What is Percutaneous Coronary Intervention?

Percutaneous Coronary Intervention (PCI) is a general term used to describe a variety of procedures used to open arteries in the heart which have become narrowed. The blockages can be caused by atherosclerosis (the buildup of fatty plaques), calcium, blood clot (as is the case in a heart attack), or from restenosis (a type of scar tissue in the artery). PCI can include balloon angioplasty, laser atherectomy, rotational atherectomy, thrombolysis, and thrombectomy as well as stenting (either with a bare metal or drug-eluting stent). Sometimes intravascular ultrasound (IVUS) is used to see the inside of the artery (like a camera) to obtain more information about the blockages. The goal of PCI is to restore blood flow to the heart muscle, improving the strength of the heart and alleviate or decrease chest pain, shortness of breath, and improve activity tolerance.

How the test is performed:
Prior to the procedure, lab work and an ECG may be performed. You will have an intravenous needle (IV) placed in your arm or hand. You will be placed flat on the catheterization table. The nurse or technician will shave and wash your groin (or arm) to reduce the risk of infection. You will receive some medication to help you relax, but you will not be given general anesthesia. Your vital signs will be monitored throughout the procedures. A local anesthetic (numbing medicine) will be injected where the sheath (a short tube) will be inserted. You may feel a brief burning or stinging sensation during the injection, but then you should not have any further pain. Medication to prevent a blood clot from forming in the procedure will be given (anticoagulation).The doctor will then place a catheter (a long, narrow tube) through the sheath and into the arteries being treated. Once the catheter is in place, contrast (x-ray dye) is injected and x-rays are taken as the contrast passes through the arteries. This helps the doctor to see the blockage. Tiny devices such as balloons, lasers, rotational atherectomy burrs, thrombectomy catheters, IVUS catheters, and/or stents are used to open the stenosed (blocked) arteries. Your doctor will determine which devices are best for your particular condition.

How to prepare for the test:
High-risk patients (e.g., those with unstable angina, diabetes, kidney disease) may be admitted to the hospital the night before the procedure to receive intravenous hydration and a steroid to lower the risk for complications. Do not eat or drink anything 4 hour before the procedure. You may take your medications, with a small sip of water. Do not take your insulin or other diabetic medications prior to the procedure. Please take all of your medications to the hospital with you, or an exact list of the medications, doses, and times you take them. Please be certain to tell us if you have any allergies to drugs or to contrast (x-ray dye). The PCI can take 30 minutes to a couple of hours, depending on the number and type of blockages being treated. Please have your family remain in the waiting room during the procedure. Be aware that the hospital and your doctor provide care for emergency situations. Although we make every effort to perform your procedure on time, it is possible that some delays may occur.

How the test will feel:
You will be awake and able to follow instructions during the coronary intervention.

You may feel some discomfort at the site where the IV is placed. Local anesthesia will be used to numb the site, so the only sensation should be one of pressure at the site. You may experience some discomfort from having to remain still for a long time.

Once the procedure is completed, the sheath is removed by a nurse or technician. Pressure is applied to the puncture site, usually in the right groin. Patients should not drive for 2 days, and should not lift anything more than 10 pounds for 5 days after the procedure. Call your doctor for any pain, swelling, bleeding, or fever post-procedure.