Coronary artery disease is one of the leading forms of heart disease and in severe cases leads to a heart attack. Coronary artery disease is a chronic disease that progresses over time, a fatty substance called plaque builds up in the blood vessels that supply your heart with oxygen. Over time your blood vessels become narrowed or in severe cases blocked. The narrowing or blocking of your arteries reduces the amount of oxygen that can reach your heart muscles leading you to experience symptoms of coronary artery disease (usually chest pain or shortness of breath).
Procedures
Percutaneous Coronary Intervention (PCI) – Stenting
Why has my cardiologist recommended Percutaneous Coronary Intervention (PCI)?
Patients who are experiencing chest pain or shortness of breath during exercise will often have a coronary angiogram to diagnose the severity of their disease. If the angiogram shows that you have a severely narrowed artery or arteries, the next step is often to perform PCI to open the artery up, allowing blood flow and therefore oxygen supply to your heart muscle to increase.
Percutaneous Coronary intervention (PCI) is a procedure that opens narrowed or blocked arteries, using small metal scaffolds (known as stents), helping to keep the artery open and reduce the symptoms you’re experiencing.
What is Percutaneous Coronary Intervention (PCI)?
Percutaneous coronary intervention (often referred to as stenting) is a procedure that is performed after a coronary angiogram when a severely narrowed or blocked heart vessel is found.
Why have I been referred to a different cardiologist for this procedure?
Western Cardiology follow a sub-specialisation model of care, this means that your procedure will be performed by a cardiologist who has undertaken extensive additional training in one area of cardiology. This style of practice has been shown to offer improved outcomes for patients, including:
- Reduced complication rates.
- Reduced re-admission rates to hospital.
- Reduced length of stay in hospital.
- Reduced mortality.
What should I expect during a Percutaneous Coronary Intervention?
At Western Cardiology all of our procedures take place at St John of God in Subiaco. The procedure takes place in a specially designed cardiac procedure room (known as ‘the cath lab’). During the procedure you will be awake, but for your comfort our team will give you a medication to help you feel relaxed (a sedative) and inject the puncture site in the wrist or groin with a local anaesthetic to numb the area.
Your cardiologist will then:
- Make a small puncture in either your wrist or groin and gently insert a cardiac catheter, a thin plastic tube.
- Slowly move the catheter up to blood vessel to your heart
- Inject a small amount of X-ray dye into the coronary arteries
- Take X-rays as the dye moves through the blood vessels on the surface of your heart, this shows areas that have become narrowed or blocked
- Insert a catheter with a small balloon into the narrowed or blocked area, your cardiologist will inflate and deflate the balloon a few times. This may feel slightly uncomfortable
- Insert a stent, using the balloon to open the wire mesh of the stent device in the narrowed or blocked artery, keeping it open and increasing the flow of blood.
- Deflate the balloon and remove the catheter.
You should expect the procedure to take less than an hour.
How should I prepare for Percutaneous Coronary Intervention?
You will need to have bloods taken before you have your procedure to check how well your kidneys are functioning
Your cardiologist may request that you stop taking some of your medications before the procedure, especially blood thinners or SGLT2 inhibitors used to treat diabetes and heart failure.
Before the day of the procedure, please register with St John of God Subiaco Hospital admissions at www.sjog.org.au/myadmission and complete the online Admissions Form and follow their instructions. If you require any assistance please call 1300 863 566.
On the day of your procedure please bring in your Medicare card, private insurance details, and all your current medications. You will have receive further details about where to present to on the day.
What are the risks associated with a Percutaneous Coronary Intervention?
A PCI or stenting is a safe, common procedure, performed by one of our highly trained interventional cardiologists.
All procedures carry a small level of risk, commonly you may experience bruising or swelling at the puncture site used by your cardiologist to access your blood vessel.
Uncommonly PCI may be associated with:
- Allergic reaction to the X-ray dye and medications given during the procedure
- Restenosis – Re-narrowing of the coronary artery – Your cardiologist will prescribe lifestyle changes and medications to reduce this risk.
- Thrombosis – Blood clots inside the stent – Your cardiologist will prescribe some medications known as anti-platelets to reduce this risk.
- Bleeding from the artery used to perform the procedure or in rare cases, from the coronary artery.
- Abnormal heart rhythms, called arrhythmias.
- Injury to the artery the catheter moves through.
- Changes to your kidney function.
- Acute heart attack or stroke.
- Emergency heart surgery or death following this procedure is rare.
Your individual risks will be discussed by your cardiologist before the procedure. They will depend on your age, your other medical conditions and other factors.
Aftercare requirements
Following your PCI or stenting you will be moved to the recovery area or the cardiology ward to rest. You may feel a little tender at the site of the catheter insertion and have some temporary bruising.
You may be required to stay overnight following your procedure.
You will not be able to drive for the following 24 hours so it is advisable that you arrange to be collected from the hospital.
You will need to take two blood thinners (aspirin and another blood thinner, usually either ticagrelor or clopidogrel) for a period of time afterwards (to be advised by the cardiologist but usually 1 – 12 months).
Coronary artery disease is a chronic condition that requires lifelong medication and lifestyle changes to reduce your risk of future events. A follow up appointment will be arranged with one of our cardiologists to review your management plan following your procedure.