A percutaneous coronary intervention (sometimes referred to as “coronary angioplasty”) is a procedure to stretch one or more narrowings in your coronary arteries. If successful, this may reduce risk of angina and may decrease your risk of suffering a heart attack.
The coronary intervention will be performed in a theatre with x-ray equipment. You will be awake during the procedure, but if you wish you can be given an injection to make you feel more relaxed.
The wrist or groin will be ‘frozen’ with local anaesthetic and a short tube called a sheath will be inserted. A catheter (long hollow tube) will be passed through this sheath up to your coronary artery.
Then a fine wire will be guided through the narrowing in the artery and a balloon will be passed over the wire and inflated (balloon angioplasty). During the inflation you may experience some chest discomfort, although this is usually short-lived.
After balloon angioplasty, it is common for a stent (wire mesh) to be placed at the narrowing and pressed into the wall of the artery, reducing the chance of the vessel re-narrowing (see coronary stenting). Even with a perfect result there can be a small chance of the area re-narrowing again (restenosis) within the first 6 months although if this occurs it can usually be treated with a further procedure
After the procedure...
The sheath will be removed from your wrist or groin and pressure applied or a plug inserted to stop it bleeding. You will have to remain resting in a bed or special lounger for approximately 6 hours.
Outcomes and complications
Success rates are >90% and in the majority of cases there are no complications. However, there is a small risk of damaging one of the coronary arteries. If the artery blocks completely during the procedure it may result in a heart attack (<1 in 200 cases). However, it is usually possible to repair the damaged vessel using a coronary stent. Rarely, it is not possible to repair the vessel and emergency coronary artery bypass surgery is required (<1 in 1000 cases). In routine procedures the risk of the risk of death is small (1 in 1000 cases) and the risk of stroke is <1 in 1000 cases. It is not uncommon to develop bruising at the wrist or groin which will resolve with time. However, occasionally the small hole created in the wrist or groin artery does not heal properly and further treatment or occasionally local surgery may be required (1 in 500 cases).
Following discharge there is a small risk (less than 1 in 100) of a blood clot forming in the stent. If you develop prolonged chest pain you should seek medical attention immediately. In order to reduce the risk of this ‘stent thrombosis’ you are usually required to take both aspirin plus a second blood thinning tablet (e.g. clopidogrel, prasugrel or ticagrelor) each day for at least 1 year. The exact time will be detailed on your discharge letter. Combining these drugs slightly increases your risk of bleeding therefore you should report any unexpected bleeding to your GP. It is best to avoid demanding activities such as heavy lifting for 1 week. If your wrist or groin should suddenly become painful or swollen you should seek medical advice. There is a statutory requirement that you do not drive for 1 week. If you hold a LGV or PSV licence you should not drive for at least 6 weeks and must first perform a satisfactory treadmill test before resuming driving.