Percutaneous Coronary Intervention

Percutaneous coronary intervention (PCI) is a minimally invasive procedure to open blocked or narrowed coronary arteries. Doing this allows more oxygen-rich blood to reach your heart. Another name for PCI is coronary angioplasty with stenting, or angioplasty for short. PCI uses a small balloon to open or widen an artery for better blood flow.

You may need a PCI procedure if you’re a good candidate. A healthcare provider may recommend PCI if you have a buildup of a thick, fatty substance called plaque in your arteries. Plaque that builds up and hardens in your arteries is atherosclerosis, which increases your risk of heart and blood vessel disease.

Your heart doesn’t pump blood efficiently when plaque blocks blood flow through it. You may have coronary artery disease symptoms, like chest pain and shortness of breath, especially when you exert yourself.

Lack of blood flow can also lead to a heart attack. Healthcare providers may use PCI as an emergency treatment for a heart attack. This procedure quickly opens blood vessels when they’re completely blocked. This can help minimize heart damage.

Providers perform more than 2 million PCI procedures worldwide each year. Usually, a healthcare provider places a small, permanent tube (stent) to keep the coronary artery open long term. It’s often a drug-eluting stent that releases medication right into your artery. This reduces the risk of the coronary artery getting narrow again within the stent.

You and your provider will discuss which treatment is best for you. A coronary artery bypass graft (CABG) surgery that reroutes blood around blockages may be a better option. It depends on several factors, like:

• The number and characteristics of the blockages you have
• Other cardiac and noncardiac medical conditions (like diabetes)
• Your heart muscle function and age

What happens during this procedure?

Your healthcare provider will tell you how to prepare for a PCI procedure. You’ll likely need to fast (avoid eating or drinking) for several hours before the surgery.

If you take blood thinners (anticoagulants), you may need to stop taking them for a short time. These medicines can increase bleeding risks during a procedure.

A heart specialist will perform the PCI. You’ll receive a painkiller and a mild sedative (“twilight”) to help you stay calm and relaxed. You’re usually awake, but you can’t feel anything during the procedure.

During a PCI, your provider will:

1. Insert a small hollow tube (sheath) through a blood vessel in your arm, wrist or at the top of your thigh (groin).
2. Guide a small, hollow tube (catheter) through the sheath and to your heart.
3. Inject a contrast dye and use X-rays to view the catheter in real time.
4. Open the blocked artery by inflating a balloon at the end of the catheter, pushing plaque against the artery walls.
5. Place a stent if needed to help keep the coronary artery open.
6. Remove the catheter and close the insertion site with a compression bandage (arm), a small stitch (thigh) or a collagen plug (thigh).

How long does this procedure take?

The procedure usually lasts between 30 minutes and two hours. The exact treatment time depends on several factors, including the extent of plaque buildup and the complexity of the areas that need PCI.

Benefits and risks

Benefits of a percutaneous coronary intervention include:

• Improved symptoms
• Better blood flow in your heart
• Possible lower chances of having another heart attack

Percutaneous coronary intervention is generally a safe procedure with a low risk of complications. But like any heart treatment, PCI has some risks. Serious complications don’t happen often. But it’s common to have some discomfort or bruising where the catheter was. Other risks of a PCI procedure may include:

• Bleeding or infection where the catheter went in
• Blood clots in the heart stent
• Damage to the widened artery
• Re-narrowing in the widened artery
• Abnormal heart rhythm
• Kidney damage
• Heart attack
• Stroke

Percutaneous coronary intervention recovery

Usually, you’ll stay in a recovery area for several hours after a PCI procedure. You may have bruising or soreness where the doctor inserted the catheter. You might return home that day or stay in the hospital overnight. If you have a PCI after a heart attack, your hospital stay will be a few days longer.

You should be able to return to your usual activities within a week after a PCI. To help your wrist or groin heal, avoid heavy lifting during that time. If your job requires physical activity or heavy lifting, you may need to wait longer to return to work.

During recovery from a PCI, your heart specialist may prescribe blood-thinning medicines. These drugs, like clopidogrel (Plavix®), prasugrel (Effient®) or ticagrelor (Brilinta®), lower your risk of blood clots. You may only need to take these for one year. The length of time and exact type of blood thinner will depend on several factors, like your age, bleeding risk and whether you had a routine or emergency PCI. But you’ll probably need to take a low dose of aspirin daily for life.

Follow-ups and rehab

You can expect to have a follow-up visit with a healthcare provider after you go home. If you had a heart attack, your provider may suggest cardiac rehab. This program helps you get the physical activity you need under the watchful eye of a provider.

Other ways to improve your health after PCI include changes like:

• Avoiding tobacco use
• Staying at a weight that’s healthy for you
• Eating heart-healthy foods with low salt and fat
• Getting regular physical activity

When should I call my healthcare provider?

After a PCI procedure, call your healthcare provider right away if you have:

• Bleeding or discharge where the catheter went in
• Chest pain
• Chills or a fever
• Coolness or numbness where the catheter was
• Dizziness or fainting
• Shortness of breath
• Swelling or pain that doesn’t go away