Interventional Cardiology

Coronary Angioplasty stenting

What is a Percutaneous Coronary Intervention (PCI)? 

Where a narrowing is identified in a coronary artery during a coronary angiogram, the cardiologist may treat the lesion using a stent (fine mesh tube). This is known as Percutaneous Coronary Intervention (PCI), which means ways of opening narrowings in coronary arteries using fine tubes called catheters introduced from the wrist or groin. Narrowings are treated with balloons and stents (fine mesh stainless steel tubes) that reduce the chance of renarrowing. PCI is also known as angioplasty or stenting.

Before and After Stenting

LCA-diseased LCA-after-stent

The first image shows a narrowing (arrow) in Left Coronary Artery (LCA) which supplies blood to the left side of the heart. The second image shows the disease area treated with a bioresorbable stent restoring the blood supply to the heart. 

Coronary angiogram and Percutaneous Coronary Intervention (PCI) are carried out in an angiography suite (“catheter lab”) at Intra. Your cardiologist will be assisted by our team of nurses and other highly skilled personnel.

Are there different types of stents?

There are different types of stents available. Your cardiologist will decide which is best suited.

• Drug eluting stents (DES)
• Bioresorbable sca olds (BVS)

DRUG ELUTING STENTS

Drug eluting permanent stents are the most frequently inserted stents with excellent results achieved over several years. These stents are coated with a medication to abolish or substantially reduce the chance of renarrowing and the need for repeat treatment.



BIORESORBABLE SCAFFOLDS (STENTS)

These are drug eluting stents that do their job and then dissolve. An artery only needs support for about three months and after this a permanent stent is unnecessary and may be disadvantageous. An analogy is that if you break your arm, the plaster cast is kept on only until the bones have healed, not for the rest of your life. While metal drug-eluting stents are excellent, a resorbable stent may be a step forward.

Bioresorbable scaffold stents are not suitable for all patients. Intra cardiologists led by Prof John Ormiston are at the forefront of international research in this area.

What will I experience during the procedure?

You will be lightly sedated but awake throughout. An intravenous catheter (IV line) for administration of uids and medication will be inserted into a vein on the back of your hand or in your arm.

You will feel the local anaesthetic injection into your wrist or groin, then a tiny plastic tube called a catheter is introduced. You should not feel pain at the entry site, but there still may be some non-painful sensations, such as pressure.

You should tell your interventional cardiologist if you are experiencing any pain.

Your cardiologist watches the catheter on an x-ray screen as he/she passes the tip of the catheter to one of the coronary arteries. A special uid (contrast or dye) that is visible on x-ray imaging is injected into the coronary arteries and movie pictures are recorded on the computer. When contrast is injected into the left ventricle (pumping chamber), you will feel warm all over for a few minutes. 

If a narrowing suitable for stenting is found, your cardiologist may then proceed to insert a stent. This procedure is referred to as percutaneous coronary intervention.

Through the guiding catheter, a wire about the thickness of a hair is passed across the narrowing. A stent (a fine mesh metal alloy tube that comes squashed down on a balloon) is directed across the narrowing by the wire.

The balloon is in ated to expand the stent and artery. The stent is pushed into the artery wall holding the artery open.

The balloon is deflated and removed leaving the expanded stent in place. Once expanded the stent cannot move

How should I prepare for my procedure?

Mercy Angiography office staff will arrange your admission time (usually two hours before the procedure).

Fasting. You may eat until two hours before admission, then you should not have anything to eat. You may continue to drink clear uids.

Allergies or previous reactions to contrast (x-ray dye). Please tell sta at the time of booking if you have any history of these.

Diabetes. If you are a diabetic you should tell the Mercy Angiography sta at the time of booking. You may need to discuss your insulin dose with your cardiologist.

Warfarin, coumadin or any other “blood thinner”. If you are taking one of these you should make this known to Mercy Angiography sta at the time of booking. It is likely that you will need to stop this medication temporarily for a few days before the procedure.

Other usual medications. Continue these unless advised otherwise by your cardiologist. In particular, please continue taking your aspirin.

Please bring with you any medication and any recent blood test results or chest x-rays. You may bring a favourite music CD, as this can be played during the procedure.

You are encouraged to bring a friend or a family member.

What happens after my procedure?

Following the procedure, your cardiologist will discuss the findings with you while you are in hospital or at a follow-up appointment. After coronary angiography, patients are usually discharged the same day, but may stay overnight after PCI.

• A small amount of bruising at the catheter entry point is relatively common. You should not be overly concerned unless it becomes painful. Bruising may stay for a few weeks.

• If you have chest pain in hospital after the PCI you should report this. Occasionally pain is due to clot within the stent that is reducing blood ow.

• For procedures from the groin, sometimes a “false aneurysm” or out-pouching of the groin artery deep under the skin occurs at the puncture site. This shows up as increasing pain at the puncture site. The diagnosis is made by an ultrasound test and treatment is usually by an injection.

What can I expect when I go home?

If you go home on the day of the procedure, someone should stay with you that night. You will usually be able to return to work the day after angiography but this depends in part on the result of your angiogram.

You should not drive on the day of the angiography procedure, so you will need to have someone drive you home. You cannot go home alone in a taxi.

The Land Transport Safety Authority says you should not drive for 48 hours after a percutaneous coronary intervention (PCI). Please ensure you make suitable transport arrangements.

It is extremely important to stop smoking.

Medication. Your cardiologist will discuss with you what medication you should take. Almost all patients should take aspirin inde nitely. After PCI, you should take one Clopidogrel (Plavix) tablet daily as prescribed by your doctor.

Many people cannot control their blood cholesterol by diet alone because their bodies make too much cholesterol. It is important for these people to take medication to lower cholesterol.

Exercise. You should build up activity gradually so that in about a week you are back to full activity. For the rst few days after a procedure carried out from the groin you should be careful with lifting to reduce the chance of problems such as bleeding or haematoma from the entry site. It is a good idea to develop a regular exercise programme such as walking, cycling, or swimming briskly enough to make you slightly short of breath for half an hour most days of the week.

Follow-up. You will need to visit your general practitioner. You should make an appointment to see your usual cardiologist 1-4 weeks after PCI.

What are the risks?

Coronary angiography and PCI are common procedures and serious complications are uncommon.

  • An allergic reaction to the x-ray contrast (dye) with rash or itching sometimes occurs. It is exceptionally rare for a severe life-threatening allergic reaction to occur.

  • Abnormal or irregular beating of the heart may occur but is usually brief and easily treated.

  • The x-ray contrast may cause some damage to kidneys that is usually temporary. It is more common in those patients who already have damaged kidneys or who su er from diabetes.

  • It is extremely rare for the artery to become worse rather than better during a PCI. Should this occur urgent bypass surgery is required.

  • Serious complications such as a heart attack, damage to the heart muscle, infection, stroke and death are very rare.