, a tight band is left on for a hours and if the groin was used you lie flat for at least an hour. Most planned patients go home the next morning, while patients treated for a heart attack stay longer.
Possible complications
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 common 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.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.