(Non-Surgical) Coronary Intervention

What is a PCI?

These non-surgical procedures are performed in the cardiac catheterization laboratory by a specialized cardiologist and a cardiovascular team of nurses andtechnicians. The procedures utilize special catheters that are used to ‘open’ blocked arteries that supply blood to the heart.

There are several types of catheters that are used in these procedures:

• Balloon angioplasty (Percutaneous Transluminal Coronary Angioplasty or PTCA
• Stent
• Rotoblation (Percutaneous Transluminal Rotational Atherectomy or PCRA)
• Cutting Balloon

An interventional procedure starts out in the same way as a diagnostic cardiac catheterization. The catheter will be selectively passed into the artery with the blockage, and the doctor will perform the interventional procedure to open the blocked artery. The procedure usually lasts about 11/2 to 21/2 hours, but the preparation and recovery time add several hours. Usually, you will stay overnight and return home the next day.

Balloon Angioplasty (Percutaneous Transluminal Coronary Angioplasty or PTCA)

A specially designed balloon catheter with a small balloon tip is guided to the point of narrowing in the artery. Once in place, the balloon is inflated to compress the fatty matter into the artery wall and stretch the artery open to increase blood flow to the heart

Balloon Angioplasty Balloon is inflated to compress fatty plaque

• A stent is a small stainless steel mesh tube that acts as a scaffold to provide support inside your coronary Artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed coronary artery. Once in place, the balloon tip is inflated, and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed, and the stent stays in place permanently. Over a several-week period, your artery heals around the stent.
• Stents are commonly placed during procedures, such as angioplasty or atherectomy, to help keep the coronary artery open.
• Stent stays in place after catheter is removed
• Beginning in 2003, most stents have been coated with medicine designed to reduce the risk of reblockage (to less than 5-10% of the time).

Stent A stent is a small stainless steel mesh tube that acts as a scaffold to provide support inside your coronary artery

Rotoblation (Percutaneous Transluminal Rotational Atherectomy or PCRA)

• A special catheter, with an acorn-shaped diamond-coated tip, is guided to the point of narrowing in your coronary artery. The tip spins around at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed safely away in your blood stream and filtered out by your liver and spleen.

Rotoblation Tip spins at high speeds to grind away Blockage

Cutting Balloon

• The cutting balloon catheter has a special balloon tip with small blades. When the balloon is inflated, the blades are activated. The small blades score the plaque, then the balloon compresses the fatty matter into the artery wall.

When you Return Home

• You will need to take it easy for a few days.
• Avoid heavy activities. You may climb stairs, but do so at a slower pace. Do not strain for bowel movements.
• Gradually increase your activities until you are at your normal activity level by the end of the week.
• Carry nitroglycerin for the first 6 months
• On the average, about one in four or five blockages return to the treated coronary artery. This is called stenosis and usually occurs in the first 6 months. Restenosis is caused by the accumulation of scar tissue at the treatment site. Fortunately, it is quite rare for restenosis to cause serious problems, such as a heart attack.
• Call your doctor if you notice a return of symptoms.

If you have angina similar to before your procedure, it may be a sign your coronary artery is re-narrowing or that you have new blockages. Call your doctor as soon as symptoms occur. Symptoms may include chest discomfort, excessive shortness of breath, dizziness, irregular heartbeats, or inability to do normal activities without becoming over-tired.