Percutaneous Coronary Intervention

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  • Improve angina in patients with one or more significant (≥70% diameter) coronary artery stenoses despite optimal medical therapy.
  • Improve cardiovascular outcomes in patient presenting with acute coronary syndromes due to vessel occlusion.
  • For left main and/or complex CAD, PCI to improve survival may be indicated in the setting when patients are not candidates for CABG or if there is significant increased risk of adverse surgical outcomes.
  • There are no absolute contraindications.
  • Relative contraindications include the following:
    • Coagulopathy
    • Decompensated congestive heart failure
    • Uncontrolled hypertension
    • Active stroke
    • Refractory arrhythmia
    • Active gastrointestinal tract bleeding
    • Pregnancy
    • Inability of patient to cooperate
    • Active infection
    • Renal failure
    • Contrast allergy in the absence of premedication
  • Sterile mask, cap, gown, gloves
  • Sterile sheet over patient
  • Crash cart with resuscitation equipment and defibrillator
  • Manifold setup and/or power contrast injector
  • One percent lidocaine
  • Twenty-one–gauge needle and syringe for local anesthesia
  • Eighteen-gauge Seldinger/Cook needle
  • Vascular introducer sheath (various French sizes) with J-tipped wire
  • One hundred eighty–inch or longer 0.035-inch J-tipped guidewire
  • Low osmolar contrast agent (ionic or nonionic media)
  • Guide catheters (e.g., EBU, JR, VL)
  • Guidewires (BMW, Prowater, Pilot)
  • CoPilot accessory kit
  • Inflation device kit (2-foot extension tubing, insufflator, 3-way stopcock)
  • Balloon dilatation catheters (on-the-wire, over-the-wire, and monorail types)
  • Stents (DES and BMS)
  • Postdilation balloon catheters
  • Adjunctive devices: atherectomy (rotational atherectomy, directional coronary atherectomy, mechanical thrombectomy, and embolic protection)
  • Right or left femoral artery
    • Alternative vascular access sites (e.g., radial, brachial) can be used.

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  • Continue bed rest and postcatheterization care per institutional protocol.
  • If IV heparin was administered during the case, remove the sheath when the ACT is less than 140 to 160 seconds.
  • If IV bivalirudin was administered, remove the sheath after 2 hours after the procedure if glomerular filtration rate is greater than 60 mL/min. Please follow institutional protocol on sheath removal in the presence of renal dysfunction.
  • Bleeding
  • Vascular injury (e.g., femoral artery dissection)
  • Iatrogenic coronary artery dissection
  • Coronary perforation
  • Air embolism
  • Stroke
  • Arrhythmia
  • Cardiac arrest
  • Myocardial infarction
  • Death
  • Tamponade

Angiographic success after PCI with stenting is gauged by <20% residual stenosis, absence of edge dissection or perforation, and TIMI 3 flow into the distal target vessel.

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