PCI - Stenting

 

Percutaneous Coronary intervention (PCI) is a procedure that opens narrowed or blocked arteries, using balloons and small metal scaffolds (known as stents) to help keep the artery open.

What is Percutaneous Coronary Intervention (PCI)?

Percutaneous coronary intervention (often referred to as balloon angioplasty or stenting) is a procedure that is performed after a coronary angiogram when a narrowed or blocked heart vessel is found.

Why has my cardiologist recommended Percutaneous Coronary Intervention (PCI)?

Coronary artery disease is a common form of heart disease that occurs when a fatty substance called plaque builds up in the blood vessels that supply your heart with oxygen. The build-up of plaque happens slowly over time, causing the vessels to become narrowed or in severe cases blocked. The narrowing or blocking of your arteries reduces the amount of oxygen that can reach your heart muscles leading you to experience symptoms of coronary artery disease (usually chest pain or shortness of breath).

Patients who are experiencing chest pain or shortness of breath during exercise will often have a coronary angiogram as part of their diagnostic work-up. If the angiogram shows that you have a narrowed artery or arteries then the next step is often to perform PCI to open the artery up, allowing blood flow to increase thereby increasing the amount of oxygen that can reach your heart muscle.

What are the risks associated with a Percutaneous Coronary Intervention?

A PCI or stenting is a safe procedure, but as with all procedures there are some risks associated.

You may experience bruising or swelling at the puncture site used by your cardiologist to access your blood vessel.

Uncommonly a PCI may be associated with:

  • Allergic reaction to the X-ray dye and medications given during the procedure.
  • Re-narrowing of the coronary artery, known as restenosis – your cardiologists will discuss lifestyle and medication requirements to reduce this risk.
  • Blood clots inside the stent, known as thrombosis – Your cardiologist will prescribe some medications to reduce this risk.
  • Bleeding from the artery used to perform the procedure or in rare cases, from the coronary artery.
  • Abnormal heart rhythms, called arrhythmias.
  • Injury to the artery.
  • Reduced kidney function.
  • Heart attack or stroke.
  • Emergency heart surgery.
  • Death from this procedure is rare.

Your individual risks will be discussed by your cardiologist before the procedure. They will depend on your age, your other medical conditions and other factors.

What should I expect when undergoing a Percutaneous Coronary Intervention?

 

Before

You will need to have bloods taken before you have your coronary angiogram to check how well your kidneys are functioning.

Your cardiologist may request that you stop taking some of your medications before the procedure, especially blood thinners or SGLT2 inhibitors used to treat diabetes and heart failure. Instructions for this will supplied to you in writing.

We would also request you remove all jewellery before the angiogram.

During

At SouthWest Cardiovascular your PCI will be performed by a cardiologist who is highly trained in performing this procedure and has undergone additional specialist training in this field. For your convenience, all of our procedures take place at St John of God in Bunbury. The procedure takes place in a specially designed cardiac procedure room. You will be awake for the procedure, but our team will give you a medication to help you feel relaxed (a sedative) and inject the puncture site in the wrist or groin with a local anaesthetic to numb the area.

Your cardiologist will then:

  • Make a small puncture in either your wrist or groin and gently insert a cardiac catheter, a thin plastic tube.

  • Slowly move the catheter up to blood vessel to your heart.

  • Inject a small amount of X-ray dye into the coronary arteries.

  • Take X-rays as the dye moves through the blood vessels on the surface of your heart, this shows areas that have become narrowed or blocked.

  • Insert a catheter with a small balloon into the narrowed or blocked area, your cardiologist will inflate and deflate the balloon a few times. This may feel slightly uncomfortable.

  • Insert a stent, using the balloon to open the wire mesh of the stent device in the narrowed or blocked artery, keeping it open and increasing the flow of blood.

  • Deflate the balloon and remove the catheter.

You should expect the procedure to take less than an hour.

After

Following your PCI or stenting you will be moved to the recovery area or the cardiology ward to rest. You may feel a little tender at the site of the catheter insertion and have some temporary bruising.

It is usual to stay with us for approximately 4 hours post-procedure.

You will not be able to drive for the following 24 hours so it is advisable that you arrange to be collected by family or friends from St John of God Bunbury.

You will need to take two blood thinners (aspirin and another blood thinner, usually either ticagrelor or clopidogrel) for a period of time afterwards (to be advised by the cardiologist but usually 1 – 12 months).

A follow up appointment with your cardiologist will be scheduled where long term management and lifestyle advice will be discussed. Coronary artery disease is a chronic condition that requires both a treatment plan and for you to follow some healthy heart advice.