Introduction
Percutaneous coronary intervention or PCI refers to a non-surgical procedure that is used for the treatment of narrowing down of the coronary arteries of the cardiovascular system, especially the heart that is found during coronary artery disease. The entire process involves the combination of coronary angioplasty along with stent insertion, which is referred to as the insertion of a permanent wire which is in the shape of a meshed tube that is either drug-eluting called DES or composed of bare metal called BMS. The stent balloon of the angioplasty catheter is then inflated with a particular media in order to force contact between the stent and the blood vessel wall. This is referred to as stent apposition and is done the widen the blood vessel in diameter.
After accessing the bloodstream via the femoral or radial arteries, the procedure then uses a coronary catheterization in order to visualize the blood vessels with the help of X-ray imaging, followed by a balloon catheter with a deflated balloon that is advanced into the artery and inflated to create space. Primary percutaneous coronary intervention refers to the urgent use of it in individuals with an acute heart attack, and evidence of heart damage is seen on the electrocardiogram. Percutaneous coronary intervention is additionally used in individuals with myocardial infarction, unstable angina, and stable angina pectoris. Percutaneous coronary intervention is an alternative to coronary artery bypass surgery or CABG, often referred to as bypass grafting.
What Are the Uses of Percutaneous Coronary Intervention?
Percutaneous coronary intervention is generally used to open a coronary artery that is blocked and to restore the arterial blood flow to the heart and related structures tissue without the need to perform open-heart surgery. For patients who have a restricted coronary artery or a blockage in the coronary artery, percutaneous coronary intervention can be one of the best options in order to re-establish the flow of blood as well as prevent an episode of angina, chest pain, myocardial infarctions, or heart attacks and even death. Percutaneous coronary intervention generally includes the insertion and placement of stents that include bare-metal stents, drug-eluting stents, or completely resorbable vascular scaffolds, also called naturally dissolving stents. The use of stents is extremely crucial during the initial three months of percutaneous coronary intervention because, after that, the artery will be able to remain open. The use of percutaneous coronary intervention is dependent on several factors and criterions such as those mentioned below.
-
Stable coronary artery disease.
-
Coronary stenosis.
-
Angina.
-
Myocardial infarction.
-
Acute coronary syndromes.
-
Patients with severe blockages.
-
ST-segment elevation myocardial infarction or STEMI.
-
Non-ST-segment elevation myocardial infarction.
-
Unstable angina.
What Are the Adverse Effects of Percutaneous Coronary Intervention?
Percutaneous coronary intervention is widely performed and has a number of risks, including several procedural complications that are not common. Percutaneous coronary intervention is generally performed by using an invasive catheter. The patient is primarily awake during a percutaneous coronary intervention, and chest discomfort is the first adverse effect during the procedure. It should be noted that the adverse effects are definitely rare but are prone to specific categories of patients, such as those above the age of 65 years, those who are suffering from kidney disease or kidney failure, and those with an improper pumping mechanism of their cardiovascular system and those with an underlying cardiovascular disorder or an underlying heart disease that has not been treated. In addition, women are more prone to developing such adverse effects than men. Mentioned below are a few of the adverse impacts of percutaneous coronary intervention.
-
Ischemia (restricted oxygen supply to a body part).
-
Bleeding.
-
Bruising.
-
Delay in hospital discharge.
-
Hematoma (clot formation in an organ or tissue).
-
Pseudoaneurysm.
-
Infection at the skin at puncture.
-
Dissection or tearing of the blood vessel.
-
Allergic reaction to the contrast dye.
-
Deterioration of kidney function.
-
Vascular access complications.
-
Death.
-
Stroke.
-
Ventricular fibrillation.
-
Non-sustained ventricular tachycardia.
-
Myocardial infarction or heart attack.
-
Aortic dissection.
-
Heart muscle injury.
-
Elevated levels of CK-MB, troponin I, and troponin T.
-
Elevated enzymes.
-
The balloon briefly blocks off the blood supply.
How Does Percutaneous Coronary Intervention Take Place?
A thin and long tube called a catheter is initially inserted into a blood vessel that has been chosen to perform the percutaneous coronary intervention, and this is then directed into the blocked coronary artery. The catheter consists of a miniature balloon at one end. Once the catheter is correctly lodged and located, that balloon is widely inflated at the same junction of the blocked coronary artery. This inflation will eventually lead to pressure build-up against the walls of the coronary artery, which then pushes the deposited plaque, cholesterol, or any form of blood clot against the sides of the coronary artery. This will make a way and a smooth path for the blood to flow. Following this, the healthcare provider and the respective team may maneuver a fluoroscopy X-ray technique. Fluoroscopy is referred to as a unique kind of X-ray that aids the healthcare provider and team in searching for blockages or stoppages in the arteries of the heart, along with the help of the contrasting dye that will float through the arteries. This entire process is referred to as coronary angiography and is a critical aspect of percutaneous coronary intervention. In addition to this, atherectomy can be done as well- the procedure of removal of the plaque accumulation within the blood vessels.
Conclusion
Percutaneous coronary intervention is the correction and treatment of the blood vessels that are blocked and obstructed due to an underlying cardiovascular disease. The procedure is not new to the science of the heart and related management. The patient undergoes several tests and measures before this procedure, along with a detailed clinical, family, drug, and medical history. The entire treatment has two main aspects- angiography and atherectomy, where the healthcare provider is the best person to decide which is necessary and vice versa. The patient is asked to stay for a day or two at the hospital to monitor the vital signs and subsequently is able to have a positive outlook on life.
