Restoring Blood
Flow to the Heart with PCI
By Malcolm Brand,
MD
Percutaneous
cardiac intervention (PCI) is a technique for going inside a blocked cardiac
artery to remove the blockage and restore the flow of blood to the heart. The
ability to offer this procedure at the Cayuga Heart Institute significantly
enhances local cardiac care services.
How does a doctor
determine that PCI is needed?
A blocked
coronary artery is diagnosed during a cardiac catheterization. This diagnostic
test allows an invasive cardiologist to look inside the heart to evaluate the
presence of blockages, to measure the pressure in the heart, and to evaluate
the heart’s pumping function.
What happens
during PCI?
In the majority
of cases when a cardiac catheterization reveals that a patient needs PCI, an
interventional cardiologist simply proceeds with PCI. This is done for patient
convenience because it saves the patient from having to undergo two separate
procedures. However, it is safe for a cardiac catheterization to be performed
in one hospital and then to have the PCI performed elsewhere.
In explaining PCI
to patients, I sometimes make the analogy of a four-lane highway. If three
lanes of the highway are blocked with a car accident, there are two choices:
the cars blocking the road can either be pushed to the side, or a new road can
be constructed that goes around the blockage.
PCI, which is
also called “balloon” angioplasty, pushes aside the blockage in the coronary
artery to restore blood flow. During PCI, the cardiologist carefully places an
extremely fine wire into the artery. This guide-wire is advanced through the
arterial blockage and comes out on the other side. Using the wire as a guide,
the doctor inserts a balloon into the spot in the artery of maximum blockage. The
balloon is then inflated, which pushes the blockage aside.
The first balloon
is removed and a second balloon, wrapped in a stent, is inserted into the
artery. The stent is made up of finely woven wire in a cylindrical shape. When
the second balloon expands, it opens the stent, which moves up against the side
of the artery and remains there to hold the blockage aside while the artery
heals.
How long is the
hospital stay?
PCI is performed
under local anesthesia and takes an average of 30-45 minutes. Following PCI,
the patient goes to recovery and then to the Intensive Cardiac Care Unit for
observation. When PCI is performed as an elective procedure on a patient who is
not having a heart attack, it usually entails a one-night hospital stay. When
PCI is performed in an emergency situation during a heart attack, the patient
stays until the evaluation is complete, which may be a few days.
Are there risks?
Not only are the
risks exceedingly low for a life-threatening complication, but also during an
acute heart attack an emergency PCI has statistically better outcomes than
other treatments, such as clot-busting drugs. For these reasons New York State
has determined that PCI is safe enough to be performed at those community
hospitals with well-established cardiac catheterization labs and good track
records for comprehensive, high quality cardiac care programs.
With the approval
of NYS, the Cayuga Heart Institute is preparing to offer PCI by early in 2011.
This is great for local cardiac care because it will save lives.
Dr. Brand is
board certified in internal medicine, cardiovascular disease, and nuclear
cardiology. He is director of the cardiac catheterization program at Cayuga
Medical Center and is a Fellow of the American College of Cardiology. He can be
reached at Ithaca Cardiology Associates at (607) 272-0460.
