Percutaneous coronary intervention: Minimally invasive treatment for coronary heart disease

Percutaneous coronary intervention (PCI) is a medical procedure used to treat blocked or narrowed coronary arteries caused by coronary heart disease, providing a minimally invasive alternative to traditional open-heart surgery.

This article provides an expert insight into PCI, exploring the indications for the procedure, the recovery process, and its effectiveness.

What are the indications for percutaneous coronary intervention?

PCI is typically recommended when a patient has significant blockages in the coronary arteries that are causing symptoms like chest pain (angina) or, more critically, increasing the risk of a heart attack (myocardial infarction).

However, PCI isn’t always suitable for everyone. In some cases, if the blockages are too widespread, if multiple arteries are affected, or if the coronary artery isn’t accessible, bypass grafting surgery might be recommended instead.

How is percutaneous coronary intervention performed?

Your cardiologist will first make a small incision, typically in the groin or wrist, to access a blood vessel. A catheter will then be inserted into the blood vessel and carefully guided to the blocked or narrowed area in the coronary artery using advanced imaging such as fluoroscopy. Once the catheter has reached the site of the blockage, several techniques may be used to open the artery.

The most common method involves balloon angioplasty, in which a small balloon at the tip of the catheter is inflated to press against the plaque in the artery, widening the blood vessel and improving blood flow to the heart muscle.

In cases where the balloon alone is insufficient to keep the artery open, a stent will be placed instead. A stent is a small mesh tube, typically made of metal or biodegradable material, that is placed into the artery to help keep it open and prevent it from narrowing again. The stent will remain in place permanently, and over time, it will become embedded in the artery wall, providing structural support to the artery.

Once the stent is in place and the artery is open, your cardiologist will remove the catheter and close the incision site with sutures. The entire procedure will usually take between 30 minutes and 2 hours, depending on the complexity of the case and the number of blockages being treated.

What is the recovery process like after percutaneous coronary intervention?

The recovery process is generally quick. Immediately after PCI, you will be monitored in the recovery area for a few hours or overnight for any complications. If the catheter was inserted through the groin, you will typically be instructed to lie flat for a while to reduce the risk of bleeding.

Most patients can return home on the same day or the day after the procedure. You may experience mild discomfort or bruising at the catheter insertion site, but this will typically resolve within a few days. You will need to avoid strenuous physical activities, including heavy lifting, for a few weeks after the procedure to allow the artery to heal.

Follow-up appointments will be scheduled with your cardiologist to check on your recovery and ensure that the stent remains properly positioned. In most cases, you will also need to take antiplatelet medications for several months afterwards to prevent the formation of blood clots around the stent.

How effective is percutaneous coronary intervention?

PCI is highly effective at relieving symptoms of coronary heart disease, including chest pain, and at reducing the risk of heart attacks. The procedure has a success rate of over 90% for treating coronary artery blockages.

However, while PCI can open blocked arteries and improves circulation, it doesn’t cure the underlying coronary heart disease. Lifestyle changes - including a heart-healthy diet, regular exercise, and smoking cessation - and effective cardiology management are therefore essential to maintain the benefits of PCI and prevent new blockages from forming.

In some cases, you will also be prescribed medications such as statins to manage cholesterol levels, and other drugs such as beta blockers or ACE inhibitors to control blood pressure and reduce strain on the heart.