Cardiac Stenting a.k.a. Percutaneous Coronary Intervention
Who is it for?
Cardiac stenting, or percutaneous coronary intervention (PCI), is recommended for people who suffer from narrow or blocked coronary arteries as a result of coronary artery disease (CAD). It is also used as an emergency treatment for heart attack cases by quickly opening the blockage and reducing heart muscle damage.
What is percutaneous coronary intervention?
PCI, also known as coronary angioplasty, is a non-surgical method used to open narrowed coronary arteries that supply the heart muscle with blood. It is performed by inserting a flexible catheter (tube) with a balloon at its tip through an artery at the groin or arm. (Heart Matters favours the arm approach where the catheter is inserted through the radial artery at the wrist. It allows early mobilisation as compared to the groin approach which requires patients to keep still for six hours at a go.)
The catheter is then threaded through the inside of the artery back into an area of narrowing or blockage, where the balloon is inflated to compress the plaque against the artery wall to restore blood flow through the blood vessel.
Cardiac Stents in PCI
A cardiac stent is a small hollow mesh that is used to widen arteries supplying the heart that have significant narrowings. It is often used in angioplasty to prevent arteries from becoming narrowed or blocked again in the months or years after angioplasty.
Cardiac stents are also used to repair torn arteries including the aorta – large blood vessel that carries blood out of the heart – or bulges in arteries (aneurysms).
Important Pre-treatment Screening
Prior to PCI, patients have to undergo a strict regime of tests to review their overall body and heart condition. This will also allow the doctor to determine which approach is best for each individual patient. These tests may include:
- Physical examination
- Electrocardiography (ECG)
- Chest X-ray
- Blood Tests
- Cardiac Catheterisation: includes Coronary Angiogram, Aortogram and other studies
- Computed Tomography (CT) Scan
- Other tests at the doctor’s discretion
What risks do PCI bring?
PCI is a common medical procedure. It is usually performed by an interventional cardiologist: a medical doctor with special training in the treatment of the heart using invasive catheter-based procedures. Major complications are rare but possible. This can include:
- Discomfort and bleeding at the catheter insertion site
- Blood vessel damage from catheters
- An arrhythmia (irregular heartbeat)
- Restenosis (tissue growth within treated portion narrows and blocks the artery again)
- Blood clot
- Heart attack
Although chest pain can occur during PCI, this is often transient because the balloon briefly blocks off the blood supply to the heart. Bleeding from the insertion point in the groin or arm is common, in part due to the use of anti-platelet clotting drugs. Some bruising is therefore to be expected.
The risk of complications is higher in:
- People aged 75 and older
- People who have kidney disease or diabetes
- People who have poor pumping function in their hearts
- People who have extensive heart disease and blockages
What are the benefits?
PCI is used to widen narrowed blood vessels and increase the blood flow to the heart. This decreases the risk of a heart attack, while reducing the discomfort and progress of coronary artery disease. It is minimally-invasive, as the procedure only requires a very small puncture for the catheter to be threaded into the coronary arteries.
What is the recovery period like?
Patients are kept at least overnight for observation after the procedure and discharged within 24 hours after PCI. They are cautioned not to do any vigorous activity or lift heavy items or weights for about one to two weeks. Some patients may be referred to a rehabilitation centre but most patients are able to continue working (not physically intensive) in about three days after PCI.