PCI technique, adjunctive therapy and coronary bypass surgery
THE CONTEXT
Coronary stenoses can be treated by catheter-based dilatation and stenting or by surgical bypass using the patient's own vessels.
PCI sequence and adjunctive treatment
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During percutaneous coronary intervention (PCI), a guidewire is advanced from the radial or femoral artery to the coronary artery under radiographic control.
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A balloon catheter is passed over the guidewire to the stenosis and inflated to dilate it. A stent is usually then placed to maintain arterial patency.
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A potent platelet inhibitor such as a P2Y12 receptor antagonist—clopidogrel, prasugrel or ticagrelor—in combination with aspirin and heparin improves outcomes following PCI.
Coronary artery bypass grafting
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Internal mammary arteries, radial arteries or reversed segments of the patient's own saphenous vein can bypass coronary stenoses.
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Surgery usually requires cardiopulmonary bypass. In off-pump surgery, grafts are applied to the beating heart.
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Operative mortality is approximately 1%. Risk is higher in older patients, those with poor left ventricular function and those with significant comorbidity such as renal failure.