Restoring Blood Flow to the Heart with PCI
to the Journal By
Malcolm Brand, MD
Medical Center has received approval from the New York State Department of
Health to offer percutaneous cardiac intervention (PCI). This 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 will significantly enhance local cardiac care services.
does a doctor determine that PCI is needed?
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.
happens during PCI?
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
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.
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.
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.
long is the hospital stay?
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
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.
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.
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.