Percutaneous Coronary Intervention

 

What is Percutaneous Coronary Intervention (also known as Coronary Angiogplasty)?

Coronary Angioplasty is a procedure which aims to dilate narrowed coronary arteries using a balloon. It was first started in 1977 by Andreas Gountzeg.


How it is performed?

It is performed using special catheters and a soft tipped, thin, wire. The wire is made to pass the narrowed site, after which a small balloon is placed inside the narrowed area in the artery. Upon balloon expansion the lumen, or the arterial narrowing widens. To prevent renarrowing or blockage, a stent (metallic scaffold) is inserted in the site that was previously occluded.





What is a stent?

It is a small, narrow, metal (mesh) tube which is inserted in the artery in order to keep it open after balloon angioplasty.


What are the indications of the procedure?

- Myocardial infarct (Heart attack) due to blockage of coronary arteries (vessels of the heart muscle).
- When a patient has chest pain, shortness of breath, fatigue etc… as a result of disease of the coronary arteries, where the condition worsens despite drug treatments.


What are the risks of the procedure?

- The procedure is relatively safe and the risks of the procedure vary from patient to patient, depending on the patient condition and type of coronary artery disease.
- Death 1-2 in 100
- Heart attack 4-5 in 1000.
- Stroke- 1 in 1000
- Need of emergency bypass surgery 4-5 in 1000
- Bleeding 1 in 20
- Heart beat disturbance 1 in 100
- Re blockage and narrowing <5 to 10-15 in 100
- Heart failure
- Coronary artery perforation
- Kidney failure
- Swelling at arterial puncture site 1 in 20
- Contrast allergy
- Major bruising around the site of puncture - usually resolves in 2-3wks.


Preparations leading to the to the procedure

  • Investigations:
    - Electrocardiogram (ECG)
    - Chest X-ray
    - Blood tests
    - Echocardiography and exercise ECG as needed
  • Anticoagulants drugs (e.g. Warfarin) or Metformin (for diabetes) need to be stopped but drugs like ASA alone or with Plavix should proceed
  • 4-6 hours fasting
  • Due to the risk of exposing the fetus to radiation, the procedure is not performed during pregnancy. Due to this female patients are required to report the period and duration of the lastmenstrual period.


    After the procedure

    - The catheter and wires are removed from the arteries - leaving the stent inside the, previously occluded, artery.
    - Puncture site haemostasis is secured using various devices.
    - Blood pressure, heart rate and puncture site for bleeding are strictly monitored.
    - 2-4hrs bed rest may be needed.
    - Light dressing will be applied to the puncture site.
    - The patient is to apply pressure their fingers over the puncture site when coughing, or straining.
    - The patient is to report to health personnel if they experience any chest pain or notice any bleeding over the puncture site.
    - TThe patient is to be hydrated.


    Follow Up

    - Patients are, usually, discharged after a days rest in the hospital
    - The patients are to continue taking prescribed drugs, especially ASA and Plavix, regularly; as a discontinuation can result in fatal blockage of the stented site.
    - The patient is allowed to take shower after 1-2 days but heavy activity like climbing stairs or exercise is adviced against fin the first few days.
    - The patient should be cautious and immediately report if any swelling or infection can be observed on the puncture site. - Avoid elective surgery for the 1st 1-2 months after PCI.
    - Patients are always briefed with instructions and the treatment plan before being discharged.

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