Chapter

Percutaneous interventional cardiac procedures

Edward D. Folland

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199204854
Published online May 2011 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.161306_update_001

Series: Oxford Textbooks

Percutaneous interventional cardiac procedures

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Percutaneous coronary intervention (PCI) is the term applied to a variety of percutaneous, catheter-based procedures that accomplish revascularization either by angioplasty (enlargement of a vessel lumen by modification of plaque structure), stenting (deployment of an internal armature or stent), atherectomy (removal or ablation of plaque), or thrombectomy (removal of thrombus).

The most common single indication for PCI is acute coronary syndrome. Randomized trials have shown that direct intervention for ST-elevation myocardial infarction (STEMI) is superior to initial thrombolytic therapy when performed in appropriate centres, and it can be used as a salvage procedure after failed thrombolytic therapy.

Balloon angioplasty is the traditional, basic technique of coronary intervention, but it is now uncommonly employed as a stand-alone treatment and finds its chief application in deployment of balloon-expandable stents, which have become the intervention of choice in about 90% of cases undergoing PCI. A variety of percutaneous techniques can be used to remove atheroma or thrombus from coronary arteries as a prelude to angioplasty/stenting.

There are two main types of coronary stent—’bare metal’ and ‘drug eluting’. The latter contain a drug (e.g. sirolimus, paclitaxol, etc.) that inhibits smooth muscle proliferation and thereby considerably reduces the risk of restenosis, which is the most common complication of stenting. Restenosis typically presents as exertional angina at 1 to 6 months following intervention: if it is not present at 6 months, it is unlikely to occur.

Percutaneous techniques can also be used to treat valvular stenosis and close cardiac defects in (highly) selected cases.

Chapter.  6066 words.  Illustrated.

Subjects: Cardiovascular Medicine

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