Information and Consent for Percutaneous Coronary Intervention (PCI)

Introduction

The term percutaneous coronary intervention (sometimes called PTCA, angioplasty or stenting) describes a range of procedures that treat narrowing or blockages in coronary arteries supplying blood to the heart.   Many patients undergoing this procedure will have previously had cardiac catheterisation (sometimes called coronary angiography) to examine the condition of the coronary vessels. Alternatively, percutaneous coronary intervention maybe undertaken immediately after the diagnostic angiogram.

Most patients with angina can be helped substantially by coronary stenting. For some patients with very mild disease stents are not required and medication is sufficient. For a small number of people bypass surgery is necessary. Almost all stent procedures are successful and completed in < 2 hours. Inevitably however there are risks and it is important that patients understand these risks before accepting treatment.

	Typical balloon catheter and wire

Every person is different

The chances of success and the risks associated with any procedure vary for each person. Important factors include

The patient – for example:
Age
Degree of heart disease
Other medical conditions for example diabetes or kidney failure.

The current situation – for example procedures have greater risk in:
Emergency cases
Recent heart attacks or when angina is unstable and occurring without exercise

The details of the proposed procedure for example:
When treating more than once narrowing or blockage during the same procedure.
The treatment of arteries that are totally blocked (rather than just narrowed).
Narrowings located to a point where the artery divides/forks.

We will discuss with you any specific additional aspects of your case before the procedure.

Will it work?

The majority of procedures result in a successful outcome at the end of the operation. Current success rates are greater than 98%. However, if an artery is totally blocked before the procedure success rates are less (approx 50% depending on the precise nature of the blockage). In cases where the procedure is unsuccessful, usually no harm is done and the patient is left no worse than before.

After a successful procedure most patients feel a benefit immediately and this will continue for many moths/years. However, for some patients symptoms will return and this relates to a re-narrowing of the artery. This problem can occur early but is more likely to occur over three to six months. This process is called restenosis and it is related to the healing of the artery. There are new stents (drug eluting stents) that make this less likely to happen. If it does occur, it is a chance event and not a reflection of the quality of the original procedure. It can almost always be treated with a repeat procedure.

Are there any risks?

Percutaneous coronary interventions are an important treatment option for patients with coronary artery disease and are performed in large numbers around the developed world. In the John Radcliffe over 1400 percutaneous coronary interventions are performed each year.

The procedure is very safe and the risk of serious complication is less than 1%. This means on average less than 1 significant complications occur for every 100 procedures.
The procedures involves guiding plastic tubes, fine flexible wires, balloons and metal stents into the coronary arteries. This involves some risk and complications can occur even when the most experienced and skilled Specialists perform the procedure.

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