brief explanation of PCI

1. Percutaneous Coronary
Intervention in IHD
Ladi Anudeep
ISM-IUK

2. Theme of presentation
• How does ischemic heart disease develop?
• How is ischemic heart disease treated?
• What is percutaneous coronary intervention(PCI)?
• What is balloon angioplasty?
• What is stent?
• What are the indications of PCI?
• What are the uses of PCI?
• What are the contraindications of PCI?
• What are the complications of PCI?
• How does patient recover after PCI?

3. ISCHEMIC HEART DISEASE
• Term given to heart problems caused by narrowed heart arteries.
• It is the most common cause of death in most western countries.
• The coronary arteries supply blood to the heart muscle and no
alternative blood supply exists, so a blockage in the coronary arteries
reduces the supply of blood to heart muscle.
• Most ischemic heart disease is caused by atherosclerosis.
• The narrowing or closure is predominantly caused by the covering of
atheromatous plaques within the wall of the artery rupturing, in turn
leading to a heart attack.
• It is usually felt as angina, especially if a large area is affected.

4. Treatment of ischemic heart disease
Drugs
• Cholesterol-modifying medications
• Aspirin
• Beta blockers
• Nitroglycerin
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II
receptor blockers (ARBs)

6. Percutaneous coronary intervention
• Percutaneous means "through unbroken skin."
• Percutaneous coronary intervention is performed by
inserting a catheter through the skin in the groin or arm
into an artery.
• Percutaneous coronary intervention is a non-surgical
method used to open narrowed arteries that
supply heart muscle with blood (coronary arteries).
• At the leading tip of this catheter, several different
devices such as a balloon, stent, or cutting device
(atherectomy device) can be deployed.

8. Balloon angioplasty
• Balloon angioplasty employs a deflated balloon-tipped narrow
catheter that is inserted through the skin of the groin or arm
into an artery.
• The catheter is threaded through the artery until it arrives in
the coronary artery where there is narrowing or blockage.
• The catheter tip is then inserted through the narrowed area.
• Once in the narrowed area, the balloon is inflated, mashing the
plaque into the vessel walls to reduce the narrowing
• The balloon is then deflated and the catheter removed. The
process is viewed by injecting a dye that allows the cardiologist
to view the flowing blood as it goes through the arteries.
• This viewing method (angiogram) can be used to assure that
the artery has increased blood flow after the balloon is deflated
and removed.

10. Stent
• A stent is an extendable metal scaffold that can be used to
keep open previously narrowed coronary arteries after
angioplasty has been performed.
• The mechanism used to place the stent in a narrowed or
blocked coronary artery is very similar to balloon angioplasty.
• The difference is that the un-extended or collapsed stent
surrounds the balloon.
• The stent surrounding the balloon is expanded when the
balloon is inflated
• After the stent surrounding the balloon extends, it locks into
place against the plaque/arterial vessel wall.
• The stent stays inside the artery after the balloon is deflated.

11. • Stents are useful because they keep the coronary artery open when
the balloon is deflated, preventing most arteries from narrowing
again (termed elastic recoil) after the balloon is deflated.
• Recurrent narrowing (restenosis) sometimes may still occur after the
stent is placed due to formation of scar tissue.
• The newest stents are termed drug-eluting stents.
• These stents are covered in a drug that slowly comes off the stent and
prevents cell proliferation (scarring or fibrosis) at the stent site more
effectively than uncoated, bare-metal stents.
• There are many other stents beside coronary stents that are used for
various other arteries and tissues.
• These include carotid artery stents (for stroke prevention), femoral
artery stents, prostatic stents, esophageal stents, and many others.

14. Procedure
• Pci is done via percutaneous femoral, radial, brachial artery puncture
• Radial approach is technically demanding comparative femoral approach
but may reduce patient discomfort, improve time to ambulation and
reduce the incidence of some complications(e.g.bleeding)
• A guiding catheter is inserted into a large peripheral artery and threaded to
appropriate coronary osteum
• A balloon tipped catheter, guided by fluoroscopy or intravascular
ultrasonography, is aligned with in the stenosis, then inflated to disrupt the
atherosclerotic plaque and dilate the artery
• Angiography is repeated after the procedure to document any changes
• This procedure is commonly done in two or three vessels as needed.

16. Uses of PCI
• PCI is used primarily to open a blocked coronary artery
• PCI may be the best option to re-establish blood flow as well as prevent
angina (chest pain), myocardial infarctions (heart attacks) and death.
• The use of stents has been shown to be important during the first three
months after PCI; after that the artery can remain open on its own.
• Reduce the number of patients with angina attacks for up to 3 years
• In patients with severe blockages, such as ST-segment elevation myocardial
infarction (STEMI), PCI can be critical to survival as it reduces deaths,
myocardial infarctions and angina compared with medication.

19. Patients recovery after PCI
• Patients are often discharged within 24 hours after percutaneous
coronary intervention and are cautioned not to do any vigorous
activity or lift over about 20 lbs for about one to two weeks.
• Patients are treated with blood thinning anti-platelet agents such
as clopidogrel bisulfate (Plavix) and aspirin.