Disease of the coronary arteries or coronary artery disease is a common heart problem. It occurs when the blood vessels supplying blood to the heart become narrowed or blocked, resulting in insufficient blood flow to the heart. Symptoms can include chest pain, shortness of breath or even a heart attack.

Coronary artery disease can be treated by medications, ballooning (or angioplasty) and stenting or coronary artery bypass surgery. A stent is a hollow metal mesh that is placed inside the artery and expanded to support the artery and prevents it from re-narrowing. Coronary angioplasty and stenting procedures are also referred to as percutaneous coronary intervention (PCI). Unlike bypass surgery, angioplasty and stenting are not surgical treatments but are procedures that utilise a small flexible tube called a catheter that is passed from an artery in the wrist or the groin, into the heart. This catheter allows the balloon or stent to be passed up into the coronary artery to treat the blockages.

Before the Procedure

The doctor will explain the indications, risks and benefits of the procedure. You must inform the doctor if you have any of the following conditions:

• Any allergies to iodine, contrast dye or any other medications
• Asthma, kidney disease or any other medical problems
• Any bleeding problems
• Taking blood thinning medications
• Pregnant or may be pregnant

Patients may be given blood-thinning medications (usually aspirin and clopidogrel) as preparation for possible PCI.

During the Procedure

1. The patient’s procedure is done in the invasive cardiac catheterisation laboratory (also referred as a ‘cath lab’).  An intravenous cannula will be placed in a vein (usually in the arm)

2. This allows administration of intravenous medications if required.  the patient will lie down flat on a table and will be hooked to monitors that measure their oxygenation, heart rate and rhythm and blood pressure.

3. A local anaesthetic will be injected into the skin area over the wrist or the groin, depending on which approach is used for the coronary angiogram and PCI.  Initial discomfort is from the needle prick of the anaesthetic, following which the area will be numb but pressure sensation may still be felt.

4. Then a small flexible catheter is inserted into the artery at the wrist (radial artery) or at the groin (femoral artery) and gently threaded to the heart using X-ray guidance.  A dye is injected through the catheter to help visualise the coronary arteries in the heart.  This procedure is called a coronary angiogram.  Any blockage or narrowing of the coronary arteries including its location and extent, can be detected.

5. If there is a significant narrowing or blockage, this can be treated by PCI. A ne guide wire is passed across the narrowing in the artery and a balloon catheter is then advanced to the site of the narrowing and inflated. The inflated balloon dilates the narrowing and makes the lumen of the coronary artery larger. Usually, a stent is then placed at the site to reduce the risk of re-narrowing. All these procedures are done under X-ray guidance. X-ray images are obtained at the end to check the results of the procedure. Once the procedure is completed, the catheter is removed and the site of insertion of the catheter is compressed with a pressure dressing to prevent bleeding.

After the Procedure

1. Patients are observed in the recovery room at the cath lab and once they are stable, they will be transferred to the ward. If the procedure is done from the wrist, the pressure bandage can be removed after 4 hours. Patients are advised not to bend the affected wrist or use that hand to carry heavy objects. If the procedure is done from the groin, the patient will need to remain in bed and keep the affected leg straight for 4 to 6 hours. The pressure bandage is removed later from the groin. Patients are usually allowed to eat and drink shortly after the procedure. They are encouraged to drink water or fluids to flush out the dye from the body. An ECG is performed to check the status of the heart after the PCI. Most patients will need to stay overnight but can be discharged the next day.

2. Patients will need to take blood-thinning medications to prevent a blood clot from forming in their stents. It is important to keep taking these medications until the doctor authorises to reduce or stop them.

3. After discharge, the insertion site (wrist or groin) may be sore and may appear bruised for a few days. If the patient experiences swelling, bleeding or redness at the site, medical help should be sought.  Patients should keep follow up appointment with the doctor as arranged.

What are the Risks of PCI?

In general, the procedure is low risk and rarely causes any major complications. The potential risks are

• Heart attack. This occurs if the blood vessel or a branch becomes blocked during the angioplasty or stenting. Very rarely, it can occur after the PCI due to sudden closure of the stent in the treated blood vessel
• Bleeding. This is often from the catheter insertion site and is more of a problem with the approach from the groin
• Restenosis. After the PCI, there is a small risk of re-narrowing or restenosis. This can result in the development of symptoms of chest pain again

See your Doctor or Heart Specialist if your experience any chest pain symptoms or dizziness after the procedure

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Disclaimer. TELEME blog posts contains general information about health conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice and should not be treated as such. 

If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.