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A percutaneous coronary intervention is a procedure to help repair parts of the heart. This lesson will discuss how a percutaneous coronary intervention is done and how the patient is managed.

Heart Attack

Mary is a seventy-year-old woman who is having severe left sided chest pain that radiates down her arm.

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She is short of breath and sweating. She arrives at the emergency room by ambulance and is immediately assessed. Mary is having a ST elevated segment myocardial infarction (STEMI).

In order to make sure that the muscles in her heart are getting enough oxygen and blood she needs to have an emergency interventional cardiac catheterization. The doctor begins explaining the procedure to Mary.

Percutaneous Coronary Intervention

A percutaneous coronary intervention (PCI) is also called an angioplasty. It is done to improve the heart’s blood flow either during or after a heart attack, or to relieve symptoms of coronary artery disease. PCI is done during a cardiac catheterization.

A cardiac catheterization is a procedure where a catheter is inserted into a large blood vessel of the arm or groin and threaded to the heart. This allows the doctor to view the inside of the heart and determine the severity of damage to the arteries in the heart. The procedure for a cardiac catheterization with PCI includes:

  1. An intravenous catheter is placed in the arm in order to administer a sedative.

    The patient will remain awake but relaxed during the catheterization.

  2. The groin or arm is numbed before the catheter is inserted into the blood vessel. It is channeled through the blood vessel to the heart.
  3. A dye is injected into the catheter and an image of the heart is seen on a monitor by using an x-ray. The dye injected into the catheter allows the doctor to see any blockages in the heart’s arteries.
  4. Once the blockage is identified, a second catheter is inserted and guided to the heart.

    This catheter has a balloon at the tip.

  5. The balloon is inflated in the blocked artery to widen it and increase blood flow. Once the balloon is inflated a stent is usually placed as well which helps the artery remain open. A stent is a metal mesh cylinder shaped tube that expands the artery walls and allows blood to flow through it.

  6. Once the PCI and/or stent is completed the catheters are removed from the blood vessel.
  7. A pressure bandage is applied to the insertion site and restricted movement is required for several hours to prevent bleeding.

Some PCI’s can be done as an outpatient procedure where the patient can go home after several hours of observation. Other PCI’s require the patient to stay overnight at the hospital.

Blocked/narrow artery requiring intervention
Blocked/narrow artery requiring intervention

Stents

There are a couple types of stents that can be placed during a PCI. These include:

  • Bare metal stent (BMS): usually made of stainless steel
  • Drug-eluting stent (DES): the metal stent is coated with growth inhibiting agents which slow down the reproduction of smooth muscle, thus reducing the occurrence of another blockage

A DES is considered superior to a BMS, but certain situations contraindicate the use of a DES.

When a DES is used, antiplatelet therapy lasts longer than with a BMS to prevent stent thrombosis (a blood clot in the artery where the stent is). Some people cannot be on antiplatelets for long periods of time making them a candidate for a BMS instead of DES.

Stent placed with balloon
Stent placed with a balloon

Mary understands the procedure that is needed to help decrease damage to her heart from the myocardial infarction. The doctor will insert the catheter through her groin and place a drug-eluting stent during the percutaneous coronary intervention. Mary does not have any contraindications for being on antiplatelets for an extended amount of time. This will help reduce the recurrence of further heart blockages.

Patient Management for Percutaneous Coronary Intervention

Before and During the Percutaneous Coronary Intervention

There is not much preparation required before a PCI, especially when needed to be done emergently. Aspirin is given before the procedure because it works as an antiplatelet to decrease blood clots without creating an increased risk of bleeding. An intravenous catheter is placed in order to administer a sedative. The area where the catheter is going to be inserted is numbed. The patient will lay flat on table.During the PCI the patient is awake but does not feel much of the procedure due to the numbing medication at the catheter insertion site. The patient lies still and is monitored by a heart monitor.

Blood pressure, oxygen level, and respirations are also monitored throughout the procedure.

After the Percutaneous Coronary Intervention

Once the PCI is completed, the patient is transferred to a bed for recovery. The area of catheter insertion cannot be moved for several hours. Pressure is applied over the site and the patient lies flat without moving the affected limb. During the recovery process the heart rate and rhythm, blood pressure, oxygen level, respirations, and temperature are monitored. Pain medication is given as needed for discomfort to the insertion site.

Dual antiplatelet drug therapy is essential for those with a stent in order to reduce the risk of blood clots forming at the stent. Aspirin is one of the medications that is taken along with clopidogrel. Aspirin is usually taken long-term over the rest of the patient’s life. Clopidogrel is taken for one month if a BMS is placed and taken for twelve months if a DES is placed.Mary’s interventional cardiac catheterization with PCI and DES stent placement went well.

She recovered with no problems, staying the hospital overnight for monitoring. She is being discharged on aspirin and clopidogrel that she will take for twelve months.

Lesson Summary

A percutaneous coronary intervention (PCI), or angioplasty, is a procedure done during a cardiac catheterization to widen narrow or blocked arteries in the heart. A catheter inserted through the groin or arm is threaded to the heart using dye to identify the blocked artery. The catheter has a balloon on the tip which is inflated in the artery to open the blockage. A stent is usually placed during a PCI to keep the artery open.

Two types of stents are bare metal stents (BMS) and drug-eluting stents (DES). Once the PCI with stent is done, the patient needs to be on dual antiplatelet medications to reduce the formation of blood clots in the artery.Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.

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