Advances in technology and research have greatly improved the use of percutaneous coronary intervention, a minimally-invasive procedure used to treat heart disease, based on a clinical update recently published in the Journal of the American Medical Association.
Percutaneous coronary intervention—a nonsurgical procedure that improves blood flow to the heart. It is used to treat patients with heart disease, which is the leading killer of men and women in the United States.
PROCEDURE-Percutaneous coronary intervention, an intravenous (IV) needle and tube may be placed in the vein in your hand or arm. Fluids or medications can be given quickly and easily through this tube if they are needed. The area where the catheters are to be inserted, either your groin, arm or wrist, will be scrubbed with an antiseptic solution to prevent infection. Your groin area may also be shaved. You will then be covered with sterile sheets. Your doctor will inject a local anesthetic (numbing medicine) where the catheters will be inserted. You may feel a stinging sensation as he or she does this. However, after the medication takes effect, you should only feel dull pressure where the physician is working with the catheters. If you do feel pain, please tell your doctor. The procedure usually lasts about 90 minutes, during which time your doctor will ask you to remain very still. For the most part, you will be comfortable but you may feel some pressure or chest pain when the balloon is inflated. The is normal and will quickly fade when the balloon is deflated.
Step 1 The balloon catheter is passed through the guiding catheter to the area near the narrowing. A guide wire inside the balloon catheter is then advanced through the artery until the tip is beyond the narrowing.
Step 2 Next, the angioplasty catheter is moved over the guide wire until the balloon is within the narrowed segment.
Step 3 The balloon is inflated, compressing the plaque against the artery wall.
Step 4 Once the plaque has been compressed and the artery has been opened sufficiently, the balloon catheter will be deflated and removed.
POST OPERATIVE CARE AND MEDICATION-
Your Recovery After the procedure, a patient is usually sent home from the hospital in one to three days. You should arrange to have someone take you home rather than drive yourself. Before you leave the hospital, your doctor will give you guidelines for activities, diet and medications. He or she may ask you to avoid demanding activities like heavy lifting for at least a week. He or she will tell you when you can resume normal daily activities and when you can go back to work. After undergoing your procedure, you may feel better than you have in a long time, but is important not to over exert yourself. Because medications will be an important part of your treatment, your doctor will prescribe drugs that you should take at home. These medications will help prevent blood clots from forming in the newly dilated artery and help prevent spasms of the artery. Notify your doctor if your medications cause unpleasant reactions, but do not stop taking them unless instructed to do so. Your doctor may be able to prescribe new medications that better suit you. It is important to keep all follow-up appointments that are scheduled. Your doctor will want to follow your progress closely and may give you tests to ensure your coronary or peripheral arteries are open and blood flow to the treated area is sufficient. If you have any questions, ask your doctor.
INDICATION-PCI has also become more safe, thanks to a better understanding of which patients are most appropriate for the procedure.
For patients with blocked arteries who are not experiencing heart attack.
PCI is not typically recommended in patients who have no symptoms, since the risks may not outweigh the benefits. PCI is also only recommended after medication has failed to improve blood flow and relieve symptoms.
In patients who are experiencing heart attack, however, guidelines are much different. It’s estimated that about 60% of patients having a heart attack will receive PCI, with the remainder undergoing open heart surgery or receiving medication alone. PCI is much less invasive and often less risky than a full-blown surgery, making it the ideal treatment for many heart attack patients.
Open heart surgery may be more effective in patients with more severe blockages and can be safer in patients with pre-existing conditions like diabetes. Thus, these more complex treatment decisions should be made with a heart care team that includes both interventional cardiologists and cardiac surgeons.