Percutaneous Coronary Intervention — Procedure Guide, Recovery & Risks | MyMedicPlus

Percutaneous coronary intervention (PCI, formerly angioplasty) is a catheter-based procedure to restore blood flow through obstructed coronary arteries. A balloon expands the blocked segment and a drug-eluting stent (DES) is deployed to prevent re-narrowing. It is used for stable angina and acute coronary syndromes including STEMI.

PCI is indicated for STEMI (within 90 minutes of first medical contact), NSTEMI or unstable angina with high-risk features, stable angina with obstructive disease causing symptoms or ischaemia on non-invasive testing, and restenosis of a prior stent. Suitable for single-vessel or selected two-vessel disease.

Via radial artery access (preferred) or femoral artery, a guiding catheter is advanced to the coronary ostium under fluoroscopy. A guidewire crosses the stenosis; a balloon catheter inflates to dilate the plaque. A drug-eluting stent is deployed and post-dilated to ensure full apposition. The sheath is removed and haemostasis achieved with a radial compression band.

Radial access allows same-day mobilisation. Most patients are discharged within 1–2 days. Dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel, ticagrelor, or prasugrel is prescribed for 6–12 months to prevent stent thrombosis. Driving resumes at 1 week for stable PCI.

Complications include access-site bleeding (radial less than femoral), contrast nephropathy (1–3%), coronary artery dissection (under 1%), stent thrombosis (under 1% at 30 days with DAPT), restenosis (5–10% with DES), and stroke (under 0.3%). Emergency CABG is required in under 0.2% of elective PCIs.

PCI relieves angina symptoms in over 90% of patients. Primary PCI for STEMI reduces 30-day mortality by 25–30% compared to thrombolysis. Drug-eluting stents achieve 5-year target lesion revascularisation rates under 8%. For single-vessel disease, PCI outcomes are equivalent to CABG for survival.