Percutaneous Coronary Intervention (PCI)
What is it for?
If the arteries supplying blood to your heart are narrowed or blocked these narrowings or blockages may need to be opened up or bypassed. Bypassing them is achieved by means of the ‘coronary artery bypass graft’ (CABG) operation – see separate sheet. In many cases, however, it is appropriate for the narrowings to be opened up by means of (angioplasty) balloons and stents and this is known as percutaneous coronary intervention.
What does it involve?
This procedure is much the same as the cardiac catheter procedure and is also done under local anaesthetic with a tube inserted into an artery either at the top of the leg or the wrist. A wire is then passed down the tube, into the coronary artery and across the narrowing. A balloon can then be passed along the wire and is inflated at the site of the narrowing to open the vessel up. A stent can then be put into the artery at this point to hold the narrowing open. A stent is a metal tube about the size of a biro spring.
Most patients will go home either the same day or the following day, depending on the complexity of the procedure.
Are there any risks involved?
Your doctor will not have recommended percutaneous coronary intervention unless the likely benefits were thought to be greater than the risks involved. It is relatively safe and serious complications are rare, the risk of a serious event (heart attack, stroke or death) being less than 1 in 100.
Very occasionally there can be a sudden change in the rhythm of the heart during the procedure. If this happens you will be given appropriate drug treatment or, in certain special cases, an electrical shock to stabilise the heart rhythm.
If you are or believe yourself to be allergic to iodine or shellfish, please inform your consultant beforehand.
Please feel free to discuss with your consultant beforehand any worries you have about the procedure and especially if you feel unable to have the test done without a sedative.
Do I have to starve before the test?
Unless you are advised otherwise, please have a light breakfast (cereal or toast and tea or coffee) no later than 0630 on the morning of the test. You may drink clear fluids up to the time you arrive on the ward. If your test has been scheduled for the afternoon, please do not eat after 1030 am.
I have diabetes, what should I do about my treatment for this?
If you have diabetes, please ask your consultant for specific instructions about what to do in preparation for the test and especially if you take metformin (glucophage).
Should I take all my usual medication on the day of the test?
Please take all your usual medication on the morning of the test. If you take warfarin or attend an anticoagulant clinic, please let your consultant know beforehand. You may be asked to stop your warfarin or similar medication a few days before the test.
What happens after the test?
If the procedure is done from the leg the plastic tube will be removed. The operator or an assistant will then press for about 5 to 10 minutes on the point where the tube went in. Sometimes a special plug device will be inserted to seal the entry point. If the plug device (Angioseal®) is used in your case you will be given specific instructions about this. You will be rested on a bed or trolley after the tube has been removed. You will be asked to rest for a few hours or for a shorter time if the plugging device is used.
If the tubes are inserted at the wrist, a special cuff will be used to maintain pressure and prevent bleeding until the entry point is sealed.
The pulse in your foot, arm or hand will be checked regularly to ensure that all is well with the circulation.
Whichever way the procedure is done you will be given further instructions about what to do after returning home.
Will I need to come to the outpatient clinic again?
You will need to see your consultant 3-4 weeks after the procedure.
Special Note For Female Patients:
If you are still having monthly periods, please let your consultant know. This is because the test uses X-rays and can only be done safely in women during some days of the monthly cycle. The test will be done during the 10 days after the beginning of your monthly period. If you have not started your monthly period as expected on the day you are due for your catheter test, please tell your consultant.