Percutaneous Coronary Intervention (PCI)
Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat the blockages in a coronary artery; it opens up narrowed or blocked sections of the artery, restoring blood flow to the heart.
The average heart beats 100,000 time per day, constantly pumping oxygen-rich blood into the arteries and onward to organs, muscles, and other tissues throughout the body. But the heart itself is a muscle, and like all the other tissues in the body, it also needs a steady supply of oxygen-rich blood to stay healthy and work properly. This blood is delivered to the heart by the coronary arteries.
Certain conditions can cause the coronary arteries to narrow or become blocked, restricting or blocking blood flow to the heart. For instance, in coronary artery disease—the most common type of heart disease in the U.S.—plaque deposits within the walls of the coronary arteries cause them to narrow, reducing blood flow and leading to chest pain and, in some cases, a heart attack.
That’s where a treatment like percutaneous coronary intervention can be important. In the U.S., around 900,000 PCIs are performed every year.
“PCI is a non-surgical and minimally invasive method of treating coronary artery disease,” says Yale Medicine interventional cardiologist Yousif Ahmad, BMBS, PhD. “In the setting of a heart attack, this is a life-saving treatment. For patients with stable coronary artery disease, it can also improve blood flow considerably, as well as relieve chest pain and shortness of breath. The procedure is typically performed through a small artery in the wrist, and our patients are usually discharged from hospital the same day or day after the procedure. Patients typically feel instantly better after PCI and go back to their normal daily routines without a long recovery time.”
What is percutaneous coronary intervention?
Percutaneous coronary intervention is a procedure that is used to restore blood flow through the coronary arteries, thereby relieving symptoms and improving heart function. Compared to coronary artery bypass surgery, which is also used to treat narrowed and blocked arteries, PCI is less invasive, is typically lower risk, and has a shorter recovery time.
How does percutaneous coronary intervention work?
PCI usually takes place in a catheterization laboratory, or cath lab, equipped with an X-ray machine. The patient is given medications intravenously to help them relax, but typically remains awake during the procedure.
An interventional cardiologist inserts a small tube called a sheath (similar to an IV) into a blood vessel in the wrist or groin. Then a catheter (a smaller tube) is placed within the sheath and guided through it to the heart. Live X-ray images help the doctor guide the catheter through blood vessels until it reaches the affected coronary artery.
Once the catheter is in place, the doctor injects a contrast liquid into the artery. The contrast liquid makes certain tissues stand out more in X-rays, allowing doctors to determine where the coronary artery is narrowed or blocked. The doctor then inserts a thin guidewire through the catheter and across the narrowed or blocked section of the artery.
Next, in what’s known as a balloon angioplasty, the doctor inserts a second, smaller catheter—equipped with a balloon—and tracks it over the wire to the coronary artery. When the balloon is positioned within the narrowed or blocked section of the artery, the doctor inflates it, effectively opening the artery. Once the coronary artery is reopened, blood can flow through it to the heart.
In many cases, the doctor will also insert a stent—a tube made of mesh wire—into the newly reopened section of the artery. The stent remains in place permanently after the procedure, holding the artery open. The stent is usually coated with a slow-release medication that helps prevent repeat narrowing of the blood vessel, a process called restenosis. This kind of a stent, known as a drug-eluting stent, reduces the risk that the artery will become blocked in the future.
What conditions are treated with percutaneous coronary intervention?
PCI is used to treat heart conditions in which one or more of the coronary arteries is narrowed or blocked. It may be used to treat people with stable symptoms, new onset of symptoms, or during a heart attack. Conditions that may be treated with PCI include:
- Coronary artery disease, a condition in which plaque buildup along the walls of the coronary arteries causes them to narrow and stiffen. Collectively known as angina, this typically results in symptoms such as tightness in the chest, neck, back, and shoulder during physical activity or emotional stress. Patients with angina may also feel breathless or as if they have heartburn or indigestion. (If the artery becomes completely blocked, it is known as a total occlusion. If it remains blocked for 3 months or longer, it is called a chronic total occlusion.)
- Acute coronary syndrome, a group of conditions in which blood flow to the heart is suddenly reduced or stopped. Heart attacks and unstable angina (new angina symptoms that occur while at rest and without emotional stress) are types of acute coronary syndrome.
Doctors will determine whether PCI is an appropriate treatment option. In some cases, these conditions may be better treated using medications and/or a coronary artery bypass graft (CABG) procedure.
What happens after percutaneous coronary intervention?
After PCI, patients spend several hours recovering in the hospital and may need to stay overnight.
After a stent is implanted, patients are typically placed on a combination of two blood thinners for several months to a few years. It is important that patients take these medications to prevent clot formation within the newly implanted stent. Patients should not stop these medications without first speaking to their doctor. Often, patients will have to take one blood thinner medication indefinitely.
To reduce the risk for additional artery blockages, it’s also important for patients to maintain heart-healthy lifestyle habits, which include staying physically active, quitting smoking, maintaining a health body weight, and following a healthy diet.
What are the risks of percutaneous coronary intervention?
PCI is a safe procedure. However, in rare cases, complications can occur. These may include:
- Heart attack
- Arrhythmias (irregular heartbeat)
- Blood clotting in the stent
Patients over age 65 and those with diabetes, chronic kidney disease, acute coronary syndrome, and heart failure may have a higher risk for certain complications.
What is the outlook for people who undergo percutaneous coronary intervention?
The outlook for people who undergo PCI depends on several factors including age and general health, as well as the type and severity of coronary artery involvement. PCI can help people with narrowed or blocked coronary arteries live longer, healthier lives. For many, the procedure leads to a reduction of symptoms and improved quality of life.
Even after undergoing PCI, however, a coronary artery can become narrowed or blocked again. In these cases, symptoms usually return, and another PCI or coronary bypass surgery may be necessary.
What stands out about Yale Medicine's approach to percutaneous coronary intervention?
“At Yale Medicine you will have a procedure done by experts in the field with a high level of competence and safety,” says Yale Medicine interventional cardiologist Glen Henry, MD. “The staff will guide you comfortably through the procedure. After discharge, continued care with maximal lowering of risk factors and participation in cardiac rehabilitation are arranged.”