Percutaneous (per-ku-TA-ne-us) coronary intervention (PCI), commonly known as coronary angioplasty (AN-jee-oh-plas-tee) or simply angioplasty, is a non-surgical procedure used to open narrow or blocked coronary (heart) arteries.
Percutaneous means “through the skin.” The procedure is done by inserting a thin flexible tube (catheter) through the skin in the upper thigh or arm in the artery. The procedure restores blood flow to the heart muscle.
As you age, a waxy substance called plaque (plak) can build up inside your arteries. This condition is called atherosclerosis (ath-er-o-skler-O-sis).
Atherosclerosis can affect any artery in the body. When atherosclerosis affects the coronary arteries, the condition is called coronary heart disease (CHD) or coronary artery disease.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
PCI can restore blood flow to the heart. During the procedure, a thin, flexible catheter (tube) with a balloon at its tip is threaded through a blood vessel to the affected artery. Once in place, the balloon is inflated to compress the plaque against the artery wall. This restores blood flow through the artery.
Doctors may use the procedure to improve symptoms of CHD, such as angina. The procedure also can reduce heart muscle damage caused by a heart attack.
Serious complications from PCI don't occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure. The most common complications are discomfort and bleeding at the catheter insertion site.
Research on PCI is ongoing to make it safer and more effective and to prevent treated arteries from narrowing again.
Your doctor may recommend percutaneous coronary intervention (PCI) if you have narrow or blocked coronary arteries as a result of coronary heart disease (CHD).
PCI is one treatment for CHD. Other treatments include medicines and coronary artery bypass grafting (CABG). CABG is a type of surgery in which a healthy artery or vein from the body is connected, or grafted, to a blocked coronary artery.
The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This improves blood flow to the heart.
Compared with CABG, some advantages of PCI are that it:
However, PCI isn't for everyone. For some people, CABG might be a better option. For example, CABG might be used to treat people who have severe CHD, narrowing of the left main coronary artery, or poor function in the lower left heart chamber.
In addition, recent studies show that people with CHD who also have diabetes may have greater benefit from CABG.
Your doctor will consider many factors when deciding which treatment(s) to recommend.
PCI also is used as an emergency treatment for heart attack. As plaque builds up in the coronary arteries, it can rupture. This can cause a blood clot to form on the surface of the plaque and block blood flow to the heart muscle.
Quickly opening the blockage restores blood flow and reduces heart muscle damage during a heart attack.
Before you have percutaneous coronary intervention (PCI), your doctor will need to know the location and extent of the blockages in your coronary (heart) arteries. To find this information, your doctor will use coronary angiography (an-jee-OG-rah-fee). This test uses dye and special x rays to show the insides of your arteries.
During angiography, a small tube (or tubes) called a catheter is inserted into an artery, usually in the groin (upper thigh). The catheter is threaded to the coronary arteries.
Special dye, which is visible on x-ray pictures, is injected through the catheter. The
x-ray pictures are taken as the dye flows through your coronary arteries. The dye shows whether blockages are present and their location and severity.
During PCI, another catheter with a balloon at its tip (a balloon catheter) is inserted in the coronary artery and placed in the blockage. Then, the balloon is expanded. This pushes the plaque against the artery wall, relieving the blockage and improving blood flow.
A small mesh tube called a stent usually is placed in the artery during the procedure. The stent is wrapped around the deflated balloon catheter before the catheter is inserted into the artery.
When the balloon is inflated to compress the plaque, the stent expands and attaches to the artery wall. The stent supports the inner artery wall and reduces the chance of the artery becoming narrow or blocked again.
Some stents are coated with medicine that is slowly and continuously released into the artery. They are called drug-eluting stents. The medicine helps prevent scar tissue from blocking the artery following PCI.
For more details about angiography, PCI, and stent placement, go to “What To Expect During Percutaneous Coronary Intervention.”
Percutaneous coronary intervention (PCI) is done in a hospital. A cardiologist will perform the procedure. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.
If PCI isn't done as an emergency treatment, you'll meet with your cardiologist beforehand. He or she will go over your medical history (including the medicines you take), do a physical exam, and talk to you about the procedure.
Once the procedure is scheduled, your doctor will advise you:
Even though PCI takes only 1–2 hours, you'll likely need to stay in the hospital overnight. Your doctor may advise you to not drive for a certain amount of time after the procedure. Thus, you'll probably need to arrange a ride home.
Percutaneous coronary intervention (PCI) is done in a special part of the hospital called the cardiac catheterization (KATH-eh-ter-ih-ZA-shun) laboratory. The "cath lab" has special video screens and x-ray machines.
Your doctor will use this equipment to see enlarged pictures of the blockages in your coronary arteries.
In the cath lab, you'll lie down. An intravenous (IV) line will be placed in your arm to give you fluids and medicines. The medicines will relax you and help prevent blood clots from forming.
The area where your doctor will insert the catheter will be shaved. The catheter usually is inserted in your groin (upper thigh). The shaved area will be cleaned and then numbed. The numbing medicine may sting as it's going in.
During the PCI, you'll be awake but sleepy.
