Treatments: Percutaneous Coronary Intervention (PCI)

What is balloon PCI?
Why would a doctor recommend PCI?
What does a PCI involve?
How long is the recovery after a PCI?

What is balloon angioplasty?

Balloon angioplasty uses a tiny balloon to open a narrowed artery and improve blood flow to or from the heart.

Often a stent—a small tube made of metal mesh—is put in the artery to prevent it from re-narrowing. Balloon angioplasty is done at Dartmouth-Hitchcock Medical Center's Catheterization Lab.

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Why would a doctor recommend balloon angioplasty?

As you age, your arteries can become clogged from a buildup of fats, cholesterol, and other substances, reducing your heart's ability to deliver blood. This narrowing of the arteries, or arteriosclerosis, can cause many heart problems, including:

Balloon angioplasty can open an artery that isn't clogged beyond repair. It is less traumatic and less expensive than coronary artery bypass graft surgery.

It is also used to treat narrowing in the arteries that supply the kidneys and the brain, and the arteries that carry blood to the far reaches of your body—your arm and leg muscles, and the organs in and below your stomach area.

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What does a balloon angioplasty involve?

With the patient awake and under local pain medicine, the doctor inserts a thin, flexible tube (catheter) in an artery, usually near the patient's groin. Using an X-ray camera, the doctor guides the catheter to the site of the narrowed artery.

The doctor then injects a harmless dye into the artery, and takes an angiogram, or picture of the artery. This helps the doctor see the exact size and place of the blockage.

Using a guidewire, the doctor threads another catheter to the site of the blockage. In balloon angioplasty, the catheter has a tiny, deflated balloon at its tip. When the doctor inflates the balloon, it makes the artery bigger, and compresses the build-up inside the artery.

In many cases, the doctor places a narrow metal tube, or stent, inside the artery to keep it from closing. Newer drug-eluting stents slowly release medication that help keep the blood vessel from reclosing. At times, a doctor will use a distal protection device—a kind of filter—to block loosened fatty deposits and other material from entering the bloodstream.

The balloon is then deflated and the catheter removed. The procedure usually takes 1-1/2 to 2-1/2 hours.

Other types of angioplasty use lasers or small blades to open the artery, instead of a tiny balloon.

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How long is the recovery after a balloon angioplasty?

Patients often can walk within six hours after the procedure. Most patients spend the night in the hospital, return home within a day or two, and go back to work within a few days.

Patients with stents should not do strong exercise for 30 days. They will be advised to take aspirin indefinitely, and a platelet-blocking drug for 10-12 months.

In a small percentage of patients, the opened artery narrows again within six months after the procedure. These patients may need another angioplasty, or coronary artery bypass surgery. The likelihood of a re-narrowing depends on a number of factors, including the diameter of the artery, the length of artery fixed, and the device used. In general, balloons alone are associated with a 40% return blockage rate, standard stents a 20% return rate, and drug-eluting stents about a 5% return blockage rate.

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