Percutaneous coronary intervention

Percutaneous coronary intervention (PCI) is now the dominant method for mechanically improving myocardial perfusion in the treatment of coronary artery disease. The procedure is performed via a small intra-arterial sheath and usually involves a single overnight stay in hospital. Day-case treatment is now possible in many cases. A balloon is used to dilate the coronary stenosis and a stent then implanted to scaffold the vessel. Renarrowing at the treated site may occur owing to neointimal proliferation but stents with drug-eluting coatings have profoundly reduced this problem. Most acute complications of PCI are mediated by platelet activation, so that appropriate drug combinations that block platelet aggregation are critical to the safety of the procedure and later outcomes. Early complications include haemorrhage from the arterial access site, abrupt vessel closure and cardiac tamponade. The requirement for emergency CABG is now about 0.1% and in hospital mortality about 1%. Technical advances mean that patients with ever more complex coronary artery disease can now be safely treated by PCI.