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Percutaneous Coronary Intervention PCI Procedure Indications Steps Complications Management
Comprehensive guide on Percutaneous Coronary Intervention (PCI) covering definition, indications, procedural steps, stent types, medications, complications, post-PCI care, and clinical outcomes for medical and cardiology learning.
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Frequently Asked Questions
❓ What is Percutaneous Coronary Intervention (PCI)?
Percutaneous Coronary Intervention is a minimally invasive catheter-based procedure used to restore blood flow in narrowed or occluded coronary arteries, usually by balloon angioplasty followed by stent implantation.
❓ What are the main indications for PCI?
PCI is indicated in ST-elevation myocardial infarction (primary PCI), high-risk NSTEMI or unstable angina, chronic stable angina with significant ischemia, and selected cases of left main or proximal LAD disease.
❓ What is primary PCI?
Primary PCI refers to immediate PCI performed as the first reperfusion strategy in acute STEMI, ideally within 90–120 minutes of first medical contact.
❓ What is the difference between PCI and coronary angioplasty?
Coronary angioplasty refers only to balloon dilatation of a coronary artery, whereas PCI includes angioplasty plus stent implantation and adjunctive pharmacotherapy.
❓ What are drug-eluting stents (DES)?
Drug-eluting stents are coronary stents coated with antiproliferative drugs that inhibit neointimal hyperplasia, thereby reducing the risk of in-stent restenosis.
❓ Why are drug-eluting stents preferred over bare-metal stents?
Drug-eluting stents significantly reduce restenosis rates compared to bare-metal stents, making them the standard of care in most PCI procedures.
❓ What is dual antiplatelet therapy (DAPT)?
Dual antiplatelet therapy consists of aspirin plus a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) to prevent stent thrombosis after PCI.
❓ How long should DAPT be continued after PCI?
After PCI with drug-eluting stents, DAPT is recommended for at least 12 months in acute coronary syndrome and at least 6 months in stable coronary artery disease, unless bleeding risk is high.
❓ What are the common access routes for PCI?
The common access routes for PCI are the radial artery and femoral artery, with radial access preferred due to lower bleeding complications.
❓ What is the no-reflow phenomenon in PCI?
No-reflow is a complication where there is inadequate myocardial perfusion despite successful opening of the epicardial coronary artery, usually due to microvascular obstruction.
❓ What are the major complications of PCI?
Major complications include stent thrombosis, coronary dissection or perforation, no-reflow phenomenon, contrast-induced nephropathy, bleeding, and vascular access complications.
❓ What is contrast-induced nephropathy after PCI?
Contrast-induced nephropathy is acute kidney injury occurring after exposure to contrast media during PCI, characterized by a rise in serum creatinine within 48–72 hours.
❓ When is CABG preferred over PCI?
CABG is preferred in patients with diabetes and multivessel disease, left main disease with high SYNTAX score, and complex coronary anatomy unsuitable for PCI.
❓ What is in-stent restenosis?
In-stent restenosis is re-narrowing of a stented coronary segment due to neointimal hyperplasia, typically occurring months after PCI.
❓ What is the most feared late complication of PCI?
Late stent thrombosis is the most feared late complication of PCI because it can lead to sudden myocardial infarction and death.