Percutaneous coronary intervention (PCI), commonly called coronary stenting, is a procedure to open a narrowed or blocked coronary artery. A balloon is inflated at the site of the narrowing and a small mesh tube (a stent) is placed to keep the artery open. Modern stents are drug-eluting, which reduces the risk of re-narrowing.
When it is indicated
PCI may be recommended for:
- Acute heart attack (urgent, often within hours)
- Unstable angina that has not settled with medication
- Stable angina that limits daily life despite optimal medical therapy
- Selected patients with high-risk anatomy on imaging
The procedure
PCI is usually performed at the same time as diagnostic angiography, through the same wrist or groin access. After the artery is imaged and the lesion characterised, a guidewire is advanced across the narrowing, the balloon and stent are positioned, and the stent is deployed. Specialised techniques such as intravascular imaging (IVUS or OCT) and pressure-wire assessment are used to plan and verify the intervention.
Risks
PCI carries the risks of coronary angiography, plus risks specific to intervention: damage to the artery during stent placement, in-stent thrombosis, restenosis (re-narrowing) within the first year, and the need for emergency bypass surgery in rare cases. Bleeding risk is increased by the antiplatelet medications used after the procedure.
Recovery and medications
Most patients stay in hospital overnight and return to light activity within a few days. Dual antiplatelet therapy is required for a defined period after the procedure (usually 6 to 12 months, sometimes longer), followed by single antiplatelet therapy long-term. Adherence to these medications is important to reduce the risk of stent thrombosis.