Percutaneous coronary intervention

Percutaneous coronary intervention

Overview

Coronary Angioplasty, also called Percutaneous Coronary Intervention (PCI), is the non-surgical procedure where narrowing of the coronary arteries caused by cholesterol plaques are removed. First coronary angioplasty was performed by German cardiologist, Andreas Gruentzig in 1977. It was the giant invention of this century, which continuously evolved and helped save billions of hearts.  The beauty of coronary angioplasty is that the whole procedure is performed in local Anaesthesia.

Initially, only balloons were used to open the blockages. Recoil and spontaneous closure was the issue with the balloon angioplasty leading to only 50 % success rate. Scientist invented special mesh-like structure called a stent to keep the artery open. Though this has helped, patients still had 30 % restenosis risk.   Restenosis is re-narrowing of artery or valve after corrective surgery. Drug-eluting stents, which release drugs reducing the restenosis rate to less than 5%,  is the game changer in present-day angioplasty.  Currently, coronary intervention always comes with a stent, and mostly it is drug-eluting stents.

Angioplasty improves symptoms of blocked arteries that include shortness of breath and chest pain. Angioplasty can also be performed during a heart attack too to open a blocked artery quickly and reduce the damage to your heart.

Why is Angioplasty done?

Angioplasty is used to treat atherosclerosis, a type of heart disease where fatty plaques are built-up gradually in the blood vessels of your heart. Your doctor may suggest angioplasty if you have a heart attack or angina (worsening chest pain) or when lifestyle changes and medications cannot improve your heart’s health or any other symptoms.

What will happen before Angioplasty

Before the scheduled angioplasty procedure, your doctor will examine you physically and will also review your medical history. Whether your angioplasty is an emergency or is pre-scheduled,, you are likely to undergo some routine tests first, such as blood tests, chest X-ray and electrocardiogram. You will also undergo a coronary angiogram, an imaging test, to check if your blockages can be treated with coronary angioplasty.

A coronary angiogram is a test where a dye is injected through a catheter (a long, thin tube) into the arteries of your heart. The catheter is inserted through an artery from your arm, wrist or groin (more commonly used) to arteries in your heart. An angiogram helps determine if your arteries to the heart are blocked or narrowed.

If a blockage is found during a coronary angiogram, your doctor may choose to perform angioplasty and stenting right away after your angiogram while the artery of your heart is still catheterized.

You will also receive instructions about drinking or eating before angioplasty. Your doctor will generally ask you to stop drinking or eating six to eight hours before the angioplasty is scheduled. If you are already staying at the hospital before the procedure, your preparation will be different.

What Happens During Angioplasty

Angioplasty is performed by a cardiologist, a heart specialist along with a team of trained cardiovascular nurses and technicians in a cardiac catheterization laboratory (often referred to as Cath Lab), a special operating room for such procedures.

Very small incisions are made in the skin on a blood vessel in the wrist, arm or leg and a catheter (small, thin tube) is inserted to perform angioplasty. Initially, small plastic tubes are inserted either in the hand or leg artery. A special catheter is taken and directed towards the coronary arteries. The procedure may go on for several hours, depending on a number of blockages, difficulty or any other complications that may arise. First, wires are used to cross the blockage; then balloons are used to dilate the lesion and finally, stents are used for long term results.

What are the risks?

Although coronary angioplasty is a minimally invasive surgery (using very small incisions) way to open blocked arteries compared to bypass surgery, the procedure, however, carries certain risks.

Common angioplasty risks include:

• Restenosis, re-narrowing of your artery (stents were developed to decrease restenosis);
• Bleeding in your arm or leg where the catheter was inserted. While it is usually a bruise, sometimes there could be serious bleeding which may require medical intervention immediately
• Blood clots, which can form within stents despite the procedure

There are other risks, though rare, associated with angioplasty. These include heart attack, stroke, kidney problems, abnormal heart rhythms, and Coronary artery damage.

Conclusion

Coronary angioplasty by removing blockages helps patients to reduce their symptoms, help to reduce risk of heart attacks. Due to its non-surgical nature, it is useful for old age patients and can be used to avoid surgery in high-risk patients. Primary angioplasty and emergency angioplasty is done in an acute heart attack to help reduce morbidity and mortality associated with heart attacks.  Lack of vascular accesses is the only contra-indication for this procedure.

Angioplasty and stenting do not guarantee that your heart disease is gone forever. You have to continue with healthy lifestyle habits and take your medicine regularly as prescribed by your doctor.

To have a heart-healthy life after angioplasty, you have to exercise regularly, quit smoking, maintain a healthy weight, lower cholesterol levels and control high blood pressure and diabetes. In addition, get a periodic heart healthy checkup or avail aHeart Healthy package offered by any local healthcare provider.