Your doctor will use a needle to make a small hole in an artery in your arm or groin. A thin, flexible guide wire will be inserted into the artery through the small hole. Then, your doctor will remove the needle and place a tapered tube called a sheath over the guide wire and into the artery.
Next, your doctor will put a long, thin, flexible tube called a guiding catheter through the sheath and slide it over the guide wire. The catheter is moved to the opening of a coronary artery, and the guide wire is removed.
Your doctor will inject special dye through the catheter. The dye will help show the inside of the coronary artery and any blockages on an x-ray picture called an angiogram.
Another guide wire is then put through the catheter into the coronary artery and threaded past the blockage. A thin catheter with a balloon at its tip (a balloon catheter) is threaded over the wire and through the guiding catheter.
The balloon catheter is positioned in the blockage. Then, the balloon is inflated. This pushes the plaque against the artery wall, relieving the blockage and improving blood flow through the artery. Sometimes the balloon is inflated and deflated more than once to widen the artery.
Your doctor may put a stent (small mesh tube) in your artery to help keep it open. If so, the stent will be wrapped around the balloon catheter.
When your doctor inflates the balloon, the stent will expand against the wall of the artery. When the balloon is deflated and pulled out of the artery with the catheter, the stent remains in place in the artery.
The animation below shows the process of PCI (also called coronary angioplasty) and stent placement. Click the "start" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
After the PCI is done, the sheath, guide wires, and catheters are removed from your artery. Pressure is applied to stop bleeding at the catheter insertion site. Sometimes a special device is used to seal the hole in the artery.
During the PCI, you'll receive strong antiplatelet medicines through your IV line. These medicines help prevent blood clots from forming in the artery or on the stent. Your doctor may start you on antiplatelet medicines before the the procedure.
After percutaneous coronary intervention (PCI) , you'll be moved to a special care unit. You'll stay there for a few hours or overnight. You must lie still for a few hours to allow the blood vessel in your arm or groin (upper thigh) to seal completely.
While you recover, someone on your health care team will check your blood pressure, heart rate, oxygen level, and temperature. The site where the catheters were inserted also will be checked for bleeding. That area may feel sore or tender for awhile.
Most people go home the day after the procedure. When your doctor thinks you're ready to leave the hospital, you'll get instructions to follow at home, such as:
Your doctor will prescribe medicine to help prevent blood clots from forming. Take all of your medicine as your doctor prescribes.
Most people recover from the PCI and return to work within a week of leaving the hospital.
Your doctor will want to check your progress after you leave the hospital. During the followup visit, your doctor will examine you, make changes to your medicines (if needed), do any necessary tests, and check your overall recovery.
Use this time to ask questions you may have about activities, medicines, or lifestyle changes, or to talk about any other issues that concern you.
Although PCI can reduce the symptoms of coronary heart disease (CHD), it isn't a cure for CHD or the risk factors that led to it. Making healthy lifestyle changes can help treat CHD and maintain the good results from PCI.
Talk with your doctor about your risk factors for CHD and the lifestyle changes you should make. Lifestyle changes might include changing your diet, quitting smoking, being physically active, losing weight or maintaining a healthy weight, and reducing stress.
Your doctor may recommend cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.
Cardiac rehab includes exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. Your doctor can tell you where to find a cardiac rehab program near your home.
Percutaneous coronary intervention (PCI) is a common medical procedure. Serious complications don't occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure.
PCI complications can include:
Sometimes chest pain can occur during PCI because the balloon briefly blocks blood supply to the heart.
As with any procedure involving the heart, complications can sometimes be fatal. However, this is rare with PCI. Less than 2 percent of people die during the procedure.
The risk of complications is higher in:
Research on PCI is ongoing to make it safer and more effective and to prevent treated arteries from narrowing again.
Another problem that can occur after PCI is too much tissue growth within the treated portion of the artery. This can cause the artery to become narrow or blocked again, often within 6 months. This complication is called restenosis (RE-sten-o-sis).
When a stent (small mesh tube) isn't used during PCI, 30 percent of people have restenosis. When a stent is used, 15 percent of people have restenosis.
Stents coated with medicine (drug-eluting stents) reduce the growth of scar tissue around the stent. These stents further reduce the risk of restenosis. When these stents are used, about 10 percent of people have restenosis.
Other treatments, such as radiation, can help prevent tissue growth within a stent. For this procedure, a wire is put through a catheter to where the stent is placed. The wire releases radiation to stop any tissue growth that may block the artery.
Studies suggest that there's a higher risk of blood clots forming in medicine-coated stents compared with bare metal stents. However, no firm evidence shows that these stents increase the chance of having a heart attack or dying if used as recommended. Researchers continue to study medicine-coated stents.
Taking medicine as prescribed by your doctor can lower your risk of blood clots. People who have medicine-coated stents usually are advised to take antiplatelet medicines, such as clopidogrel and aspirin, for up to a year or longer.
As with all procedures, you should talk with your doctor about your treatment options, including the risks and benefits.
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has helped look for better ways to treat heart problems using methods such as percutaneous coronary intervention (PCI).
The NHLBI supports research on PCI. For example, NHLBI-sponsored research includes studies that:
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to PCI, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.