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Oxford University Hospitals NHS Foundation Trust
Cardiothoracic Services

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Percutaneous Coronary Intervention (PCI)

Percutaneous coronary intervention (sometimes called Primary PCI, PTCA, angioplasty or stenting) is a technique for treating narrowing of the coronary arteries. It helps improve your blood supply to the heart muscle and can help to relieve angina symptoms.

If you need this procedure you will first have an angiogram. Sometimes the angioplasty is done at the same time as the angiogram, if the location and type of narrowing suggest this is the best treatment. However, you may need extra tests or information to decide the best course of action.

During angioplasty, a catheter - a fine, flexible, hollow tube - with a small inflatable balloon at its tip, is passed into an artery in either your groin or your arm. The balloon will then be inflated so that it squashes the fatty tissue in the narrowed artery, allowing the blood to flow more easily.

A stent
A stent

A stent is usually put in place to reduce the risk of re-narrowing - this is a small tube of stainless steel mesh which acts as 'scaffolding'. As the balloon is inflated, the stent expands so that it holds open the narrowed blood vessel. The balloon is let down and removed, leaving the stent in place.

If you have a stent, you will need to take certain drugs to help reduce the risk of blood clots forming round the stent. You will be advised about this by the team.

Primary angioplasty

Angioplasty is sometimes used as an emergency treatment for people who have had a heart attack. A heart attack is caused by a blocked artery and it is very important to open the artery as quickly as possible and restore the blood supply to the heart.

This emergency procedure is available 24/7 at the Oxford Heart Centre. The procedure is similar to an angioplasty, but because the patients are having a heart attack they may need extra equipment to help the heart pump, for example a balloon pump, or rhythm, such as a temporary pacemaker. Patients will usually stay in hospital for two to three days after this procedure.

Benefits

The majority of procedures result in a successful outcome. In cases where the procedure is unsuccessful, usually no harm is done and the patient is no worse than before.

After a successful procedure most patients begin to feel a benefit and this continues over the following months.

Risks

The procedure is safe and the risk of serious complication is less than two percent.

Risks vary for each person and important factors include:

  • age, degree of heart disease, and other medical conditions e.g. diabetes or kidney failure
  • situation: procedures have greater risk in emergency cases, recent heart attacks or when angina is unstable and occurring without exercise
  • the treatment of more than one narrowing or blockage during the same procedure, the treatment of arteries that are totally blocked (rather than just narrowed) and narrowings at a place where the artery divides/forks.

What are the risks?

  • In 5-10 percent of patients re-narrowing of the artery can occur over the next year. This is called restenosis, and is related to the healing of the artery. This happens by chance and does not relate to the quality of the original procedure. It can usually be treated with a repeat procedure.
  • In less than one percent of patients damage can occur to the artery in the leg or arm where the tubes are inserted. This can cause excessive bleeding or blockage and may require an operation to correct. Generally local bruising is the main risk and occasionally blood transfusion is all that is required.
  • In two to three percent of patients problems are caused by damage to the heart muscle supplied by the artery being treated. This can be caused by closure of small branch vessels or the release of blood clot or debris. There are not usually long term consequences.
  • In less than one percent of patients damage to a major coronary artery causes it to suddenly narrow or block. This can cause heart attack and may require treatment with an emergency coronary artery bypass operation.
  • In less than one in 200 patients an abnormal heart rhythm develops. In rare circumstances this may lead to loss of consciousness and treatment may be necessary with drugs or electric shock.
  • In less than one in 1000 patients one of the heart chambers or heart arteries is perforated, leading to a collection of blood around the heart. This may require drainage via a tube placed below the breastbone, or an operation.
  • The contrast dye used to visualise the heart arteries very occasionally causes kidney function to deteriorate. This is more likely in patients who have abnormal kidney function before the procedure. It usually resolves with time.
  • The contrast dye may also cause nausea or a skin rash but symptoms usually clear up by themselves.
  • In less than one in 400 patients there is a stroke.
  • In less than one in 400 patients there is a death, although this is more likely in an emergency rather than a planned procedure.

Figures quoted here are average figures for all cases. Your cardiologist will discuss your case with you before the procedure.

The department where your procedure will take place regularly has visitors. Most of these are healthcare professionals, qualified or in training. Sometimes there will be work experience students and specialist company representatives. If you do not wish visitors to be present during your procedure, please tell the team.