Percutaneous Coronary Intervention or PCI
Percutaneous coronary intervention or PCI involves an umbrella of procedures and techniques to reopen arteries clogged by plaque stuck to their walls. Many patients undergo PCI because of reduced blood flow to their arms and legs (Peripheral Arterial Disease / PAD) or even the heart which can, in turn, cause chest pain, pain in the extremities, and shortness of breath. Left untreated, these conditions can increase the risk of heart attack or stroke.
PCI is remarkable in its minimal invasiveness. The blood vessels are accessed via a small incision in the arm or leg through which a catheter is threaded. This tiny spaghetti-like device can make its way through an artery and your interventional cardiologist can track and guide it using fluoroscopy or continuous X-ray in a specially outfitted cath lab. Once we reach the area of the blockage, we have a number of procedures that can be used for the specific type of blockage. These can include:
- Balloon angioplasty involves the use of an inflatable balloon on a catheter that compresses the plaque against the arterial wall. With now flattened plaque, blood flow is restored and oftentimes the symptoms of the narrowed artery go away. This is the traditional angioplasty that your parents or grandparents may have had.
- Angioplasty with a stent. As with traditional balloon angioplasty, a balloon on the catheter is used to press the plaque against the artery wall. However, there is always the chance of the plaque reconstituting and creating a blockage once again, so a small tube-like lattice, known as a stent, is placed to block plaque from reforming and maintain an open artery. To combat the possibility of scar tissue formation, stents are often medicated, releasing small amounts of a drug over long periods of time.
- Rotational atherectomy is essentially the process of using a tiny drill-like device attached to the end of the catheter to mechanically remove stubborn blockages. If plaque in the arteries is calcified, balloon angioplasty cannot compress it and the blockage will remain. A rotational atherectomy is a good option before opting for a more invasive bypass or CABG.
Sometimes, the heart needs a little bit of help, therefore during a PCI procedure, we may use an Impella, or heart pump, to assist the heart function. This is a temporary option for certain patients that do not have sufficient blood pumping function.
Of course, as with any cardiovascular procedure, there are some risks. However, the minimally invasive nature of these catheter-based procedures has reduced these risks significantly while not compromising the safety or effectiveness of the procedure. Most importantly, your interventional cardiologist will discuss which PCI is best for your circumstance and offer options for the treatment of arterial occlusion.
We encourage you to schedule a consultation with our office to learn more about the potential treatments for arterial blockage due to plaque formation.