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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.








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