Coronary Angioplasty (cont.)
How do patients recover after PCI?
PCI is performed in a special room fitted with computerized x-ray equipment called a cardiac catheterization laboratory. Patients are mildly sedated with small amounts of diazepam (Valium), midazolam (Versed), morphine, and other sedative narcotics given intravenously. Patients may experience minor discomfort at the site of the puncture in the groin or the arm. Patients also may experience brief episodes of angina while the balloon is inflated, briefly blocking the flow of blood in the coronary artery. The
PCI procedure can last from 30 minutes to two hours, but is usually completed within 60 minutes.
Patients are then brought to a monitored bed for observation. The plastic catheters left in the artery are removed from the groin after four to 12 hours depending on how long blood thinning is needed to stabilize the opened artery. When these catheters are removed, the area is compressed by hand or with the aid of a mechanical clamp for about 20 minutes to prevent bleeding. In many instances, the artery in the groin may be sutured or "sealed" in the catheterization laboratory, and the catheters are immediately removed. This enables the patient to sit up in bed within a few hours after the procedure.
Most patients are discharged home the day after PCI. Patients are advised not to lift anything heavier than 20 pounds or perform vigorous exertion for the first one to two weeks after PCI. This allows the area in the coronary artery as well as the groin or arm arteries to heal. Patients may return to normal work and sexual activity two or three days after
PCI.
Patients are maintained on aspirin indefinitely after PCI to prevent future thrombotic events [(for example, unstable angina or heart attack). In patients who receive stents, an additional anti-platelet agent (in most instances clopidogrel (Plavix)] is given in conjunction with aspirin for two to four weeks; this is because the metal in the stents may promote the formation of blood clots in the first couple of weeks after the stent is inserted. After two weeks, the metal of the stent is coated with a natural tissue lining which no longer stimulates platelets to form blood clots. With the newer medicated stents designed to prevent recurrence, the process of forming this natural lining may be delayed, and aspirin and Plavix are generally continued for a year or longer. If you have a stent, always consult your cardiologist before stopping aspirin or Plavix, even for a few days.
Exercise stress testing is sometimes done several weeks after PCI and signals the beginning of a cardiac rehabilitation program. Rehabilitation can involve a 12 week program of gradually increasing monitored exercise lasting one hour three times a week. Lifestyle changes can help to lower the patient's chance of developing further coronary artery disease. These include stopping smoking, reducing weight and dietary fat, controlling blood pressure and diabetes, and lowering blood cholesterol levels. Cholesterol reduction is often aided by the addition of medications which may not only lower cholesterol levels, but may offer protection against future heart attacks.
Next: What are the long-term results of PCI? »
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