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Percutaneous Coronary Intervention (PCI, Coronary Angio)

Last updated 20.09.12

 

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Index

 

Definition

-  Imaging under fluoroscopy to assess the patency of the coronary vessles

 

Features

-  Results determine management

-  +/- angioplasty: ballooning & stenting

-  Performed with patient conscious

-  Sedative may be used

-  May involve angioplasty +/- stenting

-  May be perfomed as day procedure

-  Typically preceded by ECG, cardiac enzymes & CXR +/- EPS

 

Indications

-  Coronary Artery Disease (CAD)

-  AMI: acute management with PCI (Angioplasty..)

-  Assessment of chest pain

 

Procedure

-  Must be fasted 12 hrs prior

-  Cease anticoagulants

-  If on Warfarin change to Enoxaparin & wait for INR < 1.5

-  Cease Enoxaparin 6 hrs+ prior

-  Peripheral IV cannula

-  Site shaved & cleaned (betadine)

-  Inguinal or Arm

-  Local anaesthetic

-  18G Cook needle into artery (modified Seldinger technique)

-  Wire through Cook needle

-  Cook needle removed & sheath placed over wire

-  Wire removed

-  Cardiac catheter into artery

-  Femoral artery (typical)

-  Radial artery

-  Radiolucent dye injected through aorta into coronary vessles

-  Dye may cause transient paresthesia/warmth (10-15 sec)

 

Results

-  Chamber pressures

-  Artery patency

-  Described as % diseased

-  Triple vessel disease

-   RCA, LCx, LAD: CABG

-  2 vessel disease

-   RCA + LCx: CABG or PCI

-   RCA + LAD: CABG

-Single vessel disease: PCI

-  Dominance determined by vessel which supplies PDA (Post Descending Artery) (supplies AV node)

-RCA (Right Coronary Artery) 80%, LCx (Left Circumflex) 10%, Co-dominance 10%

 

 

 

 

 

Complications

-  AMI, stroke

-  Ruptured vessels from catheter

-  Conversion to emergency CAGB

 

Post-op

-  Bed rest

-  Analgesia

-  Assess angio site

-  Bleeding, haematoma

-  Abdo pain: intrabdo bleed

-  Ipsilateral lower limb

-  Peripheral pulses

-  Perfusion, temp

 

 

 

References