Percutaneous Coronary Intervention: Before Your Procedure
What is percutaneous coronary intervention?
Percutaneous coronary intervention (PCI) is the name for procedures to open a blocked or narrow blood vessel that gives oxygen to the heart (coronary artery). Opening the artery helps to restore blood flow to the heart. This can relieve chest pain. PCI also may help prevent a heart attack. PCI procedures include coronary angioplasty and coronary stent placement.
Angioplasty is a way to open a blocked coronary artery during or after a heart attack. It restores blood flow to your heart. It also can help prevent heart problems by widening an artery that has become narrow. This procedure also may be called balloon angioplasty.
Before an angioplasty, a doctor does a test, called a coronary angiogram, to find blocked arteries. The doctor inserts a thin, flexible tube called a catheter into an artery in your upper leg (groin) or arm. The doctor moves the catheter through that artery to the arteries on the outside of the heart and then puts a dye into the catheter. This makes your heart's arteries show up on a screen so the doctor can see any blockages or narrowing of the arteries.
If you have a blocked or narrow artery, the doctor may do an angioplasty or stent placement. The doctor uses a catheter with a tiny balloon at the tip. He or she puts it into the blocked or narrow area and inflates it. The balloon presses the fatty buildup (plaque) against the walls of the artery. This creates more room for blood to flow. In most cases, the doctor then puts a stent in the artery. A stent is a small, wire-mesh tube that presses against the walls of the artery. The stent is left in the artery to keep the artery open and to help blood flow.
The procedure may take 30 to 90 minutes. But you need time to get ready for it and time to recover. It can take several hours total. You will likely stay 1 night in the hospital.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
What happens before the procedure?
Having a procedure can be stressful. This information will help you understand what you can expect and how to safely prepare for your procedure.
Preparing for the procedure
- Bring a list of questions to ask your doctors. It is important that you understand exactly what procedure is planned, the risks, benefits, and other options before your procedure.
- Tell your doctors ALL the medicines, vitamins, supplements, and herbal remedies you take. Some of these can increase the risk of bleeding or interact with anesthesia. Your doctor will tell you which medicines to take or stop before your procedure.
- If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your procedure. Make sure that you understand exactly what your doctor wants you to do.
- You may need to stop taking certain medicines a week or more before your procedure, so talk to your doctor as soon as you can.
- You may have several tests before the procedure. These may include X-rays, blood tests, and an electrocardiogram (EKG) to check the electrical activity of your heart.
- Arrange for someone to take you to the hospital and back home after the procedure.
- You may be told to stop eating before the procedure. You will be given exact instructions for your procedure.
Taking care of yourself before the procedure
- Build healthy habits into your life. Changes are best made several weeks before the procedure, since your body may react to sudden changes in your habits.
- Stay as active as you can.
- Eat a healthy diet.
- Cut back or quit alcohol and tobacco.
- If you have an advance directive—which may include a living will and a durable power of attorney for health care—let your doctor know. If you do not have one, you may want to prepare one so your doctor and loved ones know your health care wishes. Doctors recommend that everyone prepare these papers before a procedure, regardless of the type of procedure or condition.
What happens on the day of the procedure?
- Follow the instructions exactly about when to stop eating and drinking, or your procedure may be canceled. If your doctor has instructed you to take your medicines on the day of the procedure, please do so using only a sip of water.
- Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
- Do NOT shave the procedure site yourself.
- Remove all jewelry, piercings, and contact lenses.
- Leave your valuables at home.
At the hospital or surgery center
- Bring a picture ID.
- A nurse will clean and shave the skin where the catheter will be put in.
- A nurse will put wires with pads on your chest so the doctor can see how your heart beats during the procedure.
- A small tube (IV) will be placed in a vein, to give you fluids and medicine to help you relax. Because of the combination of medicines given to keep you comfortable, you may not remember much about the procedure.
- After the procedure, pressure will be applied to the area where the catheter was put into your artery. This will prevent bleeding. A bandage may be placed on the area. The bandage will stay on your groin or arm.
- In the recovery room, the nurse will check to be sure you are stable and comfortable. It is important for you to tell your doctor and nurse how you feel and ask questions about any concerns you may have.
- If the catheter was put in your groin, you will need to lie still and keep your leg straight for several hours. If the catheter was put in your arm, your arm may be held straight with a board for several hours. The nurse may put a weighted bag on your leg or arm to help you keep it still.
- Nurses will check your heart rate and blood pressure. The nurse also will check the catheter site for bleeding.
- Your doctor will prescribe a medicine that prevents blood clots.
- You can start walking within 6 to 24 hours. You may be able to go home later the same day, or you may need to stay in the hospital overnight.
- You may have a bruise where the catheter was put in your groin or arm. This is normal and will go away.
- You will need someone to drive you home.
- Ask your doctor when you can drive again.
- You will be given more specific instructions about recovering from your procedure, including activity and when you may return to work.
When should you call your doctor?
- You have questions or concerns.
- You don’t understand how to prepare for your procedure.
- You become ill before the procedure (such as fever, flu, or a cold).
- You need to reschedule or have changed your mind about having the procedure.