Percutaneous Coronary Intervention (PCI), also known as coronary angioplasty with stenting, is a minimally invasive medical procedure used to treat narrowed or blocked coronary arteries in the heart. It is performed by an interventional cardiologist in a catheterization laboratory. PCI restores blood flow to the heart muscle. The procedure involves inserting a thin, flexible catheter into a blood vessel and guiding it to the heart to address the blockage. PCI is a common intervention for managing coronary artery disease, often offering a less invasive alternative to open-heart surgery.
Understanding Coronary Artery Blockages
PCI is necessary due to Coronary Artery Disease (CAD), predominantly caused by atherosclerosis. Atherosclerosis involves the gradual buildup of plaque (fatty material, cholesterol, and other substances) within the coronary artery walls. This accumulation causes the arteries to narrow and harden, significantly limiting oxygen-rich blood reaching the heart muscle. This lack of sufficient blood supply leads to myocardial ischemia and patient symptoms.
Reduced blood flow often presents as stable angina, which is chest pain or discomfort occurring during physical exertion or emotional stress that subsides with rest. If the blockage becomes more severe, symptoms can worsen or occur at rest, known as unstable angina. A complete blockage, usually caused by plaque rupture and blood clot formation, leads to a heart attack (myocardial infarction). In acute cases, the goal is to rapidly clear the obstruction to prevent permanent heart muscle damage.
The decision to perform PCI is based on symptom severity and the degree of narrowing found during diagnostic tests, such as a coronary angiogram. PCI mechanically reopens the artery, alleviating symptoms of inadequate blood flow. Addressing the blockage improves the patient’s quality of life by reducing chest pain and increasing their capacity for physical activity.
Step-by-Step Procedure Overview
The PCI procedure begins with the patient receiving a mild sedative, though they remain awake. A local anesthetic numbs the access site, typically the radial artery in the wrist or the femoral artery in the groin. A sheath, a small hollow tube, is inserted into this access point to provide stable entry into the vascular system.
Through the sheath, a specialized guiding catheter is threaded toward the heart’s coronary arteries. To visualize the blockage location, a contrast dye is injected into the artery, and real-time X-ray imaging (fluoroscopy) is used. This imaging allows the interventional cardiologist to precisely guide a thin, steerable guidewire across the narrowed segment.
Once the guidewire is positioned beyond the blockage, a balloon catheter is advanced over the wire and centered within the narrowed area. The balloon is inflated briefly (typically 10 to 60 seconds), compressing the accumulated plaque against the artery wall. This action, known as balloon angioplasty, widens the vessel’s internal diameter, immediately improving blood flow.
Following angioplasty, a stent—a small, wire-mesh tube mounted on a second balloon—is delivered to the site. The stent is expanded by inflating the balloon, embedding the scaffold into the artery wall. The balloon is then deflated and removed, leaving the permanent stent in place to prevent the artery from collapsing or re-narrowing.
Most modern stents are drug-eluting. This means they are coated with medication that is slowly released into the vessel wall to inhibit the growth of scar tissue and reduce the risk of future blockage.
Recovery and Follow-Up Care
After stent deployment is confirmed, the catheter and sheath are withdrawn, and pressure is applied to the access site to prevent bleeding. Patients are moved to a recovery area for close monitoring of the insertion site and heart rhythm. The hospital stay following an uncomplicated PCI is generally short, often requiring only an overnight observation period before discharge.
Post-PCI care requires adherence to antiplatelet medications, most commonly dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor like clopidogrel. These medications prevent blood clots from forming on the stent, a complication known as stent thrombosis. The duration of DAPT is personalized, often extending for one to twelve months, depending on the patient’s risks of clotting and bleeding.
Upon discharge, patients should avoid strenuous physical activity and heavy lifting for a few days to a week to allow the access site to heal. A prompt return to normal daily routines is encouraged, though activities straining the access point, especially in the groin, should be avoided. Follow-up care includes referrals for cardiac rehabilitation, a structured exercise and education program designed to optimize recovery and promote long-term cardiovascular health. These steps help sustain the benefits of the intervention and minimize the recurrence of coronary artery disease.