Percutaneous coronary intervention
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Percutaneous coronary intervention Microchapters |
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PCI Complications |
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PCI in Specific Patients |
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PCI in Specific Lesion Types |
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Percutaneous coronary intervention On the Web |
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American Roentgen Ray Society Images of Percutaneous coronary intervention |
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Directions to Hospitals Treating Percutaneous coronary intervention |
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Risk calculators and risk factors for Percutaneous coronary intervention |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]
Synonyms and keywords: PCI; balloon angioplasty; percutaneous transluminal coronary angioplasty; coronary angioplasty; coronary artery angioplasty; heart artery dilatation
Overview
Risk Stratification and Benefits of PCI
PCI Approaches
- Radial artery and femoral artery are two main methods to access the artery in percutaneous coronary intervention (PCI).[1]
- The rate of PCI through radial artery catheterization has been increased over the past decade and patients usually prefer this approach more that the femoral artery access.[2][3]
- The following are the advantages of radial artery compared to the femoral artery approach:[4]
- Earlier ambulation
- Lower rate of vascular complications
- Lower rate of bleeding complications
- Better cardiovascular outcomes
- It is recommended to evaluate the possibility of future need to radial artery for bypass grafting before using it for PCI. In cases that there is a high likelihood of future CABG, discussion with the patient and the cardiac surgeon is required.[1]
- Femoral artery remains the default PCI access in centers where expertise in the transradial approach is unavailable or if the patient has any anatomic or clinical limitations.
ACA 2021 Revascularization Guideline for PCI Approaches
| Class 1 Recommendation, Level of Evidence: A[1] |
| 1.Radial artery approach is recommended over the femoral artery access in patients with acute coronary syndromes (ACS) undergoing PCI due to lower rate of death, vascular and bleeding complications.
2.Radial artery approach is recommended over the femoral artery access in patients with stable ischemic heart disease (SIHD) undergoing PCI due to lower rate access site bleeding and vascular complications. |
Preparation of the Patient for PCI
Equipment Used During PCI
Pharmacotherapy to Support PCI
Vascular Closure Devices
Post-PCI Management
Risk Reduction After PCI
Post-PCI Follow up
PCI Complications
Factors Associated with Complications | New or Enlarging Thrombus | Vessel Perforation | Dissection | Distal Embolization | Slow Flow | No-reflow | Abrupt Closure | Access Site Complications | Peri-procedure Bleeding | Intraprocedural Stent Thrombosis | Restenosis | Renal Failure | Thrombocytopenia | Late Acquired Stent Malapposition | Loss of Side Branch | Multiple Complications
PCI in Specific Patients
Cardiogenic Shock | Refractory Ventricular Arrhythmia | Severely Depressed Ventricular Function | Sole Remaining Conduit | Unprotected Left Main Patient | Adjuncts for High Risk PCI
PCI in Specific Lesion Types
Classification of the Lesion | The Calcified Lesion | The Ostial Lesion | The Angulated or Tortuous Lesion | The Bifurcation Lesion | The Long Lesion | The Bridge Lesion | Vasospasm | The Chronic Total Occlusion | The Left Internal Mammary Artery | Multivessel Disease | Distal Anastomotic Lesions | Left Main Intervention | The Thrombotic Lesion
Related Chapters
- Vascular closure devices
- Angioplasty
- Conscious sedation
- Preparation of the patient for diagnostic catheterization
- Technical aspects of the cardiac catheterization laboratory
- Obtaining venous and arterial access
- Equipment used in diagnostic catheterization
- Hemodynamic assessment in the cardiac catheterization laboratory
- Radiation safety
- Fractional flow reserve
- ↑ 1.0 1.1 1.2 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
|pmid=value (help). - ↑ Masoudi FA, Ponirakis A, de Lemos JA, Jollis JG, Kremers M, Messenger JC; et al. (2017). "Trends in U.S. Cardiovascular Care: 2016 Report From 4 ACC National Cardiovascular Data Registries". J Am Coll Cardiol. 69 (11): 1427–1450. doi:10.1016/j.jacc.2016.12.005. PMID 28025065.
- ↑ Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P; et al. (2011). "Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial". Lancet. 377 (9775): 1409–20. doi:10.1016/S0140-6736(11)60404-2. PMID 21470671.
- ↑ Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G; et al. (2016). "Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials". JACC Cardiovasc Interv. 9 (14): 1419–34. doi:10.1016/j.jcin.2016.04.014. PMID 27372195.