Percutaneous Coronary Intervention (PCI)

...A quick review of Coronary Artery Disease (CAD)...

CAD in a nutshell is simply the narrowing of arteries and therefore a decrease of blood supply to one of the body’s favorite vital organs. The heart itself receives oxygenated blood and nutrients from two arteries (namely the “coronary arteries”) which branch around the heart and keep us and our heart alive. Arteries are circular structures which under ideal conditions are large enough in circumference to allow sufficient blood supply to flow through them. CAD is a condition whereby these coronary arteries become narrowed by plaque build up (plaque is basically a collection of sticky things in the blood such as fats, platelets, and other cells). Until very recently it was thought that the plaque continued to build up to the point whereby the artery was completely occluded thereby allowing significantly less amounts of blood to pass (ischemia) or none at all (infarction). Recent research suggests that the plaque deposits exist; however, the actual trauma of complete coronary artery occlusion is the result of a ruptured plaque deposit which in turn triggers the immune response. Platelets and other immune products form a clot which is actually the cause of artery occlusion.

Percutaneous Coronary Intervention or PCI is a process by which coronary arteries are reopened therefore resulting in an increased blood supply through the coronary arteries to the heart. This procedure was formally called angioplasty or percutaneous transluminal coronary angioplasty. A cardiac interventionalist enters the body through an artery either of the arm or leg (most commonly, through the right femoral artery) and moves through the circulatory system (generally straight up the abdominal aorta and into the coronary arteries). A dye is injected (which is seen with an x-ray machine). This allows the interventionalist to locate the occlusion. A balloon-like catheter is inflated which reopens the artery. A stent (circular, stainless steel device which resembles the spring in a ballpoint pen) may be inserted into the artery to keep it open.

Following a PCI, patients are placed on anticoagulants or “blood thinners” which help the body not to reocclude its new stent. Patients should go home on Plavix (Clopidigrel) which helps to prevent platelet aggregation within the stent as well as an acetylsalicylic acid (ASA) or Asprin protocol. ASA helps to prevent reocculsion with an anti-platelet effect as well, ASA has anti-inflammatory properties which help slow the progression of CAD.

The immediate post-procedure period is relatively straightforward. Patients lie in a strict supine position from the time that the arterial sheath is removed plus four hours (depending on anticoagulants intraprocedure). VS are monitored q15*4, q1h*4, and then q4*24.

The most noted complication is hematoma at the groin site which can occur immediately after sheath pull and well into the following thirty hours. Apply firm pressure onto the artery, if significant internal bleeding continues, call for a clamp, otherwise maintain pressure and keep the leg flat (pressure for 15 minutes and then bedrest for 1 additional hour).