Percutaneous Coronary Intervention (PCI)

Percutaneous coronary intervention (PCI) refers to a family of minimally invasive procedures used to open clogged coronary arteries (those that deliver blood to the heart). By restoring blood flow, the treatment can improve symptoms of blocked arteries, such as chest pain or shortness of breath. UCSF interventional cardiologists, who are highly skilled and experienced in using the latest techniques and devices, are able to use PCIs to fix the most complex coronary artery blockages, even chronic total occlusions.

In a PCI, the doctor reaches a blocked vessel by making a small incision in the wrist or upper leg and then threading a catheter (a thin, flexible tube) through an artery that leads to the heart. The doctor uses X-ray images of the heart as a guide to locate the blockage or narrowed area, and then uses the most appropriate PCI techniques to open the vessel.

Procedure

At UCSF, we offer a range of PCI procedures, tailoring them to meet individual needs and to optimize outcomes. All are performed in our cardiac catheterization labs, which are equipped with state-of-the-art technologies and equipment.

Balloon angioplasty. This is the basic PCI procedure. A catheter with a tiny, folded balloon on its tip is threaded through a blood vessel until it reaches the site where plaque buildup is causing a blockage. At that point, the balloon is inflated to compress the plaque against the walls of the artery. This widens the passageway, restoring blood flow to the heart. The balloon is then deflated and removed.
Angioplasty with stent. Generally, as part of the balloon treatment, we place a stent (a tiny mesh tube) in the problem area to keep the artery open after the balloon is removed. A small wire is advanced through the blockage, and a balloon catheter covered with a stent is advanced over the wire to the blockage site. Inflation of the balloon expands the stent. Once the plaque is compressed against the artery wall and the stent is in place, the balloon is deflated and withdrawn. Most stents now come with coatings that slowly release special drugs that prevent the growth of scar tissue in the artery, further ensuring good blood flow and reducing the need for future treatment.
Rotational atherectomy. For patients who have particularly tough blockages, our doctors use a special catheter-based tool to drill out calcified plaque deposits.
Impella-supported PCI. For patients at high risk of complications or with severe heart disease, a tiny device called the Impella heart pump can be temporarily inserted through the skin and into the heart to assist its pumping function during the procedure. This ensures that blood flow to critical organs is maintained.

What to expect

Before the procedure

Shortly before your procedure, you may receive a sedative to help you relax. For most PCIs, patients are sedated but not asleep.
Your hair may be clipped in the area where a catheter will be inserted, such as the groin or wrist.
An intravenous (IV) line is placed, allowing us to give you medications quickly, if necessary.
Electrodes will be placed on your body to monitor your heart, and a small device called a pulse oximeter may be clipped on a finger or ear to track the oxygen level in your blood.

During the procedure

A PCI may take anywhere from one hour to three hours, depending on complexity.
You will lie on your back on a procedure table. A local anesthetic (a medication that temporarily blocks pain signals) will be injected at the site where the catheter will be inserted.
When the catheter reaches your heart, a contrast dye – a harmless solution that shows up well in medical imaging – will be injected, so that doctors can clearly see the vessel’s narrowed area on an X-ray. The doctors will then perform whichever type of PCI is best for your condition.
When finished, the catheter will be withdrawn and pressure applied to the insertion site to stop the bleeding. If the catheter was inserted through your groin, you’ll need to stay flat on your back and keep your leg straight for several hours. If the catheter was inserted in your arm, it will be elevated on pillows and kept straight with a stabilizing board.

After the procedure

We’ll take you to a recovery room for several hours of observation. You'll need to stay in bed for two to six hours, depending on your condition and the type of PCI you had.
You may experience mild pain or an ache in your chest. If the discomfort is too much, we can give you pain medication.
You’ll be encouraged to drink water and other fluids to help flush the contrast dye from your body.
Some patients spend the night in the hospital for observation, some go home the same day. Your doctor will decide which option is best for you. If you go home the same day, you’ll need someone to drive you home. You should not operate a motor vehicle for 24 hours after the procedure.

At home

When you return home, keep an eye on the insertion site. A small bruise is normal, but contact your doctor for advice if you experience any of the following symptoms:

Increased pain
Redness
Swelling
Bleeding or discharge from the insertion site
Fever or chills

You may shower 24 to 48 hours after the procedure. For five days, avoid activities that involve lifting and pulling with the wrist. During this time, there should be no strenuous exercise; playing sports, such as golf; household chores, such as vacuuming; or demanding physical tasks, such as moving furniture.

A week after your procedure, you can resume activities of moderate intensity. In fact, moderate physical activity (such as walking, swimming or using a stationary bike) at least five days a week is recommended to strengthen your heart. You may want to ask your doctor whether cardiac rehabilitation – a customized exercise and education program for improving your health – is an option for you.