I have been performing interventional cardiology
for nearly 30 years.

Procedures - Coronary Angioplasty

 

Coronary angioplasty or percutaneous coronary intervention PCI: This is a procedure that uses balloons and stents to open partly or completely blocked coronary arteries that cause heart attack and angina. The procedure starts the same as a coronary angiogram with the painless passage of tubes from the artery in the groin to the heart. Then a very thin guide wire is steered through the artery and the narrowings (see figure). Over this wire, balloons and stents are pushed through the catheter and across the narrowings. The balloons and stents stretch up the narrowing and restore normal flow down the artery. This is a very successful procedure which was first performed by performed by Andreas Grunzig in Switzerland in 1978. I first undertook this
procedure in 1983.

 

I undertake between 300 and 600 cases per year in Cambridge with career total of approximately 8000 to 10000 cases since 1983.My PCI audit data reveals more than a 98% success rate with a very low rate of complications. For stable patients , the generally accepted risk is of death in less than 1 in 500, with a lower need for emergency surgery. The longer term risk of a reoccurrence of chest pain is between 2 and 8%. The introduction in the past few years of stents with a drug coating to prevent narrowing has reduced this further.

 

There may be a little chest pain during and after the narrowing is opened up. Usually there usually no further pain but occasionally there is some residual dull aching and stabbings in the chest over the next few days. This is sometimes called ‘stent’ pain and is thought to be due to the stretching of the coronary arteries and the surrounding cardiac tissues.

 

Who needs a coronary angioplasty?

Most procedures are undertaken in patients with chest pain and who have a demonstrated narrowing of one or more coronary arteries. PCI is often used after heart attack either immediately or soon after. Some narrowings are not suitable for PCI especially if there are many or the artery has been blocked for some time.

 

These figures are the same patient as the above and shows the sequence with a fine guide wire in the artery then a balloon delivering the stent. The final video is the result showing complete relief of the blockage. the narrowed part of the artery fully open with fine metal stent in place. The guide wire is seen.

 

See also: www.nlm.nih.gov

 

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