Percutaneous Coronary Intervention: How It Can Help Your Heart
Like all of your muscles, your heart needs a steady supply of oxygen-rich blood to remain healthy. But if there’s blockage in a coronary artery—a blood vessel that supplies blood to the heart—the result can be a heart attack. Even if blood flow is partially reduced, you can experience angina—episodes of chest pain resulting from insufficient blood flow to the heart. If your heart arteries can’t provide enough blood to your heart, you have coronary artery disease (CAD).
Restoring better circulation to the heart used to require open-heart surgery, during which a blood vessel from elsewhere in the body is grafted onto the heart to reroute blood flow around a blocked artery. Although this type of surgery is still used, for some patients, another procedure called percutaneous coronary intervention (PCI) can open up blocked arteries.
Less invasive alternative
When PCI is performed, a doctor inserts a long, flexible catheter into an artery in the groin or the wrist and threads it up to the heart. At the tip of the catheter is a tiny deflated balloon. When the tip reaches the area of blockage, the balloon is inflated, and the fatty plaque that forms the blockage is pushed away from the center of the artery to its walls. This procedure is referred to as angioplasty. Sometimes, a flexible wire mesh tube called a stent is left in place to help keep the artery open.
Usually, a person diagnosed with blockage in a coronary artery is first treated with medications and en-couraged to make lifestyle changes that involve exercise, a healthier diet, and smoking cessation. But Weill Cornell interventional cardiologist Dmitry Feldman, MD, says that medical therapy is often not enough.
“Not infrequently, despite optimal medical therapy, patients with angina will continue to have symptoms, or they may even experience worsening symptoms over time,” he explains. “For such patients, PCI can be extremely effective at relieving symptoms.”
IF YOU RECEIVE A STENT…
Depending on the type of stent that is inserted, you may require aspirin therapy and an additional medica-tion, such as clopidogrel (Plavix), to help prevent platelets from clumping and keep blood flowing through the stent.
“It is very important for patients to take these medications, as, in rare cases, when medications are omitted, a clot can form inside the stent and lead to a heart attack,” Dr. Feldman says.
Once the stent is placed, the recovery period is usually brief, and, within several days, most patients are able to resume normal activities and can expect relief of their prior symptoms. If multiple arteries are blocked, additional stenting may be required in the future to relieve those blockages.
“Once the blockage is taken care of with a stent, it is extremely important to continue taking care of major risk factors, such as smoking cessation, diet, weight loss, and managing diabetes, hypertension, and hyperlipidemia (unhealthy cholesterol levels) in order to prevent new blockages from developing in the future,” Dr. Feldman adds.
The need for PCI
Determining when PCI is necessary is a complex decision that takes into consideration standard treatment guidelines, as well as the individual patient’s condition.
Among the factors that must be considered is the severity of a patient’s symptoms, Dr. Feldman says. If angina episodes are becoming more frequent and/or more severe, PCI may be appropriate. A patient with angina will often take a stress test, which can help a physician see the extent of any CAD, how well the heart tolerates exercise, and how well the heart’s valves and blood vessels are working. Dr. Feldman says that if it appears that a large area of the heart is not receiving a sufficient blood supply, PCI may be the best course
of action.
In addition, patients who do not tolerate angina medications, which include ACE inhibitors, calcium channel blockers, beta blockers, aspirin, and nitrates, such as nitroglycerin, may need to undergo PCI.
When PCI isn’t appropriate
Patients who respond to medical therapy and whose symptoms are completely relieved by medications won’t usually be recommended for PCI, Dr. Feldman says.
Weill Cornell cardiologist Joy Gelbman, MD, adds that a patient with CAD, but no obvious symptoms, is likely to be kept on medications.
“We generally reserve angioplasty and stenting for patients with symptoms suggesting unstable disease,” Dr. Gelbman says.
If you have stable angina—when chest pain begins only after a certain threshold of physical activity has been reached—you may be discouraged from PCI. Even if the blockage in one coronary artery is 60 to 70 percent, your heart can still function healthily. When the percentage is higher, some type of intervention is then considered.
However, blockages in multiple arteries, particularly in patients with diabetes, may be better treated with bypass surgery than PCI. Patients with stable CAD who also have valvular problems that need to be addressed with cardiac surgery may be better candidates for a single surgery that can treat both issues during one pro-cedure, advises Dr. Feldman.
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