Percutaneous coronary intervention (PCI) is a minimally invasive non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The procedure is used to place and deploy coronary stents, a permanent wire-meshed tube, to open narrowed coronary arteries. PCI is considered 'non-surgical' as it uses a small hole in a peripheral artery (leg/arm) to gain access to the arterial system; an equivalent surgical procedure would involve the opening of the chest wall to gain access to the heart area. The term 'coronary angioplasty with stent' is synonymous with PCI. The procedure visualises the blood vessels via fluoroscopic imaging and contrast dyes. PCI is performed by an interventional cardiologists in a catheterization laboratory setting. Patients who undergo PCI broadly fall into two patient groups. Those who are suffering from a heart attack and are in a critical care emergency room setting and patients who are clinically at a high risk of suffering a heart attack at some future point. PCI is an alternative to the invasive surgery coronary artery bypass grafting (CABG, often referred to as "bypass surgery"), which bypasses narrowed arteries by grafting vessels from other locations in the body. Coronary angioplasty was first introduced in 1977 by Andreas Gruentzig in Switzerland.
Medical uses
PCI is used to open a blocked coronary artery/arteries and to restore arterial blood flow to heart muscle, without requiring open-heart surgery. In patients with acute coronary syndromes, PCI may be appropriate; guidelines and best practices are constantly evolving. Heart attack 'onset to treatment time' is important and significantly influences clinical outcomes of PCI procedures. The rapid reperfusion of heart muscle is critical in preventing further heart muscle damage caused by heart attacks, this time is often referred to as 'Onset-to-Door' and 'Door-to-balloon' time, shortening this time is an important goal within an emergency care/ hospital setting. A number of initiatives have been active sponsored by a variety of organizations and hospital groups since the late 1990s to reduce this time to treatment. The use of PCI in addition to anti-angina medication in stable angina may reduce the number of patients with angina attacks for up to 3 years following the therapy, but does not reduce the risk of death, future myocardial infarction or need for other interventions.
Adverse events PCI is widely practiced and has a number of risks; however, major procedural complications are uncommon. PCI is performed using minimally invasive catheter-based procedures by an interventional cardiologist, a medical doctor with special training in the treatment of the heart. For most patients who are not receiving primary PCI (not having PCI to treat a heart attack) the patient is usually awake during PCI, and chest discomfort may be experienced during the procedure. Bleeding from the insertion point in the groin (femoral artery) or wrist (radial artery) is common, in part due to the use of antiplatelet drugs. Some bruising is common, but occasionally a hematoma may form. This may delay hospital discharge as flow from the artery into the hematoma may continue (pseudoaneurysm) which requires surgical repair. Infection at the skin puncture site is rare and dissection (tearing) in the interior wall of an arterial blood vessel is uncommon. Allergic reaction to the contrast dye used is possible, but has been reduced with the newer agents. Deterioration of kidney function can occur in patients with pre-existing kidney disease, but kidney failure requiring dialysis is rare. Vascular access complications are less common and less serious when the procedure is performed via the radial artery. The most serious risks are death, stroke, ventricular fibrillation (non-sustained ventricular tachycardia is common), myocardial infarction (heart attack, MI), and aortic dissection. A heart attack during or shortly after the procedure occurs in 0.3% of cases; this may require emergency coronary artery bypass surgery. Heart muscle injury characterized by elevated levels of CK-MB, troponin I, and troponin T may occur in up to 30% of all PCI procedures. Elevated enzymes have been associated with later clinical outcomes such as higher risk of death, subsequent MI, and need for repeat revascularization procedures. Angioplasty carried out shortly after an MI has a risk of causing a stroke, but this is less than the risk of a stroke following thrombolytic drug therapy. As with any procedure involving the heart, complications can sometimes, though rarely, cause death. The mortality rate during angioplasty is 1.2%. Sometimes chest pain can occur during angioplasty because the balloon briefly blocks off the blood supply to the heart. The risk of complications is higher in:
People aged 65 and older People who have kidney disease or diabetes Women People who have poor pumping function in their hearts People who have extensive heart disease and blockages
Procedure Balloon angioplasty is the inflation of a balloon (often part of an integrated medical device combining a balloon, guidewire, and stent) within the coronary artery to 'crush' the plaque causing the occlusion into the walls of the artery. Balloon angioplasty is still often performed as a part of PCI procedure, it is rarely the only activity performed. Procedures commonly associated with PCI are:
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