What is a coronary angioplasty and how can it help?

A coronary angioplasty is also known as a percutaneous coronary intervention (PCI). It uses special wires that are passed into the blood vessels that supply your heart (coronary arteries) in order to guide and insert certain devices, most commonly balloons and metallic scaffolds called stents. 

What is a PCI used to treat?

PCI is used to treat coronary artery disease and individuals who have had a heart attack. Coronary artery disease is the leading cause of heart attacks as it causes the coronary arteries to become narrowed or blocked. 

PCI opens up the narrowed artery by passing a deflated balloon into the narrowing, which is then inflated. This pushes the blockage against the wall of the artery, improving blood flow within the artery. After the balloon procedure, a stent, which is made of metallic alloys such as cobalt, chromium and platinum, is implanted within the artery. The stent acts as a scaffold to keep the artery open and ensure blood flow to the heart remains good in the long term. 

If you have stable or chronic (long-term) coronary artery disease with symptoms of angina, but have not yet had a heart attack, PCI may reduce your chance of having a heart attack. But most importantly, it can reduce your angina symptoms which may improve your quality of life. 

If you have suffered a heart attack and are undergoing PCI following this, then the aim of the PCI is to improve blood flow to your heart to reduce damage to your heart muscle and also reduce your risk of further heart attacks in the future. This may consequently increase your life expectancy. PCI may also reduce your chances of angina recurring in the future.

What to expect during your PCI

If you have had angina for several weeks or months and drug treatments have not been effective in treating your condition, your interventional cardiologist (a doctor specialising in treating coronary artery disease) may recommend that you have a PCI procedure. This is often a day case procedure, which means you can return home on the same day as your PCI.

You will be awake during your procedure but may be offered a sedative to help you relax. A needle will be placed into the radial artery in your wrist, or into the femoral artery in your groin, through which a thin plastic tube (catheter) will be passed into your coronary arteries. You won’t feel any pain as a local anaesthetic will be applied to numb the area.

The catheter will be guided through your blood vessels into your coronary arteries and heart, with the help of X-ray images taken from multiple angles. A contrast agent will be injected via the catheter and further X-ray images taken — this will allow your doctor to see exactly where your coronary artery is narrowed. They can then insert a special wire to place the balloon and stent.

After your procedure is complete, if the catheter was passed into your body via your wrist, a wrist pressure band will be used to apply pressure to your radial artery and allow it to heal. This is normally in place for two to three hours. If the catheter was passed into your body via your groin, a collagen plug is often inserted into the artery. Whichever approach has been used, you should be up and about within four hours after your procedure and be able to go home the same day.

Is a PCI suitable for everyone?

As device technology has improved, our ability to carry out PCI procedures has expanded and we are now able to offer PCI to an increasing number of patients, even those with complex coronary artery disease. However, depending on your individual risk factors and other health conditions you have, a coronary artery bypass may remain a better option. This will also depend on several anatomical and clinical factors, which your cardiologist will discuss with you. 

Risks of having a PCI

Every surgical procedure comes with risks and for PCI, the main risks are infection or bleeding at the point where the catheter was passed into your body ie your wrist or groin. This, however, is not common, occurring in one in every 100 cases. 

If you have underlying kidney problems, there is also a risk of kidney injury due to the use of the contrast agent. However, in cases where this is a concern, PCI can be performed with very little or zero-contrast by using intravascular ultrasound imaging to guide the procedure.

In very rare cases, between one in every 500 to 700 cases, there is a risk of stroke or heart attack during a PCI. This remains rare and relates to the complexity of the arteries being treated and your other underlying health conditions.

When is repeated treatment with PCI needed?

Although PCI is a very effective treatment for coronary artery disease, in some cases, further treatment with PCI will be needed in the future. This is especially true if you have diabetes as this increases your risk of developing neointimal hyperplasia (NIH). 

NIH occurs when your body reacts to the stent placed in your coronary artery by triggering inflammation and remodelling of the walls of your coronary artery. This causes the artery to narrow again, leading to angina and in some cases, heart attacks. 

To reduce the risk of NIH, it is important to manage your other health conditions, especially if you have diabetes. This includes controlling your blood sugar levels if you have diabetes, quitting smoking and reducing high blood pressure and high cholesterol

If, for whatever reason, your coronary arteries have narrowed again, this can be treated with another PCI, where a new stent is placed inside of the previous stent.

What is the future of PCI?

Advances in engineering and technology continue to push forward treatment with PCI. There are a number of advances within the field.

The most important way of ensuring the best possible PCI result is by using intracoronary imaging, such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). Both of these technologies are well established but are not yet used widely in PCI.

In the future, robotic-assisted PCI may allow for better accuracy in placing stents and a more ergonomic environment for cardiologists to operate in. Stent technology is also continually advancing with the development of absorbable plastic stents that dissolve over time and consequently may reduce the risk of NIH.

Author biography

Dr Kalpa de Silva is a Consultant Interventional Cardiologist at Spire St Anthony’s Hospital, specialising in coronary artery disease, its prevention, diagnosis and management, including percutaneous coronary intervention (PCI). He also holds a PhD in coronary physiology from St Thomas' Hospital, King's College London and continues to be involved in cardiovascular medical research through his appointment as an honorary senior lecturer at King’s College London.