Percutaneous coronary intervention of PCI heart, is one of the two coronary revascularization techniques which are currently used for treatment of ischemic heart disease, while the other being coronary artery bypass grafting or CABG surgery. PCI heart involves non-surgical widening of coronary artery with help of a balloon catheter which is used to dilate the artery from within. A metallic stent is usually placed in the artery during this procedure after dilating. Anti-platelet agents are also used during this procedure. Stents which are used in this treatment may either be bare metal or even drug-eluting in some cases.
Indications for PCI Heart or Percutaneous Coronary Intervention
It is important to note that percutaneous coronary intervention or PCI heart may change as procedures continue to get refined with emerging evidence.
- ST Segment Elevation Myocardial Infarction (STEMI)
- As early intervention for patients treated with thrombolysis
- As rescue treatment for patients treated with thrombolysis, in case there is failure to reperfuse, further myocardial infarction (MI) or further ischemia
- Angioplasty with stent placement is the optimal method of reperfusion for STEMI when it is available. Target ‘door to balloon time’ available is 90 minutes
- NSTACS or Non-ST Elevation Acute Coronary Syndrome
This involves an unstable angina & non-ST Elevation Myocardial Infarction (NSTEMI)
- Ideal for patients with medium-to-high risk of subsequent cardiac problems, offers PCI and/or angiogram before discharge. Revascularization & early invasive investigation can reduce subsequent refractory angina & MI.
- PCI treatment for non-acute coronary artery heart disease has shown no evidence of myocardial infarction or death when compared to medical therapy. Revascularization is most appropriate for patients with stable angina in the following conditions.
- Symptoms which are persistently limiting despite optimal medical therapy
- Certain anatomical patterns of disease or significantly proven ischemic territory even among asymptomatic patients. Significant stenosis of the left main artery & significant proximal to left anterior descending disease, especially in presence of multi-blood-vessel coronary artery disease are specifically strong indications for revascularization.
- CABG appears to offer survival advantage & marked reduction in need of repeat revascularization in most severe patterns of coronary artery disease, albeit with a higher risk of cerebrovascular event, especially in case of left main artery disease.
Undergoing PCI Heart Procedure
PCI heart options for patients with coronary artery disease includes, Percutaneous balloon angioplasty, Percutaneous cutting balloon or stent placement. Percutaneous laser coronary angioplasty may also be used in carefully selected patients where conventional angioplasty procedure would otherwise be technically difficult.
- PCI heart should be performed by well experienced & high-volume operators & healthcare institutions.
- There is no requirement of anesthesia in PCI heart intervention, although patients are given a sedative to relax. Moreover, PCI heart patients can mobilize a few hours after the procedure & go back home the same day or on the next day.
- PCI heart technique involves gaining arterial access through the brachial, radial or femoral arteries. Usually performed under fluoroscopy, a guided wire is passed into coronary artery & across stenosis. The stent catheter or balloon is passed over the location of stenosis & the lesion dilated and/or stented this way.
- Glycoprotein IIb/IIIa inhibitors are normally given in high risk cases & opiates may also be used when angina occurs during angioplasty.
- Intravenous glycoprotein IIb/IIIa inhibitors reduce risk of death when administered during PCI heart procedure & of death & myocardial infarction at 30 days & 6 months. However, it increases risk of severe bleeding in PCI heart patient.
Affordable Medical Tourism in India
Over the past few decades India has emerged as a leading global medical tourism destination providing a wide spectrum of affordable medical procedures including PTCA angioplasty (Percutaneous Transluminal Coronary Angioplasty) & PCI heart procedures. India is home to a large pool of cardiac surgeons who are reputed to be some of the best in the world. Moreover, India features an extensive network of specialty & multispecialty hospitals providing simple to complex surgical solutions to a variety of heart problems including coronary artery disease.