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Percutaneous coronary intervention, PCI

PCI is a method where one block up the narrow portions of coronary arteries using a catheter that is passed through the skin, through an artery to the aorta, and then into the narrow crane hearth.

The procedure is also called coronary angioplasty, PTCA shortened

Coronary Arteries

The heart is a powerful muscle that pumps blood around the body. To clear pump job requires heart constantly supplied with oxygen (O 2, oxygen) and other nutrients. This industry is supplied through the blood vessels located outside of the heart arteries (coronary arteries). There are three major arteries, each of which divides into many smaller branches. Together they ensure good supply of oxygen and nutrients.

Angina pectoris and myocardial infarction
As we age, the arteries become narrower due to deposition of fatty material inside the vessel wall, it is called atherosclerosis . When an artery is narrowed, this can lead to oxygen deficiency in the part of the heart muscle that is nourished by the narrow blood vessel. First, this will be felt when the heart rate rises during physical activity. A heart that pumps urgently need more oxygen, and in such a situation may arise hypoxia. Oxygen deficiency in the myocardium labeled as chest pain or pressure / chest tightness. When the activity stops and the pulse rate will be lower, decreases oxygen demand - and if the heart muscle when getting sufficient oxygen, the pain goes away. Such an exercise-induced hypoxia and chest pain called angina pectoris .

If a coronary artery, or a small branch of the artery suddenly becomes completely clogged, part of the heart muscle lose oxygen supply. In a short time, this part of the heart muscle die and gradually replaced by scar tissue. This is called a heart attack , or sore at heart. At the heart experiences the most sudden, strong and oppressive pain behind the breastbone, ev. also to the jaw or the arms.

What is percutaneous coronary intervention?
The procedure involves an internal opening ("repair") of the vessel wall of a coronary artery. If you come quickly after a clot has closed a vein, one can manage to avoid the heart muscle dies or damage can be limited in scope. To achieve this it is urgent hospitalization and treatment of myocardial infarction.

The procedure
The first part of the procedure consists of a catheter (a thin tube) that passes through the skin and into an artery in the inside of the arm. If you are not going to the arm, a larger vein in the groin (in exceptional cases). The catheter entered the bloodstream up to the aorta just outside the heart, where the coronary arteries have their origin. Along the x-ray fluoroscopy is used to verify that the catheter is in the right place.

Through this catheter is injected into contrast, and on a screen, your doctor may follow and image contrast flowing into the coronary arteries. You get a picture of any narrow sections or areas full stop of blood flow. If conditions are favorable swelled and stenting goes one further procedure.

Until the block is applied where a catheter near the tip of the catheter is mounted on a balloon that inflates from the outside. Surface this balloon is a compressed metal mesh (stent) that folds out when the balloon is inflated. After the stricture is located maneuvered the probe into the relevant crane artery, and passed on to the balloon stands in the cramped party. The balloon is then pumped up with so much force that the blood vessel is directed or "burst" out. When the air is then discharged metallstenten again and keep the vein open, and the catheter can be withdrawn.

If everything goes smooth and uncomplicated, the whole procedure from start to finish to be over in half an hour. After the procedure will be added compression on the injection site on your arm to prevent bleeding, and the patient is monitored in terms of complications of the procedure, and considering requiring treatment arrhythmia.

Stent to be inserted to keep the flared portion open, is made of body-friendly metals. There is now such that most stents also have a sheath that contains and releases a small dose of a drug (chemotherapy) to the vein wall. This drug makes scar treatment does not grow too quickly and thereby prevents arrskrumpning and disease recurrence.

When done PCI?
PCI is now routine therapy for acute myocardial infarction in all that can reach a hospital who master this technique, within 90-120 minutes after symptoms started. If treatment is started much later than this, the damage has come too far for any muscle can be saved. The treatment is available at all regional and university hospitals, and some other major hospitals. The treatment is centralized because it is necessary to frequent and regular exercise at all levels in order to do this safely.

Patients who have a long pathway, and can not reach the hospital in time, the clot-dissolving medicine directly into the bloodstream of the local doctor or hospital, if necessary. ambulance. This is also a very good treatment of acute myocardial infarction?

PCI is also done on patients with angina pectoris where drug therapy alone does not lead to control of symptoms. If the study with contrast injection shows narrow portions of the coronary arteries, which are suitable for stenting, treatment can be performed in a manner consistent with acute myocardial infarction. It is possible to enter multiple stents during the same procedure.

The alternative to PCI in angina open heart surgery where they sew into new blood vessels that lead blood past the narrow sections. This is done primarily if the anatomical conditions are such that one can not come to the catheter. This procedure requires general anesthesia and the use of heart-lung machine, and is overall a much larger and more burdensome interventions than PCI.

Is PCI durable?
After PCI was introduced as standard treatment for heart attack survival is significantly improved! In 2000, the mortality rate within 30 days after an acute myocardial infarction approx. 9% - in 2009 this was reduced to 2.5%. The Nordic countries have the lowest mortality rate in the world in this area.

Some patients (approximately 10%) will relapse within one year after the procedure. In such cases it is necessary to make a new stenting. Alternatively operation arise.

To prevent new problems after PCI treated everyone with blood-thinning medicine (Albyl-E) and cholesterol-lowering medicine. When using drug-stent used two blood-thinning drugs for the first year. Most also get the addition of beta blockers and anti-hypertensive therapy when needed. Exercise, healthy eating and smoking cessation is also important to prevent recurrence of angina or infarction.

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