Coronary Stent Placement (Percutaneous Coronary Intervention – PCI): A Complete Patient-Focused Guide

Coronary stent placement, also known as percutaneous coronary intervention (PCI), is a minimally invasive procedure used to open narrowed or blocked coronary arteries and restore blood flow to the heart muscle. It is a key treatment option for people with coronary artery disease (CAD) who experience symptoms such as chest pain (angina) or who are at risk of heart attack.

Understanding Coronary Artery Disease The heart muscle receives oxygen-rich blood through the coronary arteries. In coronary artery disease, these arteries become narrowed or blocked due to the build-up of fatty deposits called plaques, which contain cholesterol, calcium, and inflammatory cells.

As plaques grow:

• Blood flow to the heart muscle decreases
• The heart receives less oxygen (a condition called ischaemia)
• This can cause chest pain or discomfort, especially during physical activity or emotional stress

Chest pain due to reduced blood flow is known as angina pectoris, often shortened to angina. Angina is a warning sign that part of the heart muscle is not receiving enough oxygen.

Treatment Options for Coronary Artery Disease There are two main approaches to treating symptomatic coronary artery disease:

1. Medical Therapy This includes:

• Medications to reduce chest pain
• Drugs to lower cholesterol and blood pressure
• Antiplatelet medicines to reduce clot formation Medical therapy can relieve symptoms, slow disease progression, and reduce the risk of heart attack.

2. Interventional Treatment When symptoms persist despite medications, or when artery narrowing is severe, interventional treatment may be recommended. This includes:

• Coronary stent placement (PCI)
• Coronary artery bypass graft surgery (CABG)

The main goals of interventional treatment are to:

• Improve quality of life
• Reduce angina
• Restore blood flow to the heart muscle

What Is Coronary Stent Placement? Coronary stenting is a procedure in which a narrowed coronary artery is opened using a balloon-tipped catheter, and a small metal mesh tube called a stent is placed to keep the artery open.

The procedure is called percutaneous coronary intervention (PCI) because:

• Percutaneous means “through the skin”
• Coronary refers to the heart arteries
• Intervention means a treatment performed without open surgery

Stents help maintain blood flow by preventing the artery from collapsing or narrowing again.

Why Might I Need a Coronary Stent? You may be advised to undergo stent placement if you have:

• Ongoing angina despite optimal medical therapy
• Significant narrowing in one or more coronary arteries
• Evidence of reduced blood flow to the heart muscle
• Certain types of heart attacks

By improving blood flow, stenting can relieve symptoms and reduce the risk of further heart damage.

Benefits of Coronary Stenting Before stents were widely used, balloon angioplasty alone was performed. However, this approach had limitations.

Limitations of Balloon Angioplasty Alone

• Acute recoil – the artery could partially collapse after balloon inflation
• Negative remodeling—gradual narrowing of the treated segment
• Restenosis – regrowth of tissue causing the artery to narrow again

How Stents Improve Outcomes Stents:

• Prevent arterial recoil
• Maintain a larger artery opening immediately after the procedure
• Reduce negative remodeling.

With stenting, late narrowing of the artery (late lumen loss) is mainly due to neointimal hyperplasia—growth of tissue inside the stent.

Drug-Eluting Stents (DES) Modern stents are usually drug-eluting stents (DES). These are coated with medication that:

• Inhibits excessive tissue growth
• Significantly reduces the risk of restenosis DES are now preferred for most patients.

Bare-Metal Stents (BMS) Bare-metal stents are now rarely used, as DES have better long-term outcomes. Even in patients who may need surgery soon after PCI, current practice generally favours DES with appropriate antiplatelet management.

How Is Coronary Stent Placement Performed? Access to the Artery The procedure is done using a catheter inserted through:

• The radial artery (wrist) – most common
• The femoral artery (groin)
• Less commonly, the brachial artery (arm)

Step-by-Step Overview

• Catheter Insertion A thin, flexible tube is guided to the coronary arteries under X-ray imaging.

