B.12 Percutaneous Coronary Intervention

Question 1

B.12 Percutaneous Coronary Intervention

define

Answer 1

A therapeutic procedure carried out during cardiac catheterization in which a blocked coronary vessel is opened and appropriate blood flow is restored. A balloon catheter is used to dilate the narrowed section, with/without the placement of a stent to keep it patent.

Question 2

B.12 Percutaneous Coronary
Intervention

Indciation

Answer 2

Acute and chronic occlusion of coronary arteries

• Myocardial infarction (primary revascularization or primary PCI)
• Occlusion of bypass grafts and stents
• Recurrent ischemia after PCI or bypass surgery

Question 3

B.12 Percutaneous Coronary
Intervention

Procedure

Answer 3

a catheter is inserted through the access site → a deflated balloon catheter is advanced into the obstructed artery → balloon is inflated at the obstructed/narrowed section → the narrowing is relieved → stent may/may not be deployed to keep the blood vessel open

Question 4

B.12 Percutaneous Coronary
Intervention

Types of Stents

Answer 4

Bare Metal Stent
Drug eluting stent

Question 5

B.12 Percutaneous Coronary
Intervention

Describe Bare Metal Stent

Answer 5

bare-surfaced, metallic stent that provides a mechanical framework to keep the artery open.

After placement, endothelial cells begin to cover the bare surface of the stent (stent endothelialization) → ↓ exposure time of the foreign, thrombogenic material → ↓ risk of stent thrombosis → ↓ time of post-placement anticoagulation

Thus, bare metal stents are better suited to patients who are not compliant with long-term oral medications and/or those who may need to undergo surgery in the near future.

Question 6

B.12 Percutaneous Coronary Intervention

Describe the Drug-eluting stent

Answer 6

stents that are coated with antiproliferative substances (immunosuppressant drugs, cytostatic drugs) that prevent excessive intimal hyperplasia

this reduces the risk of in-stent restenosis. However, it requires that post-placement anticoagulation be used for longer, because the stent undergoes slower endothelialization. It is therefore avoided in patients who may require a surgery soon. Used in patients with a high risk of restenosis (e.g., diabetics, previous restenosis).