• Coronary Angiography Contrast dye is injected to visualise blockages.

• Predilation (in most cases) A small balloon may be inflated to prepare the artery for stenting.

Stent Deployment

• The stent is mounted on a balloon
• The balloon is inflated, expanding the stent against the artery wall
• The stent remains in place when the balloon is removed

Post-Dilation

• High-pressure balloon inflation is often used to ensure full stent expansion.
• The procedure typically takes 30–90 minutes, depending on complexity.

Principles of Optimal Stenting Importance of Full Stent Expansion The single most important factor for long-term success is achieving a large, well-expanded arterial lumen. Proper expansion:

• Reduces the risk of stent thrombosis
• Minimises restenosis Stents are commonly deployed at pressures of 12–16 atmospheres (atm).

Complete Lesion Coverage The stent should cover:

• The entire plaque
• All areas affected by balloon predilation

In long or diffusely diseased arteries, overlapping stents may be required, although longer stent length slightly increases restenosis risk.

Role of Intravascular Imaging (IVUS and OCT) What Are IVUS and OCT?

• IVUS (Intravascular Ultrasound)
• OCT (Optical Coherence Tomography) These imaging tools provide detailed views inside the artery and stent.

Benefits of Imaging-Guided PCI Clinical studies show that PCI guided by IVUS or OCT:

• Reduces heart attack risk
• Lowers cardiac and all-cause mortality
• Improves long-term outcomes

Imaging is especially recommended for:

• Complex lesions
• Left main coronary artery disease
• Bifurcation lesions
• Long or heavily calcified arteries

Use in Stent Failure If a previously placed stent fails, IVUS or OCT helps identify:

• Under-expansion
• Tissue overgrowth
• Stent malapposition
• New plaque formation

Treatment is tailored based on these findings.

Factors That Can Affect Stent Placement Some artery characteristics can make stenting more challenging:

• Very small arteries (less than 2 mm)
• Severe calcification
• Tortuous or angulated vessels
• Chronic total occlusions

In such cases, additional techniques such as plaque modification or specialised balloons may be required.

What Happens After Stent Placement? Hospital Recovery

• Most patients are monitored for 24–48 hours
• Early mobilisation is encouraged
• Wrist or groin access sites are monitored

Medications After Stenting You will need antiplatelet therapy, usually: Aspirin

A second antiplatelet drug (P2Y12 inhibitor) These medications are essential to prevent stent thrombosis.

Risks of Coronary Stenting While PCI is safe and widely performed, potential risks include:

• Bleeding at the access site
• Blood vessel injury
• Heart attack or stroke (rare)
• Stent thrombosis
• Restenosis

Your cardiologist will discuss these risks in detail before the procedure.

Life After Coronary Stent Placement Most people experience:

• Significant relief from angina
• Improved exercise tolerance
• Better quality of life

However, stenting does not cure coronary artery disease. Long-term success depends on:

• Taking medications as prescribed
• Controlling cholesterol, blood pressure, and diabetes
• Quitting smoking
• Adopting a heart-healthy lifestyle

Advanced Heart Care at KIMSHEALTH KIMSHEALTH provides comprehensive, state-of-the-art care for coronary artery disease through its advanced cardiology and cardiac catheterization services. Our cardiac care includes:

• Advanced coronary angiography and PCI
• Drug-eluting stent placement
• IVUS- and OCT-guided complex interventions
• Emergency heart attack care
• Multidisciplinary cardiac rehabilitation and prevention programmes

We focus on precision, safety, and long-term heart health.

KIMSHEALTH Call to Action If you are experiencing chest pain, have been diagnosed with coronary artery disease, or have been advised to consider coronary stent placement: Schedule a consultation with the Cardiology Department at KIMSHEALTH today. Our experts will evaluate your condition, explain all treatment options, and guide you toward the safest and most effective care plan. KIMSHEALTH – Advancing Heart Care, Saving Lives.